VICTORIA – B.C.’s health care system is struggling to adapt to changing conditions, including a shortage of family doctors and an increase in walk-in clinics to serve a growing – and aging – population.
The B.C. Medical Association executive has begun meetings to come up with a new plan to encourage family practice, after the province’s doctors voted down a $70 million proposal to provide extra fees to those taking on patients who require more time, such as the chronically ill. Doctors say the current system forces them to subsidize care of high-demand patients.
The health ministry put up $10 million initially, and then offered to match up to $30 million more if the BCMA could come up with savings within their existing fees. The BCMA proposed to reduce its fee for a doctor’s office visit by a dollar, and reduce other treatment fees by about four per cent, to provide their share of a fund that would pay doctors an extra $16,000 per year for high-demand patients.
In a vote conducted during August, 59 per cent of BCMA membership rejected the plan. Doctors have been subject to the same government wage freeze as the rest of the B.C. public service, and have been increasingly attracted to working shifts at clinics rather than the extensive on-call demands of family practice with elderly and seriously ill patients.
B.C. is beginning to licence nurse practitioners, with funding provided for each health region to hire four in the 2005-06 budget. The first nurse practitioners graduated from the University of B.C. in June, upgrading from registered nurse degrees to a master’s program that qualifies them to prescribe medication and order lab and diagnostic tests. Another class is to complete training at the University of Victoria by this fall, and a nurse practitioner program begins at University of Northern B.C. in September.
B.C. is one of the last places in Canada to have nurse practitioners, already in use in nine other provinces and territories. The Registered Nurses Association of B.C. has just completed a changeover to the College of Registered Nurses of B.C., the licencing body for nurses and nurse practitioners.
Nurse practitioners are expected to help handle the province’s other big challenge, providing health care to a huge and sparsely populated rural area. Another tool for this effort is B.C. Nurseline, a 24-hour phone service for medical information and advice. Two years ago B.C. Nurseline made pharmacists available to provide advice on the phone between 5 p.m. and 9 a.m. when many pharmacies are closed.
B.C. Nurseline can be reached in Greater Vancouver at 604-215-4700 or toll-free elsewhere in B.C. at 1-866-215-4700.
B.C. continues to lose doctors to the United States as well, according to the Canadian Institute for Health Information. Last year there was a net loss of 15 B.C. doctors to the U.S., although B.C. did also attract a net 39 family practitioners from other provinces during 2004.