Over the past decade there has been a remarkable change in the ownership of family medicine practices in BC. Large numbers are now owned and operated by private corporations, which are neither owned nor controlled by the physicians who work in them. This has occurred largely because family physicians are neither business people nor endowed with the upfront financial resources to invest in the start-up of increasingly large and complex office structures.
These corporate structures often operate efficiently and all are well equipped with modern electronic medical record systems. They give more freedom to the individual physicians who have no financial obligations to the practice. They have definitely filled a void in medical care in BC, but the question arises whether they will have a net benefit to the people of the province. After all, it is the people of BC who pay for them through taxation and fees paid to these corporations through physicians’ billings.
So, one must first ask: Why would private corporate entities want to invest in primary care delivery? All private companies exist to make money for the owners of those companies. In health care this is no different.
The answer is that private companies have seen the void in the organization of primary care in BC and identified it as a business opportunity. The owners of these companies all want financial compensation for their investment. If this compensation can be attained by driving efficiencies in primary care and saving money globally, then the corporations can be viewed as a net benefit for the people of BC and also for the physicians who work for them.
If, however, these private companies excessively control the behavior of the physicians who work in them, and demand excessive profits for their efforts, then they will be viewed through a different lens. It must also be understood that these private companies control the electronic health records of the patients registered with them. While it can be argued that the medical records belong to both the patient and the physician, there have been instances in BC where conflicts have arisen between private clinic owners and physicians working in those clinics. These conflicts have resulted in physicians being physically locked out of the private premises and being denied access to their patients’ medical records. This is a dangerous situation for the people of BC.
As well, private corporate structures can terminate the contracts of physicians who work on their premises. If this happens, these physicians are at the mercy of the corporations when it comes to supplying them with their patients’ electronic medical records. And not having immediate access to patients’ electronic medical records makes practising medicine very difficult, if not impossible.
I think it is both prudent and necessary for the Ministry of Health and Doctors of BC to review the status of primary care in BC as it relates to private ownership of medical clinics. The corporatization of primary care in BC reminds me of the corporatization of all medicine in the US. I practised in the US for nearly a decade, and I have intimate knowledge of the abuse of corporate medicine. Currently in the US, over 65% of all family physicians work in privately owned corporate structures. These corporate structures use something called “economic credentialing” when they review the usefulness of the physicians who are contracted to work in the clinics. If physicians don’t make enough money for the private corporations, they are let go. Conversely, if the physicians make more money for the corporations, they are rewarded financially. This means that these family physicians end up working for the benefit of the corporations, not for the benefit of their patients. This is one of the many fundamental stumbling blocks in American health care.
This letter is meant to serve as a warning for the possible storm on the horizon in BC. We do not want to have anything resembling the American health delivery system in Canada. The time to conduct this due diligence is now, before private corporations become any more powerful in the ownership of family medicine in BC.
—Robert H. Brown, MD, CCFP
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