As a family physician in practice in BC for 35 years, it is nice to see that our incomes may be rising with recent negotiations with our government. However, I believe that the core problems in primary care go well beyond that. To me, the biggest issues are an appalling lack of physical infrastructure and a lack of proper organization of primary care practitioners.
I feel that government needs to partner with physicians to build large physical offices that can house 15 to 20 practitioners and accommodate nurse practitioners, registered nurses, and social workers. The physical spaces should be equipped with the equipment needed to allow family physicians to offer expanded services, which will take pressure off hospital emergency rooms. We can do many more procedures, such as outpatient IV therapy, minor surgery, cast application and removal, and skin lesion removals. These physical spaces should be leased (on at least a 10-year term) for zero dollars to attract groups of physicians. The physicians need to own and operate the practices, and private business must be excluded from any portion of ownership.
In return, the respective physicians must agree to offer prompt 24/7 access to the patients registered in a particular practice. They need to have enough members that there is no need to attract locums. These groups are self-sustaining. They need to use all allied health professionals in such a manner as to expand their attachment capabilities. Their manner of billing can remain exactly as it is presently, whether that be fee for service or the new Longitudinal Family Physician Payment Model.
This arrangement would bind together all the practitioners into large functional groups, which would be much more efficient and cost-effective than the small, scattered groups that exist presently. We would see economies of scale give big rewards to all participants. It is a practical way to close the loop on the patient medical home model, which we all believe in but is not operational across the board. Governments and practitioners are struggling to find the best solution, and I feel this is a good one.
—Robert H. Brown, MD, CCFP
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