The future of medicine and health care in BC and Canada: Where are we going?

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2016-07-21 Dr Z. Essak, MD - Vancouver, BC

What is the future of medicine and health care in BC and Canada? Where are we going?

While everyone is out having fun in the summertime, the Government and other organizations, use the time to put out information they know few people will have time to see or digest. Much like they also use the busy time of Christmas and the winter holiday season to slip through items. Some people may just consider it prudent timing, others may see it as deliberate avoidance of proper public consultation.

In the summer of 2016 we heard about the "Team-based care" initiatives of the BC Government with co-management by the Doctors Of BC, legally incorporated as the British Columbia Medical Association.

Transforming what began as the "GP for Me" initiative, one of several emanating from the agreement of 2006, with the goal of a GP for everyone in BC who wants one by 2015 - a goal that has not been met.

We do not hear the BC Minister of Health, Terry Lake, or the Doctors Of BC speak of having failed to meet the target.

Instead we hear the plan is not that everyone have direct access to a GP but the substitution of a team based care initiative. Is this the new panacea for primary care? Is it a new solution for failed results or the next stage of intended consequences?

Is the team based care initiative, the Primary Care Home or Medical Home, a new idea, is it effective and efficient for delivering medical and health care?

Or is it a fuzzy term with ideological and political implications and little or no evidence for better care?

All the leaders seem to be on the band wagon.

Are they all reading from the same page?

The BC Liberal Government Minister of Health, Terry Lake, assures us that the Primary Care Home model of team care will solve the problems of primary care along with a province wide Electronic Medical Record (EMR) despite problems evident in clinical settings such as Naniamo, BC and calls for an independant review of the security, usability, and clinical integrity of the systems being implemented throughout BC.

On CBC Radio Health Minister Terry Lake declared, "that Marcus Welby model we all grew up with is changing, you may not always see the same face each time."

He is not alone in his enthusiasm. The Doctors of BC President, Dr Alan Ruddiman, representing the medical association co-managing health care also assures us that the team based initiative is the solution for primary care needs. What evidence is there for this? Is this good for public medical and health care? Or will it result in further cracks for which private care may be needed?

The list of leaders promoting this single solution for medical and health care goes on.

The Ontario Medical Association now wishes to climb into co-managment with the Ontario Government.

The College of Family Practice of Canada is poised to capitalize on this through workshops on how physicians can prepare to practice in the new model. An organization that already sustained a windfall of annual income since 2010 when the College of Physicians and Surgeons of BC, the CPSBC, abdicated the role of tallying physicians hours spent on CME and transferred the responsibility allowing the CFPC to charge extraordinary fees for the simple use of a web-based reporting form to tally CME hours.

For the past five years, the CFPC has been advocating for the Patient Medical Home ...

Also, throughout BC, we hear leaders of the Divisions of Family Practice promoting the same single solution.

One of the Division leaders Dr Terence (Terry) Chang, Chair of the Vancouver Division of Family Practice, shared views in the recent "Opinion: A GP for Me has helped many find a family doctor" published in the Vancouver Sun, June 10, 2016.

As a division leader he, too, supports the team based care initiative as the solution for primary care and the solution for our new younger doctors desire for a different ratio for work and personal life balance.

I was surprised when I considered the size of this endeavour. But we rolled up our sleeves to tackle the challenge and, now, I am pleased to see how far we have come.

The truth is the "GP for Me" initiative has failed, it did not meet the goal and it has been substituted by a team care initiative, the Primary Care Home, that remains unproven.

Dr Terence Chang informs us,

Divisions of Family Practice, geographically-based organizations that were funded through a joint agreement between the Doctors of B.C. and the Ministry of Health, were to be one of the main drivers of this government program, subsequently dubbed A GP For Me.

"Divisions ... were to be one of the main drivers of this government program."

This reminds us, that Divisions were established through diverting provincial health care dollars ($130 million annually) from direct patient care to create divisions as vehicles to drive the objectives and agenda of the BC Government and the Ministry of Health with co-management by the Doctors Of BC, to bring about system change?

With the BC Government and all the leaders of the establishment(s) promoting the same single view what are we to think?

Do we need to read between the lines?

Who's driving the bus?

Is it already too late?

Are medical schools failing to prepare our younger generations of physicians to be independent medical practitioners with primary responsibility to the patient?

Are young doctors becoming employees of the health system, bound by policies and rules from management rather than the hippocratic oath?

What has happened to the look of relief and trust on the faces of individuals and families when they would see their familiar doctor in the office, or in the hospital, or even on a house call?

Is it time for some new thinking in medicine and health care?

Is there a better way? What alternatives are there?

What will the Federal Liberal Government do? Will they succomb to the Provinces demands for more money or will they insist on changes to refocus and improve health care throughout Canada?

These are some of the questions I would like to explore further in future posts, comments and discussions.

Web links:

Addendum: Attached file below "GPSC meeting summary 2016-07.pdf" from
http://www.gpscbc.ca/sites/default/files/uploads/GPSC%20meeting%20summar...

2016-04-24 Times Colonist: A GP for me? Don't hold your breath

http://www.timescolonist.com/a-gp-for-me-don-t-hold-your-breath-1.2238281

2016-06-07 Doctors petition for halt to health record system rollout

http://www.timescolonist.com/news/local/doctors-petition-for-halt-to-hea...

More than 100 doctors have signed a petition ... The petition asks that Island Health suspend the system’s implementation until software that they say is canceling, overriding, changing or doubling up some drug orders is fixed or replaced. ...

... Island Health, which has declined to suspend the rollout, has a 10-year, $50-million deal with software-developer Cerner Corp. of Kansas City, Missouri, for the system. Island Health will spend an additional $124 million for hardware and training. ...

... Nurses, like doctors, say any problems are blamed on the users, not the system. ...

2016-06-10 Vancouver Sun Opinion: A GP for Me has helped many ... by Dr Terence Chang

http://vancouversun.com/opinion/opinion-a-gp-for-me

2016-06-21 Is your practice ready to be a Patient's Medical Home?

http://bccfp.bc.ca/e_news/practice-ready-patients-medical-home/

2016-07-04 CBC Radio, Has BC's Minister of Health found a cure for the doctor shortage?

CBC radio interview with BC Minister of Health, Terry Lake.

http://www.cbc.ca/news/canada/kamloops/has-bc-s-minister-of-health-found...

Primary Care Home, you may see a different health care provider ...

Secure patient portal for patients to access their own records

"that Marcus Welby model we all grew up is changing, you may not always see the same face each time you go"

Have to look at different ways of funding

2016-07-18 Doctors Of BC: News Release, presentation by Dr Alan Ruddiman, and promotional web page

https://www.doctorsofbc.ca/news/doctors-leaders-health-care-change-%E2%8...

The full text of presentation

https://www.doctorsofbc.ca/sites/default/files/select_standing_committee...

For our organization, “Better – Together” is not just a tagline, it represents the fundamental approach we take as leaders and physicians of influence in advocating for positive change in BC’s health care system.

... In 2014, the Commonwealth Fund looked at 11 developed nations’ health care systems and found that Canada is second to the bottom when measured across all dimensions of our health care system. Only the United States scored lower than we did – and they at twice the per capita cost to us here in Canada.

... A key component of the government’s primary care strategy focusses on expansion of interdisciplinary, team-based care.

... more patients will be able to get continuous primary care – maybe not from the doctor all the time, but depending on the complexity and severity of their condition.

... Doctors of BC is generally supportive of this direction.

... In a visioning consultation conducted by the GPSC with more than 3,000 doctors, the majority viewed the concept in a favourable light, particularly our younger doctors who see this as a way to continue to provide quality patient care while also providing for a more balanced working career. ...

the DOBC web page promoting this

https://www.doctorsofbc.ca/working-change

2016-07-18 Globe and Mail

http://www.theglobeandmail.com/news/politics/trudeaus-smooth-provincial-...

... Provincial anxiety is coming to a head now because a long planned change to health transfers is about to kick in. A guaranteed annual transfer growth of 6 per cent is ending next year. Instead, transfers are scheduled to increase in line with the rate of economic growth and the guaranteed increase will drop to 3 per cent.

2015-12-14 Vancouver Sun, BC Health Ministry wants second IT opinion

http://www.vancouversun.com/health/health+ministry+wants+second+opinion/...

... The B.C. government has come under fire from critics for bungled IT projects that don’t deliver promised features or performance, cost taxpayers more than expected and take years longer than advertised.

Now it wants to get itself “on a solid base” to try to stop the cycle of grandiose modernization projects that crash and burn and, years later, are chronicled in a series of post mortem reports by auditors general and other inspection agencies.

Of eight high-profile IT projects recently undertaken by government — with a total price tag of $2.5 billion — several have faced serious difficulties and collectively they’ve overshot their budgets by a combined $350 million and counting.

The largest and most expensive of those projects, totalling more than $1 billion, are under the Ministry of Health and B.C.’s health authorities.

Much of that work relates to what government describes as “eHealth” projects, ...

... A scathing report by Auditor General Carol Bellringer this summer prompted Brown and Health Minister Terry Lake to question their IT approach. Why, they asked, can the ministry build a complex hospital within 10 per cent of its original budget but lose control of the purse strings on a computer project?  ...

... “This is only one in a whole series of very large-scale information technology projects,” Liberal MLA Ralph Sultan said last month during a legislative committee deconstruction of the Panorama failure. “If they have any common characteristic, they are always overly ambitious, perhaps under-resourced, based on dreams as much as reality, and there are lots of tears at the end and lots of finger-pointing.”  ...

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