CHARBONNEAU – All doctors should become government employees
(Image: Pixabay.com)
SINCE DOCTOR want the benefits of employees, the logical thing to do is to make them employees of the government. Some already are.
Associations representing family doctors in British Columbia say that they want paid sick days, vacation coverage, extended health and dental benefits, and a pension plan.
Two groups, the B.C. College of Family Physicians and B.C. Family Doctors, are lobbying politicians in advance of the provincial election on Oct. 19 for changes in their working conditions.
They say the province is in a “family doctor crisis.”
I couldn’t agree more. I’m one of 700,000 British Columbians who don’t have a family doctor. My doctor for 20 years worked in the traditional model, that is, a business model where he rented office space and hired staff and was paid by B.C.’s Medical Services Plan (MSP) on a fee-for-service basis.
When he “retired,” he didn’t stop practicing medicine – he became a “hospitalist,” an employee of the government hired to work at Royal Inland Hospital.
Many new doctors want to practice medicine without the hassle of running a business. They don’t want to labour at a model that is broken. The fee-for-service means of income barely makes ends meet — and only when doctors put in long hours and see as many patients as possible.
It’s not a model that fosters long term relationships with patients.
No wonder new doctors are skipping the high patient loads and the pressure of running a business.
B.C. has revised the old business model with the Longitudinal Family Physician (LFP) payment model. The province hopes new doctors will be lured into long-term practices that provide comprehensive care for patients.
The LFP model uses a combination of payments.
Under the new model, family doctors receive a base salary that accounts for the number of patients they care for and for the complexity of care those patients need. Additional payments are made for administrative tasks, complex cases, and after-hours work.
The measure of acceptance of this the new model will be how many new doctors choose it.
So far, the new model hasn’t resulted in me securing a family doctor.
You may be surprised to learn that there is no shortage of doctors in B.C. Instead, there is a shortage of doctors who want to work in the traditional model of long hours that churns out patients and barely makes ends meet.
British Columbia has about 6,800 family doctors by training but fewer than half of them regularly see patients.
There is no shortage of graduates either. Each year, about 175 new family doctors graduate from residency programs in British Columbia, mainly from the University of British Columbia.
But many of them don’t set up office.
They opt for other forms of practice, such as Locum positions (temporary doctor coverage), employment as hospitalists, emergency medicine and focused practice areas such as geriatrics and sports medicine.
They also work in walk-in clinics, where they treat patients who they will never see again.
To me, the solution to our healthcare crisis is obvious: the province should build clinics and hire all those thousands of doctors as employees.
David Charbonneau is a retired TRU electronics instructor who hosts a blog at http://www.eyeviewkamloops.wordpress.com.
ArmchairMayor.ca 
For many years, Canadians have never needed to discuss user fees, extra-billing by physicians, and privatization that some propose as a way to fix the ailing healthcare in Canada. It is only recently that we have been forced to define our health care system’s sustainability. Some think that privatization will fix the problem when one of the major problems in health care delivery is privatization.
In 1995 in order to control its deficit, the Federal Finance Minister made drastic, unexpected cuts of $30 billion in federal transfer payments to provincial health care programs. Combined with this, the Liberal government in BC introduced tax cuts, privatization, the sale of assets, and outsourcing, and in the process, doubled the provincial debt. The cost of servicing this debt increased over time, thus leaving less and less money for health care and other government programs.
Rather than reforming the organization and functioning of the existing health care system such as the governance (IHA), budgeting, integration of nurse practitioners in patient care, use of generic drugs, record sharing, triaging wait times, and interdisciplinary team work, the BC government chose a quick fix. The fix was to increase user fees, privatization, hospital closures, and amalgamation of services, while parroting the “myth” that aging and a lack of privatization are the culprits of unsustainable health care.
Certainly, the aging population adds about 1% annually to our health care costs, but that is also true in the European nations that have sustainable health care costs. The difference between them and us is that they use more preventative approaches and different ways of caring for the health of their elderly population in settings outside of hospitals, which reduces the health costs of an aging public. We tend to herd the elderly into private care homes where the word “care” is synonymous with drug them and ignore them in crowded facilities with minimal contact hours with care givers.
The other “myth” that many thinks will solve the problem is privatization. Many claims privatization is needed to lower the costs of healthcare. By 2015 Canada’s healthcare costs were 11.3% of our GDP. The private component in these costs was over 30% while countries delivering high quality healthcare its less than 20% so if privatization works why is our healthcare failing us, but the costs are sustainable in less privatized countries? The health care costs are not sustainable because private cost such as medication grew annually at 7.5%, capital costs grew at 14% and other private health costs increased at 9.3 %. In contrast public costs went up only 4.9% annually. In other words, public costs (hospital and physician) are relatively sustainable compared to private costs. Thus, the more we privatize healthcare the less it is sustainable.
Health care is about our political will to make non-partisan collective choices where our human values do not triage treatment of sick people by their ability to pay.
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The only thing that is truly well-understood by the medical community in B.C. and perhaps in Canada is vacation time. No wonder our health outcomes are worsening.
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Politicians & prisoners can access private health care with a public pay. So if you are in urgent need – commit a crime or run for office. Some may think they are one and the same.
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I definitely want private health care. Only I don’t want to pay for it.
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This was tried under the Social Credit government of the day in the late 1980’s. The Association took it to court and won. Doctors are not employees, they are independent contractors. I broached this subject with a physician several years back and I think he was close to throwing me out of his office, he was mad.
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This sounds like a socialist nightmare. Our health care system expends more than most countries yet our outcomes are worse than many western democracies.
I think the solution is private healthcare and far lower taxes, with a minimal state system for those that need it.
What use is universal health care when it means that universally you can’t get a doctor or receive timely care?
Adding a layer of red tape to this system will drive it further into the ground, although it’s hard to imagine what that would look like considering how bad it already is.
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If you think Socialism is a nightmare you need to examine Capitalism. All national essential services world over are organized on a socialist model. military, education, fire protection, utilities, sewer, water, transportation, and so on. Capitalism means freedom of enterprise but it does not exist in any capitalist or socialist society. Government sets standards through regulations thus both economic organizations tend to combine elements of both systems. Without regulation in the market place, we would have chaos in a capitalist society.
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The impetus is now about life/work balance with a great emphasis on “life” as in time away to enjoy the opportunities given by high incomes. Granted it is a grunt attending years of school one would think that the health outcomes of the population is steadily improving but it appears the opposite is true. Perhaps let the private sector run healthcare. Governments prioritize 4 years cycles whereas private sector companies prioritize long term. While indeed there are many examples of corporate failures there also are many good examples of corporate successes.
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