PRIMARY HEALTHCARE

A Family Doctor’s Prescription for Fixing Primary Care

BC College of Family Physicians’ president Jeanette Boyd on how to improve care and patient outcomes without the risks of corporate medicine.

Andrew MacLeod 14 Sep 2020 | TheTyee.ca
Andrew MacLeod is The Tyee’s Legislative Bureau Chief in Victoria and the author of All Together Healthy (Douglas & McIntyre, 2018). Find him on Twitter or reach him at amacleod@thetyee.ca.

Dr. Jeanette Boyd says the rise of corporate health care is a symptom of a sick system — one that governments could cure. Image from YouTube.

[Excerpts] The rise of corporate health-care providers in British Columbia is worrying, says Jeanette Boyd, president of the BC College of Family Physicians. But she says it really needs to be recognized as a symptom of a deeper disease.

Boyd, who has a family practice in Nelson, said she personally thinks corporate care is significant and “there should be concern about the real risk it has to further fragment health care in the province.”

“Absolutely they are filling a vacuum, but it’s a vacuum I feel is artificial and can be addressed in other ways,” she said. “If we all work together, we can potentially find solutions that don’t bring in the same inherent risk that bringing in a big corporate agency does.”

Boyd has practised in B.C. since 2007 and been president of the college for two and a half years. In a wide-ranging interview, she discussed the challenges to primary care, the threat corporate care poses, what she sees as the solutions and the government’s slow response.

“We know that care that is provided by a family physician working in a well-supported environment who is providing comprehensive, continuous longitudinal care is really where the best value is,” said Boyd.The Tyee is supported by readers like you Join us and grow independent media in Canada

Over time that relationship leads to improved outcomes for patients, increased rates of cancer detection, decreased amounts of chronic disease and better quality of life, she said. It also ultimately saves the publicly-funded system money.

And yet more than 700,000 people in B.C. lack access to a family physician. 

The problem is not a shortage of doctors. The province is producing more family physicians than ever, she said, but the system encourages them to move into other areas of practice.

Doctors get into family medicine because they want to make a difference and value the long-term relationships involved in providing direct patient care, she said. But they find the fee-for-service system, where each visit or treatment is assigned a dollar value, doesn’t allow them to spend as much time with patients as they may need. 

“The time it takes to provide that quality patient-centred care isn’t remunerated in a system that values more episodic care or volume of care as opposed to quality of care,” she said.

“It’s this constant battle between trying to balance the patient in front of you who is really important, but you still have 20 more patients in the waiting room that have booked appointments that also have important issues that need to be seen that day, and you need to see that many patients in order to meet your overhead to pay your staff in order for you to continue to work.”

It’s tricky to find a balance in clinics that are run on fee-for-service billings, she said. Family physicians are also now seeing patients with more complex needs, such as people with multiple diseases that need to be carefully managed.

The provincial government could do much to improve primary care, Boyd said. 

It needs to get rid of the fee-for-service payment model and instead create a system that facilitates high-quality care, she said.

She argues for more flexible funding that would allow physicians to look at the community where they’re working, assess the needs particular to that place, and build a team with other health-care professionals who have the skills and resources to meet that population’s needs. 

“When you ask the patient what they value, what they think is important to their health, it is being able to talk to somebody who knows them, who trusts them,” she said. “And we know that relationship, for people who’ve been able to access that relationship, that’s where we really see the true savings in terms of health care.

To access the full article, click on A Family Doctor’s Prescription for Fixing Primary Care

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Study: Primary Care Doctors Increase Life Expectancy, But Does Anyone Care?


Robert Pearl, M.D.Healthcare

April 8, 2019
In a shocking development that could transform the medical profession, the International Journal of Health Services published the findings of a study titled, “Primary care, specialty care, and life chances.”

Using multiple regression analysis, the researchers concluded that “primary care is by far the most significant variable related to better health status,” correlating with lower mortality, fewer deaths from heart disease and cancer, and a host of other beneficial health outcomes. By contrast, and perhaps equally deserving of shock-value, the researchers determined “the number of specialty physicians [i.e., surgeons, cardiologists, orthopedists, etc.] is positively and significantly related to total mortality, deaths due to heart diseases and cancer, shorter life expectancy,” along with a host of other worrisome health outcomes.

The most recent study to analyze the value of primary care – published February 18, 2019 in JAMA Internal Medicine – not only confirms decades of prior research, but also spotlights troubling trends in workforce planning, physician reimbursement and residency training.

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BC Health Coalition Applauds the new Team Based Primary Health Care Strategy
May 24, 2018
Team-based strategy will ensure faster and more appropriate care
Vancouver, BC – Unceded Coast Salish Territories – The BC government announced today a major investment in the new primary health care strategy to improve access for British Columbians. Team-based care is central to the new primary health care strategy. This announcement indicates a change of approach and a system-wide transformation of primary care.
“Primary health care is not one size fits all. People need to be able to access the type of health care worker that can best address their needs–this might be a physiotherapist, a social worker, a pharmacist, or a doctor,” says Edith MacHattie, BC Health Coalition co-chair. “Providing team-based care will better meet the needs of British Columbians.”
Read the full BC government release here.

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Life expectancy grows with supply of primary care doctors

Lauren Vogel CMAJ March 25, 2019 191 (12) E347; DOI: https://doi.org/10.1503/cmaj.109-5729

People live longer in areas with more primary care doctors, according to data from the United States. But the supply of these doctors is shrinking as more medical students choose higher paying specialties.

Life expectancy increased 51.5 days for every 10 more primary care doctors per 100 000 people in the United States between 2005 and 2015, according to a study led by researchers at Stanford and Harvard universities. A similar increase in other specialists boosted life expectancy only 19.2 days.


“Greater supply of primary care physicians appeared to increase the chances that a person would be treated for cardiovascular disease risk factors like high blood pressure or high cholesterol, or caught early for major cancers like breast cancer or colon cancer,” according to lead author Dr. Sanjay Basu.


Basu’s team examined data from 3142 counties, 7144 primary care service areas and 306 hospital referral regions. Unlike some previous studies, they accounted for regional factors that might influence longevity, such as poverty levels and numbers of hospital beds, as well as individual factors, including smoking habits and obesity

To read the full article, click on: https://www.cmaj.ca/content/191/12/E347