Dr. Denise McLeod presents to the province’s select standing committee on health (from the Prince George Citizen – Brent Braaten, Photographer)
The following is the content of the presentation given to the BC Select Standing Committee on Health by Edward Staples, SOHC President:
July 4, 2016 – 11:00 am
Douglas Fir Committee Room (Room 226), Parliament Buildings, Victoria
Thank you for holding these public hearings on health care in British Columbia. I am here today representing the Support Our Health Care Society of Princeton and the BC Health Coalition as a member of their Steering Committee.
My original interest in the work of this committee was in 2014, when I made a written submission as President of the Support Our Health Care Society of Princeton. I’m pleased to see that the Committee is looking for more information on three of the original questions and that the information gathered on end-of-life care has now been released in the report, Improving End-of-Life Care for British Columbians. Congratulations to the Committee for the work you’ve done on that important issue.
How can we improve health and health care services in rural British Columbia? In particular, what long-term solutions can address the challenges of recruitment and retention of health care professionals in rural British Columbia?
I’ve been a resident of Princeton for eight years and have been actively involved in health care in our community for the past four. For this reason, I feel most comfortable addressing the first question regarding health care services in rural British Columbia.
Princeton, I believe, is typical of what it means to live in a rural, remote community in BC. Our population base is roughly 5,000 (on a good day); our demographic consists of an ever larger senior population; our economy is based on forestry, mining, ranching, and, increasingly, tourism; and our nearest regional service centre (Penticton) is about an hour and a half away. Four years ago our community was in a health care crisis with only one doctor providing on-call service, 24 hour emergency department services only available on weekends, an acute shortage of health care professionals, and residents who were up in arms. Since then, through a collaborative effort involving local organizations, elected officials, health care practitioners, and IH administrators, Princeton is now in a much better position with four full time GPs, two NPs sharing a full time job, and a full complement of professional staff.
But our situation is still not ideal. We are still short one general practitioner and many residents are unattached and looking for a family doctor elsewhere in our area. At present, there are no practitioners accepting patients in the Okanagan-Similkameen region and
one of our SOHC Executive members recently searched the College of Physicians and Surgeons website and the only doctor he could find that was accepted patients was in Courtenay.
We also understand full well that it doesn’t take much for things to change and our biggest challenge now is to sustain our present situation and work to make things even better for our local residents.
Even though things are better for us in Princeton, I’m not sure that this is the situation throughout BC. To improve things for everyone living in rural British Columbia, we first have to identify the problem, which can be summed up in one word: “access”. Whether it’s the length of time it takes to get to see a general practitioner, the amount of time and money it takes to get to a specialist appointment, or the inability to become attached to a family doctor, for most rural British Columbians, access to health care services remains their primary concern.
The main source of the problem is the shortage of health care professionals in the province. Although there are shortages in most areas, the greatest impact felt by rural communities is the chronic shortage of General Practitioners. According to advertisements on the Health Match BC website, in December of 2014, there were 333 General Practitioner vacancies in the province. In Interior Health (where I live), there were 33 communities looking for 66 GPs. Over the past 18 months, the situation has’t improved. There are now 441 General Practitioner vacancies province-wide and in Interior Health there are 37 communities looking for 85 GPs.
Based on this information, I think it’s important to understand that asking communities to be responsible for recruitment ignores the reality that there are not enough general practitioners available to fill the present vacancies.
I believe that most rural communities have made an effort to develop recruitment strategies to attract practitioners but this becomes an exercise in futility when so many communities are competing for such a small number of candidates. Making your community more “attractive” or “special” only works when there are sufficient numbers of physicians available to fill all the vacancies. In the present environment, communities are tempted to offer incentive programs that can turn into unethical “bidding wars” where only the richest communities attract doctors.
The other challenge (if you’re lucky enough to recruit a practitioner) is how to get them to stay. From our experience in Princeton, retention of health care providers is most dependent on the level of satisfaction with their working conditions. High levels of stress resulting from staff shortages is the strongest contributor to thoughts of leaving. When there are so many openings, often in lower stress environments, why would a doctor or nurse practitioner stay in a situation that is stressful and emotionally draining.
Retention is also affected by the level of satisfaction within the community. The lack of timely access to health care services leads to fear, frustration, and anger that is often inappropriately directed at practitioners and staff. In our community this has often led to a vicious circle of accusation and repercussion often unraveled through social media sites like the Facebook vortex. With health care providers powerless to respond, it only increases their level of dissatisfaction and increasingly, thoughts of “getting out of town”.
But I expect that members of this Committee are already fully aware of this situation. What we need to determine is how to address this problem.
One initiative that shows some promise is UBC’s Distributed MD program. This program recognizes the importance of building a student base that represents the diversity of BC’s communities, particularly among areas that have been traditionally underrepresented, i.e. aboriginal and rural communities. To achieve this diversity, UBC and UNBC developed the Health Care Traveling Roadshow and the Aboriginal MD Admissions program to attract students who are not only familiar with the challenges of rural remote living but who are also more likely to return to their rural roots to set up their practice after graduation.
Recently, Support Our Health Care (SOHC) organized a visit by the Traveling Roadshow to Merritt, Princeton, and Keremeos. The Roadshow group consisted of eleven university students representing a wide range of health care areas, including family practice, nursing, speech pathology, lab technology, midwifery, massage therapy, and occupational therapy. This is the first time that the Traveling Roadshow has toured in southern BC communities. It is hoped that the introduction of this program to our area will establish a Traveling Roadshow sponsored by colleges and universities in the south. Already there is interest from UBC Okanagan in Kelowna and Selkirk College in Castlegar who sent staff members to observe the tour and learn about the program.
An important side benefit to this program is that it offers university students the opportunity to get a glimpse into what life, and establishing a practice, would be like in rural areas of BC.
Another approach that shows potential is the streamlining of hiring procedures for physicians from foreign countries. The provincial government has implemented a “fast track” approach, where international family physicians are initially screened by Health Match BC, and if they qualify, are selected for the province’s new Practice Ready Assessment program. Princeton recently recruited a new doctor from Egypt who qualified through this program.
International medical graduates are most often registered in the provisional class as an interim step, where they apply their knowledge and skill under supervision. Many provisional class doctors are placed in rural communities and provide excellent health care services to communities in need. However, this usually has limited potential as a long term solution. Using Princeton as an example, recently we’ve had two provisional class doctors completing their two-year required term. Once completed, they both left to set up a practice in the lower mainland, where their families were already living. Rural communities provide convenient openings for foreign doctors to enter our province but based on our experience in Princeton, a long term commitment to rural medicine is unlikely.
In my 2014 written submission, I was very critical of Health Match BC, the health professional recruitment service funded by the Government of BC. At that time their website was poorly organized, often not kept up-to-date, and very difficult to navigate. I’m happy to report that these concerns have been addressed and their present website is vastly improved.
Another major problem in rural communities is transportation. For people living in rural communities, access to health care services requires access to transportation. As our population ages, this requirement means a greater dependency on transportation provided by others. Public transportation service is limited and for many elderly residents needing specialist care, an all-day trip to a regional hospital is a daunting proposition, not to mention the out-of-pocket costs that may be a significant hardship for some seniors. In my view, there are two options for improving this situation: either make it easier for the patient to get to the specialist or bring the specialists to the patient. Although it is understood that the Ministry of Health is not responsible for public transportation, improved services that would provide better local service and access to regional centres would have a profound impact on the health outcomes of rural residents.
There are two initiatives that have the potential to vastly improve access to health services for rural residents. The first is the Princeton Access to Specialist Care Project, a program funded by the BC Shared Care Committee. This pilot project brings specialists to Princeton on a regular basis to see patients who are referred by their family physician. In its first year of operation, there were 14 specialist outreach clinics and 135 patient appointments. For patients who have missed specialist appointments in
the past because of transportation difficulties, the clinics provide much improved
access. Numerous patients have stated their great appreciation for the clinics being
held in Princeton.
The second is the Community Paramedicine program, a province-wide initiative intended to help provide patients with better access to health care in rural and remote communities by expanding the role of qualified paramedics. Princeton was fortunate to be one of two communities selected to prototype this initiative. The full benefit of this program is yet to be realized but early indications are that it will have an impact on monitoring patients and freeing up health care practitioner time.
According to the 2011 census, the percentage of BC’s population aged 65 and older is roughly 13%. In rural remote communities this percentage is generally much higher. Princeton, for example, sits at 28% and if you look at the percentage of the population over the age of 55 it jumps to 46%. Adjusting our health care system to meet the needs of our aging population is a challenge for our government. One way of addressing this challenge is to provide programs aimed at keeping seniors living at home longer.
Although the benefits of at-home care are proven, the province has yet to provide an adequate model to support seniors who wish to live at home longer. It’s hoped that the Ministry of Health will soon recognize the long term benefits of adequate home support to the health of seniors and the cost-effectiveness in terms of savings to the provincial health care budget.
I’ve chosen to present what I believe are the most pressing concerns and some of the many initiatives that hold potential for improving health care in rural BC. There are others, but I think that’s all the time that I have. I look forward to reading the reports that will be generated from this public consultation.