Salpy Kelian

Tying the Hands that Heal You: How a Distrust for Doctors Is Hurting BC Healthcare “Doctors can’t be trusted and must be micromanaged.” That’s the most influential presumption lying beneath B.C.’s current approach to healthcare, according to a prominent Victoria physician I spoke with recently under the condition of anonymity. “Doctors have been muzzled”, he said. They fear retaliation from VIHA or the Ministry of Health if they speak out. And their main advocacy group, Doctors of BC, can’t give you the straight goods either because it’s funded by the government. Family doctors used to be the bedrock of the entire healthcare system. But according to this Victoria physician with over 20 years of experience practicing medicine in Canada, the NDP’s deep distrust of doctors is frustrating the government’s own efforts to expand primary care. Take Urgent and Primary Care Centers (UPCCs), a flagship project of the NDP to address the acute shortage of family physicians. The government enticed doctors to join UPCCs by covering a large percentage of their overhead costs, in some cases reducing those costs entirely for a savings of approximately 40% of the total expenses otherwise borne by family doctors. Plus, UPCCs also allowed doctors to work part-time and step away from the professional obligation each family doctor has to guarantee 24/7 coverage for their patients. Did this bring more doctors into primary care? Not at all. It was as if the government had jumped on a leaky air mattress, pushing doctors from family practice into UPCCs and hastening the escape of many from full-time practice altogether. The motivating force for UPCCs, as many know, was Minister Adrian Dix’s belief that nurse practitioners (NPs) working in frontline primary care could and perhaps should replace family doctors, having inferred as much in the Legislature in May 2022. But NPs aren’t trained as family doctors. And the lengthier time spent with patients isn’t a substitute for the rigorous diagnostic training required for physicians. Thus, the attempt to replace doctors with NPs inside UPCCs has lowered the quality of care for patients, lowered the volume of patients seen, angered and demoralized doctors, and heaped unsustainable expectations and] workloads onto NPs themselves, who are burning out and leaving the system. Lose, lose, lose, lose. Tragically, the “team-based” approach that the NDP (is rightly) aiming for is being thwarted by its own ideological distrust of doctors and its obsession with top-down bureaucracy. How? It’s VIHA bureaucrats who are responsible for handpicking and managing the nurses, mental health counsellors, social workers, medical office assistants, and other staff members on the UPCC “team”—not the doctors actually working at the clinics whose hands are tied. This opens the door for all sorts of interpersonal conflicts and service-delivery issues to fester inside UPCCs before they reach distant government boardrooms. Many of these issues were raised by doctors to VIHA and the Ministry of Health as UPCCs were first being rolled out. But I’m told that VIHA and the Ministry did not take kindly to the criticism and have tried to brush the issues under the rug. I’m sure they won’t appreciate hearing about them here. But we need to look under the rug. We need to clean up the debris. BC’s healthcare is broken. But we can rebuild it. We can look outside of Canada and beyond “US style” healthcare to the many successful models across the globe which protect publicly funded care for the most vulnerable while giving doctors the freedom and the respect needed to deliver high quality healthcare for their patients. To want to come to BC and to stay here to heal our sick, our elderly, and our vulnerable. To care for all of us.