B.C.’s growing doctor shortage is a long-term problem and team-based care with nurse practitioners is part of the solution that the province’s physicians support, Health Minister Adrian Dix says.
Dix was on the defensive in the B.C. legislature this week, with nurses staging a candlelight vigil and rally outside to highlight their staff shortages in hospitals. Opposition MLAs highlighted emergency ward closures in small communities and burnout among doctors and nurses as they work overtime to keep hospital services open, while family doctors close practices.
Doctors of B.C., representing 14,000 independent physicians, about half of them family doctors, are negotiating a new fee-for-service contract. The latest three-year deal expired at the end of March. Some doctors reacted with anger to Dix’s comment in debate on his ministry’s growing budget this week, where he referred to salaried nurse practitioners being able to spend more time with patients than fee-for-service doctors. Doctors of B.C. issued a statement headlined “Nurse practitioners cannot replace doctors.”
Doctors of B.C. is calling for increased compensation and “new practice models,” and continued support for team-based care as well as reduced administration and after-hours help for family doctors.
The fee of less than $32 for a doctor visit is driving away new graduates who don’t want to manage a business that means long hours and low pay once rent and staff expenses are paid.
Dix has said the ministry is “slowly” moving away from the fee-for-service, and his strategy depends on primary care clinics with teams including nurse practitioners and specialty services such as mental health and addiction treatment. Those clinics have been filling up as quickly as they open, leaving people with no alternative but walk-in clinics, which are also over-burdened or closing, or hospital emergency wards.
“Almost one million people in British Columbia do not have a doctor, and this minister continues to say everything’s okay,” B.C. Liberal health critic Shirley Bond told the legislature May 12. “Doctors are closing their practices, and many more have indicated they will do that because they feel undervalued.”
Dix replied that the doctor shortage is a problem he inherited when appointed health minister in 2017, after 16 years of B.C. Liberal administration that saw fewer people attached to a doctor.
“There were twice as many unattached people in 2017 as in 2003,” Dix said. “The rate of unattachment increased by 70 percent in that period. What that tells you is that that’s a trend over a period of time.”
The B.C. Liberal government introduced master’s degree programs for nurse practitioners in 2005, with programs at the University of B.C., University of Victoria and University of Northern B.C.