A year on from changes to the provincial funding model for family physicians, a Squamish-based doctor says that health care in British Columbia is back from the brink.
"It's allowed us to actually survive," said Dr. Lawrence Klein in an interview with The Squamish Chief. "I would say it's been our salvation—we would not have viable primary care in British Columbia if this had not happened."
The changes to the funding model—referred to by the provincial government as the 'Longitudinal Family Physician (LFP) Payment Model'—were introduced in February 2023, and serve to better compensate family physicians by the number of patients they see, and the complexity of patient cases.
The previous model saw doctors compensated per patient, without any heed to the complexity of cases, or how long patients needed to be seen.
Klein, who has worked in Squamish since the mid-90s, said that the community has benefited greatly from the changes because previously, a combination of factors, including poor compensation (through the single-payer fee-for-service model) and the high cost of living in Squamish were driving much-needed physicians away.
"We've managed to keep some physicians who we would have almost certainly lost to other medical roles or provinces, and have definitely added a significant number; I would suspect it's reasonable to attribute that at least five family physicians are currently working in Squamish, who wouldn't have otherwise been able to financially justify working here, thanks to this new payment model," he said.
Klein said that Squamish—and British Columbia—had been "on the precipice" before the changes.
"We'd lost a very significant number of physicians—a few who simply retired, but many who left their practices for better-paying roles outside of family medicine. ... While we are arguably no longer 'on the precipice,' we nonetheless still haven't fully made up for those unfortunate losses, nor managed to attract enough family doctors to care for the many Squamish patients who remain unattached and who currently struggle to manage their often-complex health issues with the help of telemedicine and walk-in clinics—and sometimes even by utilizing emergency departments for their primary care."
"Unattached" refers to those in the community without access to a doctor, a number which Klein said the Sea to Sky Division of Family Practice had roughly estimated to be as high as 5,000 people in Squamish.
Klein said that while the data was hard to nail down, the realities on the ground told the story.
"The numbers aren't likely completely accurate, but the best estimate comes when doctors open new practices, and we see how quickly they fill, and they would definitely fill very quickly."
The changes to the funding model seem to be allowing doctors to hang on and has even drawn more in, and allowed more locals to get access to the health care they needed, said Klein, who added that while there was a raft of other provisions introduced by the government that had the potential to move the needle both on a short and longer-term, making family medicine more attractive needed to be the primary goal.
"I think what will be most impactful and cost-effective for the government is if we can continue to shift the current paradigm to make family medicine a more attractive option for newly-graduating physicians, and continue to recruit new full-service family doctors and potentially some nurse practitioners to our communities.
"As the LFP model has shifted British Columbia from arguably the poorest-paying province to one of the better-paying ones, we are beginning to see physicians moving here from other provinces and even from the U.K."
Other ideas in the pipeline are transitioning British Columbia to a "team-based care" model meant to lighten the load on family physicians by bringing in more supports for patient care, such as dietitians and social workers; the creation of a new medical school in B.C.; the addition of nurse practitioners in primary care, more capabilities for pharmacists to assess and treat less-complicated medical conditions, and efforts to streamline the referral system.
Klein said that as Squamish stands today, things are much better than 12 months previously.
"We've come back from the precipice, and the situation has finally started to look relatively good," he said.
"It's a work in progress; we're all trying our best to retain those family physicians we're lucky enough to still have—while at the same time educating, recruiting, and, hopefully, ultimately retaining enough practitioners to meet the demands of our current and seemingly ever-growing population."
