Doctors of BC address concerns that 'shrinking practices' cause access problems

Vancouver - A recent study published in Health Affairs found that B.C.'s primary care doctors are taking on fewer unique patients, and that practice sizes had declined by 10% between 2005 and 2012. "Although the feminization of the workforce—and, to a lesser extent, its aging—contributed to this decline, the primary driver appears to be a broad trend toward reduced clinical activity over time," the study authors concluded. Dr. Trina Larsen SolesThe suggestion was simple, yet inflammatory: doctors are working less. A later article in the Vancouver Sun, said their search for a better work-life balance was "exacerbating patient access problems."But Dr. Trina Larsen Soles, the president of Doctors of B.C. and a primary care physician herself, said she doesn't believe that's fair—or true."What all this doesn't take into account is that practice is different, and that the age and complexity of patients have gone up," she told the Medical Post. "I'm seeing fewer patients a day but I'm not doing less work."There are a few aspects to this change. The first, she pointed out, is that B.C. is becoming a hot spot for retirement, and a more elderly population means more complex patients. The onus falls on primary care doctors to ensure these patients are properly cared for and, when possible, kept out of hospitals"So we"—Doctors of BC working with the government—"developed a set of incentives to get these doctors to slow down and deliver more comprehensive care, and then you turn around and analyze data and say 'you're not seeing enough patients'," Dr. Larsen Soles said. She also said doctors are seeing fewer patients because their administrative burden has increased. The day before she spoke with the Medical Post, she had gone into her clinic for the morning for about four hours—she spent the first hour seeing two (only two) complex patients, and the other three doing paperwork. She said that all this paperwork is required for these patients to access health-care and social services."The National Physicians Survey shows that, as a result of the increased paperwork, GPs in BC saw a decline of 10.2% in the number of hours of direct patient care between 2004 and 2014," she wrote in a recent Doctors of BC blog post, addressing these same issues. She said that after dinner, following a full day seeing patients, she often spends her night charting.While Dr. Larsen Soles openly encouraged further study of physician practice patterns, she suggested that it might be more useful to focus on system—rather than practitioner—productivity. Determining how to streamline access to services for patients without relying so heavily on doctors, and offloading some of the administrative duties to appropriately trained clerical staff, would be a start, she said."When you have 30-50% of physicians suffering from burnout and you start asking them how to be more productive, you're not going to get a great response," she said."It's unfair to say doctors who are looking for better work-life balance are victimizing patients," she added. "And it's just not true. Happier doctors are more productive."

Doctors of BC address concerns that 'shrinking practices' cause access problems

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