Inflated numbers on docs, nurse practitioners at urgent-care clinics

The B.C. government’s throne speech contained misleading information about the number of doctors being hired for 10 urgent-care centres across the province.

“These new centres will come with 200 more family practice physicians, 200 nurse practitioners and 50 clinical pharmacists and other health-care providers,” the speech stated.

However, when questioned Wednesday about those inflated figures, the Ministry of Health acknowledged the speech “wrongly linked” 400 health professionals to the clinics, five of which have opened and five more that are slated to open by May.

Ministry of Health spokeswoman Kristy Anderson said that while “some” of those nurses and doctors will be working at urgent-care facilities, the rest will form part of the government’s overall objective for its primary-care strategy. She couldn’t provide the number of nurses and doctors working now, or in future, at urgent-care centres.

The five clinics that have opened so far are in downtown Vancouver, Surrey, Kamloops, Quesnel and Langford. The government will not reveal where the next five will be.

As of today, there are about 6,600 family doctors (also called primary-care physicians or general practitioners) licensed and actively working in B.C. That’s about 200 more than last year, so the throne speech implied that the government was grabbing almost every new doctor for urgent-care centres, an unlikely scenario.

Similarly, there are 500 practising nurse practitioners (NPs) in B.C. and only 54 new NPs in the province in all of 2018, so for the throne speech to state that 200 will work in urgent-care facilities is a stretch.

Anderson said the government aims to staff urgent-care clinics with doctors who’ve recently completed their two-year, postgraduate specialty medical training (residencies) in family medicine. Such doctors don’t yet have a “panel” of patients, so working in urgent-care centres gives them an instant pool of patients and a team around them, including nurse practitioners and medical mentors, she said.

There are about 170 doctors who complete their residencies in family medicine each year in B.C., so if every one of them were to be snapped up by urgent-care centres, there would be no doctors to take over the many practices of retiring doctors.

Urgent-care centres have been a stated priority for Adrian Dix since he was appointed health minister. Last spring, the government said urgent-primary-care centres would be a new medical-service model intended to take pressure off hospital emergency departments. They are also designed to provide ongoing primary care — or link patients to such doctors. They all offer extended hours, weekends and evenings.

Until Wednesday, when Postmedia News challenged the ministry on figures in the throne speech, the government has been unwilling to share information about the business models of the government-sponsored clinics, despite numerous repeated requests for such info going back to last October. Instead, each time a new clinic has opened, like the one in Premier John Horgan’s riding, a news release containing few specifics has been issued.

(Late Tuesday, the ministry offered a briefing by senior officials but stipulated that all information was background only.)

Liberal health critic Norm Letnick said he found the throne speech not only short on substance in the health arena, but also “thin everywhere else too.”

Dr. Eric Cadesky, president of Doctors of B.C., said his understanding is that physicians being hired for such clinics are being paid through salaries or contracts rather than billing on a fee-for-service model. The contract-payment model is appealing to doctors who don’t want overhead costs and businesses to run. In that sense they’re better for “work-life balances.”

It’s unclear if the government is handing money over to clinics directly or if they’re channelling money through health authorities. In a few cases initial setup costs were about $2 million and annual operating costs per year are said to be up to about $4 million.

“Hopefully, these clinics will achieve their stated goal of providing after-hours care to patients as well as ongoing care for patients who are unattached (without a family doctor),” Cadesky said.

There are pros and cons to the urgent-care model, he said. On the plus side, they have labs, pharmacies, other health-providers like nurses and imaging facilities. But Cadesky said the potential unintended consequence of such centres is that they could siphon doctors away from full-service, cradle-to-grave, primary care clinics.

“Some doctors may choose to start off with this kind of model. It’s seen as less stressful and less costly than running a business, but we still need doctors working in private practices across the province,” he said, referring to ever-increasing rents for medical clinics and staff costs.

Doctors of B.C. is presently engaged in talks with the government on a new contract and one of the priorities for doctors is more money to “sustain” the independent, medical-clinic model, Cadesky said: “With the high cost of living and sky-high rents, it’s becoming more and more difficult to operate medical practices and to recruit staff.”

Dr. Afshin Khazei, medical director of the recently opened Vancouver City Centre urgent-care clinic at 1290 Hornby St., said that 14 doctors are on staff, including family doctors and emergency room specialists, but some work only part-time. While the clinic expects to eventually see 36,000 patients a year, volume so far during the “soft opening” has been lower. Next month, however, renovations to the second and third floors will be complete. On those floors, patients can get connected to up to 40 family doctors with offices there.

“That’s important because there are 18,000 in the downtown area who don’t have a family doctor,” he said.

The extended hours of the clinic are proving to be hugely beneficial. On Tuesday night, the urgent-care clinic offered measles vaccinations after public-health clinics closed at 4 p.m.

“We vaccinated six infants and 13 adults in a few hours last night,” Khazei said.

Twitter: @MedicineMatters

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