We need more family doctors in New Brunswick

We believe every New Brunswicker should have a family doctor.

This is one of three major issues we hear from our patients. The other two are emergency room wait times and the need for more nursing homes

Family doctors are important in our lives. They help us address health problems before they worsen. They provide care to babies, young people, and seniors alike, through thick and thin. Family doctors are the quarterbacks of the health care system and are uniquely qualified to provide care and advocacy on a patient's behalf.

We ask a number of New Brunswickers on a regular basis if they have a family doctor, to help us determine if patient access to family doctors is getting better. Right now, we’re beating the national average – over 90% of New Brunswickers have a family doctor. Those people often have a tough time getting in to see their doctor, which we will talk about later. But 50,000 people have no doctor at all, and tens of thousands of patients are on the provincial waiting list.

Why is this important?

Early access to care for health problems is critical. Most New Brunswickers who need care have chronic diseases, which need ongoing management. If patients don’t have access to family doctors, they don’t get the preventative and ongoing care they need to live healthy lives.

Patients without family doctors have to use emergency rooms and walk-in clinics for their minor care needs, which isn’t good for a few reasons. One, there’s little information sharing with other physicians, resulting in a number of duplicate tests. Two, there’s no tracking of their health needs over time, as care is episodic. Three, a piecemeal approach wastes patient time and the system’s precious health dollars.

The current challenges

New Brunswick’s system of primary care is based on a very old model: someone gets sick, they see their doctor, the doctor has a remedy, and the patient goes home. In the 21st century, doctors know that this isn’t how it usually works anymore.

  • Tools. Only 34% of GPs are using an electronic medical record, which is just over half the national average. EMRs help doctors provide better quality care.
  • Teams. Most physicians in the country are encouraged to work together with other providers, but only 16% of physicians in New Brunswick work in interprofessional practices.
  • Timely access. New Brunswick’s doctors have some of the highest patient loads in the country: 1800 patients per GP, compared to 1000 patients per GP next door in Quebec. This means only 30% of New Brunswickers can see their doctor for a same-day appointment.

Patients need family doctors who have the right tools, team, and schedule.

To truly fix primary care for patients, we need concrete action to:

  • Improve timely access to care through the development of more collaborative care teams, where doctors, nurse practitioners, and allied health providers work together.
  • Remove New Brunswick’s command-and-control approach to where and how doctors provide patient care, called billing ‘numbers’.
  • Modernise remuneration in New Brunswick to ensure we, like most other provinces, offer doctors more than one model for remuneration that is reflective of today’s family medicine.
  • Create and execute a physician recruitment strategy to ensure we don’t train the next generation of Alberta’s doctors and are able to replace the ones we are losing here.
  • Responsibly partner on the provincial Electronic Medical Record program, now seen as the standard of care by nearly all new family doctors, by integrating other provincial health systems.

There are good things happening which need political support.

The arrival of Family Health Teams is underway. We’ve been heavily involved in the creation of these teams, which are considered by many family doctors to be the way of the future. Second, electronic medical record adoption rates are also improving rapidly, thanks to the new Provincial EMR Program, run by the NBMS and supported by the federal and provincial governments.

Our signature priority to fix the rest of the problem is this: To help with timely access to care, we need more family doctors to share the load. We have very poor data on physician to population ratios – some figures say we’re among the lowest in the country for population to GP ratio, and some say we’re in the middle of the pack. We do know that:

  • 81% of New Brunswickers are happy with their doctor- they’re happier with their doctor’s services than those of the overall system (65%) or emergency rooms (55%).
  • Over three quarters of patients feel they have enough time in their doctor appointments to discuss problems.
  • 81% of New Brunswickers have seen their doctor in the last year.

We continue to ask politicians and health system leaders to adopt a priority of recruiting and retaining 50 net new family physicians before the end of 2018.  Additional family doctors –ten net new family physicians a year– will absorb the entire waiting list and improve timely access to care by better distributing patients among family doctors.

To do this, we need a recruitment policy of bringing on our own residents and medical students, keeping young and highly trained New Brunswickers at home and finally making New Brunswick an attractive national destination for new physicians.

While improved primary care results in cost savings down the road (by preventing and mitigating health concerns that could end up being costly to health and the system), there is a cost in bringing on more family doctors. We estimate the investment to be $12 million annually by the end of 2018.

The return is generated through timely access to family doctors, which can save some of our annual 606,000 visits to emergency rooms (which cost $83 a visit, almost always for one complaint). If we were to avoid 5% of these visits, we could save $2.5 million annually. This doesn’t count decreased utilisation of walk-in clinics, or prevention and maintenance of chronic diseases.