If you’re like the 50,000 other New Brunswickers without a family doctor, you know finding one who is accepting new patients can be challenging. Like many other jurisdictions in Canada, there are simply not enough physicians in New Brunswick to serve the patient population.
The best point of contact to find a doctor is through the government’s waiting list for people without family doctors. Filling in your information online or calling a phone number gets you on the list. This list is called Patient Connect NB, and people waiting will be assigned to a doctor on a first-come, first-serve basis.
Patient Connect NB is a partnership between the Department of Health, Service New Brunswick, the Regional Health Authorities and primary health care providers (family doctors and nurse practitioners). For more information visit their website or call Tele-Care 811.
Family doctors play an important role in our healthcare system as the first point of contact for most patients. It’s been estimated that 80 percent of what happens in health care takes place in what we call the “primary care setting,” which usually means a patient in their family doctor’s office.
In fact, there is considerable evidence to show that having a regular family doctor is far better for patients than having to rely on short-term care for acute problems. Patients understand this intuitively – it’s always better to have someone who knows your family’s medical history than visiting an emergency room for basic but necessary care.
Family doctors assess, diagnose, and treat patients themselves. They also refer patients for tests, procedures, and for consultations with specialists.
Patients understand the constraints placed on doctors and while we often wish we could improve access, over 80 percent of people in New Brunswick are happy with their doctor. Over three quarters of patients feel they have enough time in their doctor appointments to discuss problems, concerns, or fears. But New Brunswick’s doctors know we have more work to do, and those numbers can always improve.
Health care is a demand-driven industry. In a world of fixed resources, that means as more people need to see a doctor, the less access is available to other people. A doctor only has so many hours in a day.
In fact, New Brunswick has several challenges with maintaining good access to care.
We’re the sickest province in the country. Sixty percent of New Brunswickers have at least one chronic disease, and 13 percent of those people are on six or more medications. We also have the second highest rates of disability. We have the third highest diabetes rate in Canada (PHAC 2011) and the third highest rates of cancer in Canada. Sick people see the doctor more.
New Brunswick has the highest rate of seniors in the country. We know visits to the doctor take longer and happen more frequently for them than for others. Generally, the higher number of seniors in an area, the worse access is to doctors. Seniors’ care requires five times as many resources as caring for younger people.
We have the second heaviest population in Canada – over half of New Brunswickers are overweight or obese. Only half of us believe we are in very good or excellent health, and only half of New Brunswickers believe our health depends on how well we take care of ourselves, which is the second worst rate in Canada. Poor choices add up to higher risk for many chronic diseases, which then require management with a doctor’s help.
On average, physicians in NB are taking care of more patients than anywhere else in Canada. New Brunswick family doctors have some of the largest patient loads in the country. Half of the province’s family physicians have patient loads greater than 1,800, compared to the Canadian median of 1,400. Next door in Quebec, the average number of patients per doctor is almost half of what it is here (1,000). Doctors end up taking on more patients than they’d like, because there continues to be a shortage of doctors.
This creates another problem – getting an appointment with your doctor might take longer than it should. This usually means your doctor has many, many patients. While over 90 percent of New Brunswickers report that they have regular access to a doctor, New Brunswick is seventh out of 10 in Canada in terms of the number of doctors we have. That means each doctor in New Brunswick is seeing many more patients than other doctors in Canada. In fact, we have had one of the lowest physician-to-population ratios since 1979.
Doctors must take care of so many patients because we are the only province in Canada to force a restrictive “billing number” system on doctors. This means the government dictates how many doctors get to practice here, and where and how they do so. Every other province used to do this and gave it up years ago, because they learned that doctors are much faster and better at choosing where to practice to take care of patients than bureaucrats. New Brunswick is alone in the country in this rigid system.
Internationally, improving access to primary care has been accomplished through a variety of means. While compensating providers differently is key, equally tough reforms have centred on three goals.
Parents know not every scratch and bump needs the attention of a doctor. But most people just don’t know how many services can be provided by “allied health workers.” In fact, many complex tasks are performed now by non-physicians. New Brunswick’s doctors welcome and look forward to more teamwork with nurse practitioners, nurses, pharmacists, physician assistants, and more. We aren’t in favour of duplicating services or allowing untrained providers to take care of ailments beyond what they are competent to do. Working together, doctors and other allied health workers can use each person’s skills to the best of their ability.
Many other provinces already believe in the value of teamwork, and we’re actively engaged with the government to ensure teams provide care here, too. For patients, this means that if they need a flu shot, they’ll likely get it from a nurse who works with the doctor. If they need their medications explained to them, the pharmacist can work with the doctor to do this education. For more complex problems, you’ll still see a family doctor. This way, patients can get “the right care, at the right time, in the right place.” New Brunswick’s doctors are a driving force behind the creation of these new teams of providers.
Of course, it’s hard to practice in teams when your health care providers don’t understand each person as an individual patient, or have to make you repeat a long medical history over and over. New Brunswick’s doctors are actively leading the charge on the creation of an electronic medical records system. This means that your health information is secure and safe, but can be shared with other providers who care for you.
Electronic medical records have been shown to improve the quality of care provided to patients by helping providers remember preventative screening and care routines, clearly documenting prescriptions and lab results, and helping to track your health over long periods of time. These tools also must be integrated with health information that isn’t in a doctors’ office – like your emergency room visit or the prescriptions you just picked up. Having all of this information accessible to doctors takes a lot of time, work, and resources. New Brunswick’s doctors are working with the government and a company led by doctors called Velante to provide these tools to physicians who want them.
Finally, some countries and jurisdictions have done their best to educate patients on where they can get quick access to safe care. Ontario has spent millions of dollars encouraging patients to find the best avenue of care for their particular need and level of urgency. Some provinces have worked hard to try to steer patients away from emergency rooms if they need primary care. But our best options are twofold. One, patients need a family doctor. Two, they need to make healthy choices in their own lives whenever possible to ensure they are living as healthy a life as they can.
No one chooses to have an illness, but many of us make unhealthy choices that increase our risk for a chronic illness every day. Doctors are trying to play a more active role in keeping people healthy and we support our patients who are trying to live healthier lives. As the old saying goes, getting healthy starts long before you walk into the doctor’s office.
To learn more about how New Brunswick’s doctors think we should change the current system, click here.
To help address these serious challenges facing our health-care system today, we have signed an agreement with the Government of New Brunswick to develop a new, collaborative model of practice that will:
This new model will lead to improved access and health outcomes, more comprehensive and continuous care, and chronic disease prevention – the most significant cost driver in health care today.
This initiative has been, and will continue to be, physician-led, building on all of the work we have done over the past several years to design a better model for family medicine in New Brunswick. To begin, the Medical Society has struck an advisory group, which is aiming to develop and launch the initiative in 2017.
For more information, read our February 2, 2016, news release, “Medical Society applauds new family medicine agreement with government”.