A new type of doctor's office has been proposed for Prince George to alleviate the backlog of patients with no doctor. They are called unattached patients by the healthcare industry.
According to local research by the Prince George Division of Family Practice (a group of co-operating doctors established by the provincial government in 2009), there are 15,000 people in the city with no family physician.
Five thousand of those are considered patients with complex medical needs - everything from heart conditions to diabetes to chronic pain to drug addictions to mental health infirmities and often several things at once.
A clinic has been proposed, in collaboration with Northern Health, to open a clinic that would serve the needs of these particular patients. Northern Health would fund approximately two doctors and three nurse practitioners, plus other healthcare professionals would be included in the model so these patients with deeper needs could be handled by a team, all in one place at one time.
The plan has its detractors. One local general practitioner spoke to The Citizen on condition of anonymity with concerns over efficiency and fairness. Firstly, many of these complex care patients have troublesome behaviours like abusiveness to doctors and apathy with their own health, yet this clinic will cater to them "while patients doing all the right things" were still relegated to walk-in clinics or the hospital Emergency Room.
Secondly, the detracting doctor said, the physicians working at this clinic will be on a salary instead of a fee-for-service payment method so they will likely see only a fraction of the patients a conventional doctor would see in the same amount of time.
"There certainly is potential for the unattached/complex care clinic to be less efficient, in that sense, but the alternative is for low-impact episodic care - a walk-in clinic - and the research is quite clear that it doesn't take long for that to show an inefficient side that is far worse and far more costly," said Dr. Barend Grobbelaar, one of the leaders of the proposed new clinic.
"It's true that episodic care clinics can pump the patients through, but there is no relationship between doctor and patient, there is no sense of history or sense of future, the patient really only gets maybe a prescription filled out and some immediate medical advise.
"That's fine for many, but complex patients are not helped by that and it can actually create health consequences as people end up not getting the level of care they really need. That drives up the numbers of visits to doctors, visits to ER, and the overall cost to the healthcare system. We can get truly better outcomes if we directly address complex care patients who are stuck in this limbo."
There is also a component being designed into the clinic, said Grobbelaar, that would act as a support system for the regular family physicians around the city who need help once in a while with their own complex care patients, so it would be a help to attached patients as well.
The proposed clinic needs startup money. According to Prince George Division of Family Practice executive director Olive Godwin, it will take about $600,000 to do all the necessary equipment purchases and renovations to the home they searched out at the Commonwealth Health Centre. Most of that is one-time cost.
"The province and Northern Health are making contributions to the services but not the physical space," she said, as is typical for medical facilities off-site from a hospital.
The search is on for donors and partners. The group has hopes that the Spirit of the North Healthcare Foundation will provide support but that is still pending.
