The fault in our stars

Issue: BCMJ, Vol. 59, No. 5, June 2017, page(s) 257,274 Letters
John Walton, MD

The letters in the April issue by Drs John Albrecht and Robert Brown [BCMJ 2017;59:146,147] bring to the fore the perilous state of general practice in BC. Congratulations to Dr Brown for having the courage to offer a solution.

For many years in the Interior, clinics made up of GPs, often including specialists, did offer comprehensive 24-hour care. It was a very satisfying way to practise—sharing calls, pooling knowledge, and covering each other for holidays. Unfortunately, the profession bears some responsibility for the demise of these clinics. The section of general practice could never negotiate a fee schedule that would cover the overhead for a decent clinic. When physicians were allowed to incorporate, it made it more difficult to share expenses. Allowing walk-in clinics to bill on our fee schedule siphoned off the easy money. Our own greed and shortsightedness blinded us to the realization that high-quality care cannot be delivered with our anachronistic fee schedule.

“The fault, dear Brutus, is not in the stars, /But in ourselves that we are underlings.”

Meanwhile, the government laughs, realizing they are saving money not having to properly fund comprehensive primary care. The result, however, is that care is now fragmented and much of it off-loaded onto the emergency wards with their massive overheads.

The cost of ICBC neck claims alone in 1 year was $661 million, almost as much as was paid to all the GPs in the province in that year. This is a massive misallocation of capital. Imagine using some of this money to create a one-stop medical centre. Perhaps to keep the stench of government bureaucracy and public sector unions out of the care centres, we could ask for help from Walmart.
—John Walton, MD