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System 'crumbling at seams,' MD says

September 13, 2016 9:17 A.M.


While the provincial government fears a two-tier medical system would undermine our Canadian principles, a retired Kelowna physician says we already have a two-tier system and the public model is broken.

Dr. Mark Fromberg spent decades as a family physician throughout B.C. and other parts of Canada, working in Kelowna's Mission area for the final 15 years of his career.

He said the medical system in Canada is falling apart and something has got to give before patients start to get better access and treatment in this country.

“There are already two classes of people, those who have benefits and those who don't,” said Fromberg who explained that many will go without prescriptions, dental and other treatment, as they cannot afford it without work benefit plans.

Fromberg shared his perspective as a lawsuit challenging the public health-care system plays out in Vancouver – and has the potential to spawn a Canadian two-tier model.

While the retired doctor said he fundamentally believes in our public health care system, he said private health care can help alleviate pressures by allowing those who can afford to skip the line to free up ever-growing wait times for those who can't.

“They are people crying for access. Do you want to deprive them of that just because we are trying to uphold this holy grail of a universal system,” said Fromberg. “We have two choices; somehow put more money into the system so it will pay for all this – which is increasingly impossible, or, contemplate some kind of balanced process.

“It is a wonderful ideal to have this great universal medical system, but it is crumbling at the seams.”

At the heart of it, he and many other doctors throughout this county believe Canadians should have free access to the care they need, but to allow this to happen, the model needs to change.

Fromberg told Castanet he has a suggestion that could fix the system within a year, but the government needs to listen.

He presented his ideas to the Select Standing Committee on Health in July, arguing politicians need to start thinking like physicians.

He argued that the government needs to eliminate the barriers on general practitioners, or family physicians, that literally limit their ability to provide more care.

As it stands, explained Fromberg, GPs are punished by being paid less per patient, after the mandated 50 patient/day cap.

“Every other job I can think of you get paid more for staying longer,” said Fromberg. “It is a fundamental flaw in our system.”

He said early in his career in Ontario he would see about 40 patients during the day at his office and then see another 40 patients during a shift in the ER, but the system now provides no incentive for doctors to do those long hours.

“That is a major barrier to primary care,” said Fromberg. “GPs are the only ones punished this way.”

His argument also includes changes to the system that would allow doctors to actually delegate easier tasks like prescription renewals and dressing changes, so that they can take on more patients.

“The nurse practitioner programs all say a nurse practitioner can fully do 80 per cent of what a GP can do, so let's run with that,” said Fromberg, who added that the nurse practitioners would be under medical and legal responsibility of the physician.

“If I was allowed to delegate, and that cap goes out the window, my capacity in my GP office can literally double,” said Fromberg. “My capacity has gone up, the waiting lists to see me will disappear and I could probably take on another 800 or 1,000 patients.

“The beauty of this is that they are just policy changes, somebody just needs to change their damn mind. Let us do what we can do.”

The Cambie Surgery Centre, a private clinic in Vancouver, is currently suing the B.C. governmentfor using the Medicare Protection Act to prevent doctors from providing medically necessary treatment in both the public and private systems and to forbid private insurance for core medical services.

Along with the Cambie Surgery Centre, plaintiffs include several patients who argue that forcing people onto wait lists for medically necessary procedures violates Canadians' charter rights.

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