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North Shore-based internal medicine specialist Dr. Kevin Mcleod is calling for the province to allow physician assistants to work in clinics, which could help to ease backlogs and wait times for patients
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In under 48 hours last week, Dr. Kevin Mcleod received 56 new patient referrals, many of them requiring urgent care for serious illnesses such as diabetes or cancer.
“If there’s that many coming in two days, well, I can’t see that many new people in two days,” said the North Shore-based internal medicine specialist who already manages about 8,500 patients as part of his practice. “So you’re always in a deficit and getting further behind because if you don’t see those 56 people in that 48 hours, well then they’re sitting on a waiting list and waiting lists grow and grow.”
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Mcleod can’t see some of the urgent patients for weeks, which puts their lives at risk. What could help his clinic, however, are more nurses and physician assistants to help ease the backlog.
The province has started allowing physician assistants in emergency rooms but not yet in clinics, something Mcleod says must change. Having a physician assistant to call patients to inform them their screenings were clear would free him to talk to patients who have urgent diagnoses, he said.
He would like to see individual clinics hire their own nurses instead of going through the Health Ministry, and says the province should make it easier for physician assistants to work in B.C.
“If somebody’s waiting three to four months to see me for their diabetes, it may mean the difference between landing on an oral medication or needing insulin. As soon as someone needs insulin, the process becomes more complicated,” he said.
“Or pancreatic cancer. Getting that early is key. Six to eight weeks may make a huge difference in that patient.”
He added that the stress of not being able to get to urgent-care patients can also lead to physician burnout, which would create even more delays.
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His plea comes as thousands of British Columbians continue to be wait-listed for a family doctor because of a shortage, forcing people to turn to walk-in clinics or overcrowded emergency rooms.
According to Mcleod, most of his referrals used to come from family doctors but now the majority are from emergency rooms.
“I’m not sending someone back to the emergency room for care so they become my patients, which creates an even bigger backlog of referrals,” he said.
He said the urgency of referrals has skyrocketed over the past two decades. For instance, in the past someone with a blood clot may have been admitted to hospital for a few days but now they’re sent home and referred to a specialist.
“I’m not arguing that they should stay a couple of days but getting people out more quickly from hospital does put a really substantial burden on the community,” said Mcleod.
Asked during an unrelated news conference why physicians assistants are limited to emergency rooms, Health Minister Adrian Dix said B.C. doesn’t have a training program for physician assistants so they’re recruited here from other jurisdictions.
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“We feel given the extraordinary situation facing emergency rooms everywhere in B.C., that we would focus that resource in the first period on emergency rooms,” he said. “We’re not going to divide the resource everywhere, we need supports in emergency rooms now and that’s what we’re doing.
“The numbers (of patients) vary day to day, but the absolute numbers in emergency rooms everywhere is up year over year every year. And that’s why adding physicians’ assistants to support that — and associates physicians and expanding the scope of practice of health-care professionals — is a good idea,” he said.
Opposition health critic Shirley Bond said she’s concerned for doctors like Mcleod and other physicians who are feeling a sense of moral distress about their ability to keep up.
B.C. must expand licensing physician assistants so they can work in clinics, she added.
“If family doctors had a physician assistant, they could take a much more team-based care approach and increase the number of people with a family physician and reduce those wait-lists. It makes sense to me. I’ve been bringing this up for years with Minister Dix and we are still waiting.”
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Dr. Vincent Wong, president of B.C.’s College of Family Physicians, also pointed out that many doctors in the province are spending too much time with administration work.
“Up to 25 per cent of a family doctor’s week is taken up with administrative work rather than providing the direct patient care, so while that takes up time that also turns some folks away. It’s a major investment to practise family medicine,” said Wong.
— With files from Katie DeRosa
ticrawford@postmedia.com
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