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COMMENTARY: Primary health care in crisis

Primary care is the cornerstone of a high-functioning healthcare system. Yet, many Albertans are struggling to find a family doctor, or if they are lucky enough to have a family doctor, to get an appointment in a timely fashion. 

Primary care is the cornerstone of a high-functioning healthcare system. Yet, many Albertans are struggling to find a family doctor, or if they are lucky enough to have a family doctor, to get an appointment in a timely fashion. 

In response to this crisis, the UCP government announced the Modernizing Alberta's Primary Health Care System (MAPS) initiative last month to identify immediate and long-term improvements to our primary care system.

In Canada, primary care is provided mostly by family physicians with a small percentage of Canadians seeing registered nurses, physician assistants or nurse practitioners as their regular primary care provider. Primary care comprises services that prevent disease, promote health, treat common illnesses and manage ongoing medical conditions such as diabetes, arthritis and mental health conditions.

Primary care providers are usually the first point of contact with the health care system for most people. In addition to diagnosing and treating medical conditions, they also coordinate specialist care and treatment for patients. 

Importantly, primary care providers have trusted, long-term relationships with their patients and get to know them in fullness of their lives – often providing health services from cradle to grave for patients in their community.

Studies show patients who see a regular primary care provider have better long-term health than those who don't.  They experience better access to health care, fewer duplications of tests and referrals and have fewer hospitalizations. Ultimately, they live longer and in better health.

Primary care provides all these benefits while at the same time lowering health care expenditures, increasing patient satisfaction and contributing to are more equal society.

But these benefits are available to fewer and fewer Albertans as the number of family physicians accepting new patients in our province has dropped by half in the last two years.

If we are to reverse these trends, governments, healthcare organizations and ordinary citizens have to acknowledge the crisis in primary care and take action.

Governments need to invest adequate resources into primary care to build a strong and reliable foundation for the rest of the healthcare system. Resources include properly funding the provision of primary care by recognizing clinic overhead costs paid by family doctors and addressing the administrative burdens they face. Compensation also has to take into account the extra time and effort spent in the care of complex, fragile or socioeconomically disadvantaged patients.

Family medicine is experiencing the lowest interest among medical students with only 31 per cent of medical students choosing family medicine training as their first choice upon graduation from medical school. Proper support, reimbursement and recognition can make the practice of primary care attractive and prestigious for young health professionals.

Governments also need to invest in a robust primary care workforce plan that includes plans for training, recruiting and retaining primary health care providers. The shortage of primary care providers will only get worse as Alberta’s population ages and the number of older patients with multiple and complex medical problems grows. More seats in medical schools, and increased access to training programs for nurse practitioners, physician assistants and other providers of primary care are needed now in order to meet current and future demands.

Additionally, the thoughtful integration of nurse practitioners and physician assistants into community clinics will allow patients to have timely access, choice of primary care provider and the opportunity to build long-term relationships. Such an approach should allow nurse practitioners and physician assistants to perform duties to the full extent of their training while at the same time providing support and pathways for referral to family physicians or specialists when required.

System changes to create multiple access points to primary healthcare can also help patients access timely and appropriate care. Whether the patient accesses care through a pharmacist, a physiotherapist, a public health nurse or an emergency room doctor, they should receive the care and treatment they need in the moment, but with a reliable system in place to ensure coordination, collaboration and information transfer back to the patient’s primary care provider.

We are told the UCP government’s MAPS advisory panels will report back in Spring 2023 with advice from strategic, Indigenous and international perspectives on primary care reform in the province. But with the swearing in of new party leader, Danielle Smith, and her own willful ideas about health care in Alberta, we are left wondering if this government will follow through on a thoughtful and collaborative approach to improving primary care that is desperately called for in our province.

Vamini Selvanandan is a family physician and public health practitioner in the Bow Valley. Her commentaries appear in the Rocky Mountain Outlook on the third Thursday of each month. For more articles like this, visit www.engagedcitizen.ca.