Solutions for Primary Care and Family Medicine: 5 Minutes with Dr. Lawrence Loh

1. With the release of “A Prescription for Primary Care”, what are the key takeaways you want your peers and future physicians to know and put into their practice?

We’re hoping that physicians will be able to come together around the prescription for primary care. We recognize that primary care is the foundation of the healthcare system. Without a primary care system, you result in a significant overflow and overcharge in hospitals, and I think this is where between family medicine, primary care professionals, you know, allied health professionals as well as our specialist colleagues, we all need to come together to fix and focus on what is happening in the community.

We’ve seen after the COVID-19 pandemic, a real unprecedented crisis in the primary care system. What the prescription for primary care offers is some clear solutions, which are not new, frankly, but clear solutions that are needed to support and improve the access for patients and support physicians in the primary care system and directly other physicians elsewhere. It discusses the solutions that aren’t going to work, things that aren’t going to necessarily address the current crisis.

2. Who are the main stakeholders that must collaborate to alleviate these challenges in the Canadian healthcare system and with the family medicine physicians?

It all starts and ends with the government. It’s the federal government as well as the provincial governments altogether who are coming together on a new health accord, coming up with new agreements for the Canadian Health Transfer and how they spend that money.  

It’s also the accountabilities they put in place for that money that will shape how the primary care and healthcare system will look over the next 5 to 10 years. So, they are very important stakeholders, they are the ultimate decision-makers that are making these decisions that need to hear the importance of focusing on primary care and finding solutions as identified within the prescription for primary care.  

Certainly physicians, family doctors, family medicine specialists as well as other world college specialists. We all need to come together in recognition that we all need each other. Family doctors do a lot of undifferentiated primary care. We need support in the communities to keep it in communities and out of specialist offices in the hospitals and similarly, once that happens and we also need the specialists, you know where there’s support to complete and follow through on their consoles, to work through to take the consoles to support family doctors in the traditional symbiotic way that we have.  

Then, we also really need other healthcare providers to come around, especially the community. One of the things that prescription for primary care is trying to drive is the idea of team-based care, you know, the idea that we need to have patients working and attached to a primary care team that’s working on their interest. So, other health professions need to be on the table and we’re very excited that we have coalitions that come together, and I think the public and patients need to let people know. I think we have good evidence that they still see a significant value in having their family doctor, 84% of patients said that they would rather wait for their family doctor for a few days to get care rather than see a provider that they don’t know.  

So, I think patients need to come out and recognize both the need for access to primary care delivered in well-resourced, well-supported teams, but also the access to the unique expertise and that complex integration, that continuity that family doctors bring. Those are sort of some of the groups that really need to pay attention to the prescription for primary care and then add their voice to making it a reality. 

3. Why is recruiting more physicians, particularly international physicians through international research, not a single-handed solution for this current crisis?

I think that reducing barriers to qualified international medical graduates is very important and streamlining that process is critical, but we have to remember that it’s not a numbers game. You can’t necessarily train up a whole bunch more people. And even if you reduce barriers for international graduates, and trained a whole bunch of doctors tomorrow, if the system is still organized the way that it is right now, you’re putting people into a broken system that’s not going to work and that’s the challenge. 

It is about the elements of the prescription of primary care, which are about developing teams and primary care interprofessional teams that are supported with administrative resources and digital solutions. Solutions that are not problems. For example, electronic records that talk to each other are interoperable with hospital systems and with laboratory systems.  

Then of course, compensation ensures that family doctors are compensated differently, and you know fairly for the complexity that they deal with and also supported administratively to address a lot of them. You don’t want family doctors sitting there and filling out a bunch of forms. You want them to see patients and you want them to see the most critical patients in the community that need to have a broader context, integration and differentiation.  

So those are the solutions you need, and you know those are the key ones. You can increase numbers all you want, but unless the system moves towards you know more optimal functioning, it doesn’t matter how many international graduates or even Canadian graduates you train, it is still going to be a broken system.

4. How will having that well-resourced team of interprofessional healthcare providers help support current family physicians?

The reality is right now that there are a lot of patients looking for access and they’re looking for challenges. But one of the things that we don’t want to see is competition between different health professions. I think competition just confuses the public. It confuses patients. It also burns providers out because the reality is that there’s no single provider that can solve the current primary care crisis.  

By coming together in teams, you know, you have allied health providers, you’ve got family physicians, you’ve got pharmacists, you’ve got nurse practitioners. You’ve got all these folks under one roof. You can provide different routes of access to care for patients, and it’s a recognition that it doesn’t always need to be the family doctor that does the script refill or does the blood pressure check.  

You have everyone practice to the top of their scope in the specific areas that they need, so if you’re coming in and your diabetes is controlled, you know, the broader question then becomes, well, if you just need some counselling, it doesn’t need to be the family doctor that does that. The dietician can do the counselling. Similarly, if you’ve got a musculoskeletal injury, maybe the person you want to see is the physiotherapist, you know, not necessarily the family doctor right away. I 

 think it’s about really ensuring that patients are matched to the right care at the right time, you know, with the right person who’s got the right scope to support them in health. 

5. Regarding reducing the administrative burden for family physicians, are there any examples of cases where maybe this implementation has already been successful?

Absolutely, in the United States as well as in different places in British Columbia and PEI, lots of different models have been used to address administrative burdens. In certain team-based settings, you have medical scribes, or you have, you know, additional administrative staff who can help with the population of forms and all those other things that then get signed off. In British Columbia, they are now remunerating positions for hours spent on administrative work.  

In addition to those settings, in terms of addressing administrative work from the receiving side, there needs to be work done in addressing it from the sending side as well. We know governments even have a role to play in that. Some of the forms nowadays, you know, I remember forms that I started in residency and early family practice with that were three to five pages. Now they’re 12 pages.  

The thing is, people come up with this form and they just see one form, but they don’t realize that when you duplicate those over hundreds or even thousands of patients, that represents many minutes and many dollars being spent on forms which really could be spent elsewhere.  

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