Public solutions that work

With a health care system under pressure often comes calls to turn to the private sector to “fill-the-gaps”. This false narrative both ignores the evidence that shows how privatization deepens the gaps in the system by putting additional strain on the public system providers. It also distracts from having conversations about evidence-based solutions that can make a real difference within the public system. 

The second panel explored some of the solutions that have been slow to implement but could make the greatest difference in terms of access to primary health care and addressing the worker shortages in all health care professions. 

Investing in primary care infrastructure

Dr. Rita McCracken, a family doctor and Assistant Professor in the Department of Family Practice at the University of British Columbia, addressed the roots of our current primary health care access problems. While often framed as a “family doctor shortage”, with one in five Canadians not having access to a primary care provider, Dr. McCracken reminded us that BC currently has more family doctors per capita than ever before. 

According to Dr. McCracken, the real issue isn’t a lack of family doctors but a lack of publicly funded primary care infrastructure. Her research has shown that almost half of family doctors surveyed within Vancouver Coastal Health region said they would prefer to be an employee of a clinic rather than a small business owner. They prefer to be an employee as it would allow them to work in teams, have a stable income, be able to take vacation, and go on parental leave. However, the way that primary care delivery is currently organized does not provide these options for practice. 

An alternative model would be to structure primary health care delivery in a similar way to the public education system. With this approach, residents would fall under a catchment area and have access to their local publicly funded community health centre. In a community health centre, family doctors would be salaried employees that benefit from working with an interdisciplinary team of allied health professionals, an approach that has been shown to improve work satisfaction and reduce burnout. 

Dr. McCracken acknowledged that physicians are most often the only partners invited to help solve issues with primary care access,  but equally important is inviting other voices at decision making tables including allied health professions and patient and community representation. 

You deserve a team: engaging the full team of allied-health professionals

Dr. Kelvin Bei, a Nurse Practitioner at RISE Community Health Centre, shared his experiences working with an interdisciplinary team. He shared stories of working closely with pharmacists to bring a patient at risk of hospitalization back to a stable state or working with a counsellor to support a youth contemplating suicide. He talked about how rewarding it is to work with a team that can address a patient’s holistic needs. He noted that no amount of money could prevent burnout as effectively as the feeling that you are making a difference. 

When asked about the barriers to expanding this model, Dr. Bei reiterated that allied health professionals have long been excluded from decision-making tables. Doctors still act as gatekeepers who must be convinced to direct primary care funding towards team based care. These decision-making structures will need to shift to see any significant change. In order to get to team-based care, we need team-based governance. 

The quality of work is the quality of care

Building on the discussion about the kind of work conditions andenvironment that will help address the worker shortage across our health care system, Ronnie Nicolarosa, Director of Membership Services at the Hospital Employees Union, talked about the difference a good public sector job can make in the lives of frontline workers. 

Nicolarosa was a hospital laundry worker in the early 2000s when the BC Liberals brought in Bills 29 and 94. He shared the devastating impact this legislation had on him and his coworkers, some of which were laid off overnight and offered back the same jobs at half the pay. As a result, he saw colleagues work multiple jobs to make ends meet while struggling to find time to see their families. 

In August 2021, the Government of British Columbia announced that, after almost 20 years, they were bringing thousands of support service workers who were previously contracted out to private companies back to the public sector. Nicolarosa has been working to support this repatriation effort and sees the difference it makes in workers’ lives when they can rely on stable work. 

Workers in stable public jobs are more likely not to cut corners or feel rushed as a result of understaffing. Nicolarosa sees how these better conditions of work directly impacts the quality of care. For example, he shared a story of a contracting company cutting corners with deep cleaning following a patient with an infectious disease. Rather than adequately staffing a shift to ensure hospital cleaners have time to properly disinfect rooms, private employers were caught removing notices that let cleaners know to follow appropriate cleaning protocols. 

While bringing these workers back into the public sector is an important step, more needs to be done to ensure our health care system has the workers it needs. Nicolarosa shared that the Hospital Employees Union recently released results from a poll that showed that almost half of care aides, who deliver the majority of direct care in long-term care and other care settings,  plan to leave the sector. It’s never been more urgent to ensure our health care system offers high quality, attractive jobs to recruit and keep the workforce we need.