Dr. Rita McCracken, MD, PhD (she/her) Profile picture
Dec 7, 2022 14 tweets 5 min read Read on X
To fix the #FamilyDoctorShortage...
how many
family doctors
do we need?

The math should be simple, right?

A 🧵 to explain
why we need a whole
new math equation
to actually
fix the problem of
equitable access to
🇨🇦primary care

1/
We only need 4400 family doctors...

2/
We have a shortage
because
the assumptions
of the math equation
are... wrong.

❤️‍🩹Not every patient has the same primary care needs
❤️‍🩹Not every family doctor provides community-based longitudinal care
❤️‍🩹Not every doctor can work 5 days/week, 52 weeks/year, forever

3/
let's use public schools as an (imperfect) analogy

if we just took the
# of school-age kids
+
divided by
average class size
we might get a good estimate of
the # of teachers needed
to provide equitable public school access

BUT

education is more than just teachers

4/
teachers are
absolutely essential
to education

but we don't ask them
to use their own income
❓to open their own school
❓hire their own staff
❓select & maintain an IT system
❓assess a community's needs, etc

yet we ask family doctors to do this
5/
teachers need schools
and
schools need funding
and community/province level
organizing

it's called
INFRASTRUCTURE

&
primary care needs it too

the first step is to start using the
CLINIC/PRIMARY CARE TEAM
as the unit of service delivery
(not the individual doctors)

6/
Team-based primary care
is the new gold standard
& is
where a patient
gets access to
wrap around care
by a cohesive, collaborative
group of healthcare professionals
incl:
-doctors
-nurses
-midwives
-pharmacists
-OT/PT/Social Work
-cross-cultural health brokers
& others

7/
❤️‍🩹🩺
not every patient
needs the same care
at the same time
some groups predictably need more care, including:
-pregnant people
-frail elders
-people at end of life
-people with mental health d/o's
-people experiencing poverty, racism

A primary care team can help everyone

8/
So, we need some new math
where we calculate the number of clinics needed
and
hire the right team for each clinic

9/
Interestingly...
COMMUNITY HEALTH CENTRES ("CHC's")
an existing form of
Primary Care Teams
have not had issues with recruiting and retaining doctors
and they have
good patient outcomes, as well

(policyalternatives.ca/chcs-in-bc)
Our new math needs:

❤️‍🩹the clinic as the unit of service delivery

❤️‍🩹adjustment for actual population needs

❤️‍🩹adjustment for: admin burden, access to specialists & community resources

❤️‍🩹primary care teams that work well together & respond to feedback & change
It is a whole new way to think about
providing access to primary care
& like schools
it needs funding that
directly funds INFRASTRUCTURE
as well as provides attractive
work environments for
family doctors
& all the other essential team members
Some very interesting work being done by the folks @UBCISU to be able to "calculate" how many patients get access with differing team compositions.
In summary,
we need funding & policy decisions for a system that will be around in >30years
&
provides equitable access no matter your needs
&
rethinks existing assumptions

Looking forward to talking about this at the @CMA_Docs event Dec 8 cma.ca/health-summit-…

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More from @DrRitaMc

Oct 25, 2022
🩺❤️‍🩹
The #FamilyDoctorShortage in 🇨🇦 is ... bad.

What can you do to keep yourself as healthy as possible if you don't have a family doctor?

A🧵of (unofficial) ideas for "the unattached" 1/11
2/
❤️‍🩹🩺
First, let's get this important caveat out of the way...
If you are VERY SICK
e.g. issues breathing
or chest pain
or you're bleeding excessively
or another urgent/emergency condition

GO TO THE CLOSEST EMERGENCY ROOM or CALL 911
3/
🩺❤️‍🩹
2nd crucial caveat
If over the last 3-6 mon you

-had unintended weight loss >10lbs
-have drenching night sweats (& aren't experiencing menopause)
-blood in your stool/urine
-have a breast lump

Get seen by an MD < ~2 weeks, & tell them these things (in person>>virtual)
Read 11 tweets
Sep 20, 2022
How do we fix healthcare?

A @CBCnewsbc spoiler 🧵
1/

❤️‍🩹🩺⬆️⬆️ FED & PROV 💰💰 in PRIMARY CARE

=Directly fund buildings + operations + non-MD staff

= "global funding" to CHC's-no more grant hustling to pay for community health needs

=transparent evaluation & QI

#bcpoli
2/

❤️‍🩹🩺 SHIFT MD PAYMENT TO MODELS THAT INCENTIVIZE HIGH-QUALITY, LONGITUDINAL CARE

= e.g. capitation (lump sum pay based on # and complexity of patients in a practice)

≠ fee for service - it incentivizes VOLUME
3/

❤️‍🩹🩺 INTEGRATE PRIMARY CARE w MENTAL HEALTH & SOCIAL SERVICES

💥income disparity, racism, colonialism, etc have serious deleterious effects on health

💥addressing these "social" determinants of health in primary care is essential (ref: @BCACHC)
canada.ca/en/public-heal…
Read 6 tweets
Aug 31, 2022
🧵 1/5
Will "time modifiers"
added to family doctors fees
help more people in BC
access primary care?

🩺❤️‍🩹Probably not

2006-14, BC spent a BILLION $$ (!!)
with incentive fees family doctors for work that typically takes more time (e.g. mental health)

#bcpoli #primarycare
2/5
The new fees were "on top" of the usual "fee-for-service"

The stated aim:
💥to encourage family doctors to return to a traditional model of "full-service family practice"💥

And acknowledged that some work was taking doctors MORE TIME⌚️
@globeandmail
theglobeandmail.com/opinion/was-bc…
3/5
The result?😢

-family doctors got paid more
-family doctors saw fewer patients

⁉️But maybe patient outcomes like hospitalizations improved, she types hopefully (see next tweet...)

ref: longwoods.com/content/23782/…
Read 5 tweets
Aug 31, 2022
1/5
Today is International Overdose Day

Education is important

Whether it's
understanding how to use naloxone students.ubc.ca/health/health-…
or
proper language when speaking about substance use
fnha.ca/Documents/FNHA…

there is a lot of learning to do.

#IOAD2022 @BCCSU @CHEOSNews
2/5
Our REDONNA team has been working on educating prescribers in BC about sparing opioid analgesics for noncancer pain among opioid-naïve patients.
@ShawnaNarayan @ircoopy @JanKlimas @Drug_Evidence
ti.ubc.ca/2021/11/24/web…
3/5
200 participants (FPs, NPs, Nurses, and community members) attended an educational webinar focused on opioid sparing practices and the (lack of) evidence for opioid analgesics to treat noncancer pain.
You can read more here: doi.org/10.1093/fampra… (3/5)
Read 5 tweets
Aug 31, 2022
The REDONNA study doi.org/10.1016/j.cct.…
began from the motivation for improved & safer opioid prescribing in primary care

We aimed to educate MDs about their OWN prescribing practices using audit & feedback letters developed by the @Drug_Evidence @JanKlimas @ShawnaNarayan 1/4
They received information about the number of new opioid initiations & how they compared to the average physician. They were provided information on the (lack) of effectiveness on pain for opioid naïve patients through an educational webinar: doi.org/10.1093/fampra… (2/3)
From this study, we hope to support the uptake of quality prescribing practices that are equity-oriented and evidence-based to help patients experience less pain. (3/4)
Read 4 tweets
Aug 25, 2022
1/ Why I am worried about these emergency funds and why I think they probably won't help improve primary care access, a thread #bcpoli #PrimaryCare
2/ 💯Primary care is in a terrible state in BC (has been worsening for 20 years), and this money might "stem the bleeding" but it won't remedy the sharp objects causing the bleeding🩸🩸🩸
3/ Imagine public education in the same state, a million kids don't have a school to go to and teachers quitting everywhere because they are burnt out, and the cost of running their own school is unsustainable
Read 19 tweets

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