47,000 people with doctors rely on ERs instead, health council says

Already-long waits to see family doctors are continuing to rise across the province, sending people to ER waiting rooms instead, a new study by the New Brunswick Health Council says.

Only about 56 per cent of New Brunswickers with doctors are able to get appointments within five days, a decline from more than 60 per cent in 2014, the council found as it carried out its primary health survey.

When the results are broken down, they show it's much easier to get quick appointments in some places than others. The percentage who get appointments within five days ranges from a low of 19 per cent to a high of 75.4 per cent, depending on the community.

The council, which monitors the quality of health services and how the system performs, doesn't identify the communities with the worst and best wait times for doctor appointments.

Some have no doctors at all

"We have a situation in New Brunswick where we have a minority of people whose family doctor can see them either same day, next day or within the next few days," said Stéphane Robichaud, the CEO of the council.

"There's a big proportion of people who have to wait much longer."

The long waits may be one of the reasons an estimated 47,000 people across the province who already have family doctors still use hospital emergency rooms as their regular place of care, the council suggests.

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This use of ERs instead of family doctors is happening in a province where thousands of people have no family doctors at all and no choice but to use emergency rooms or walk-in clinics.

Robichaud said one of the key messages from the health survey is that timely access to family doctors needs to be improved.

For its latest survey, the health council talked to more than 14,000 people.

A scheduling issue

While many doctors have effective scheduling practices, and patients get appointments fairly quickly, there's another category of doctor's office, where patients can wait two to three weeks or more for an appointment, Robichaud said.

"If people need to wait more than four or five days, they'll probably go somewhere else and often that somewhere is the emergency room," he said.

"You have one category of doctors whose offices leave a little bit of room for walk-ins and emergencies and there's another category where they tend to mark off the next available spot, and if it's flu season that's a ways away."

Dr. Dharm Singh, president of the New Brunswick Medical Society, found the study concerning to both patients and doctors in New Brunswick, but he wasn't surprised by the results because of changing demographics.

We need to be more aggressive and creative in recruitment in family doctors in this province.- Dr. Dharm Singh, president of the New Brunswick Medical Society

"It tells us and other stakeholders in the province in health care, that a lot more needs to be done in order to improve access to primary care in this province," Singh said.

He said there are multiple reasons why it's difficult to get an appointment, including demography and New Brunswick's aging population.

Demand from older patients has increased the requests for appointments, which causes lengthy delays seeing family doctors.

"As we age we require increased access to health care," Singh said. "We need to see our family doctor more often and for more complex medical problems."

Playing multiple roles

Singh said family doctors in New Brunswick are also playing multiple roles in the health care system.

They have a responsibility to see inpatients admitted to hospitals. They're also asked to care for patients in emergency and palliative care.

While he applauded the province for creating 25 new doctor positions in the province in the coming year, he said there's still a shortage.  

It's important to increase recruitment efforts to fill the new and existing openings and recruit more family doctors, he said.

Almost 10 per cent, or about 73,000 New Brunswickers, don't have family doctors, and 15,000 to 20,000 of these people have said they need one.

"We need to be more aggressive and creative in recruitment in family doctors in this province," he said. "That's one of the reasons why it's easier to get appointments in five days [and] in some areas it is not easy."

The New Brunswick Medical Society, in conjunction with the Department of Health, is trying to improve the health-care system using the Medicine New Brunswick program.

It's a model that requires collaboration and teamwork by family doctors who wish to participate, but it allows more doctors more time for patient care.

"It's a new innovative, collaborative model to practise family medicine in this province," Singh said. "It is good for patients, it is good for doctors, especially young doctors, and it's good for recruitment of the doctors."

The first team began in January in the Oromocto area, and now more than 10,000 New Brunswickers get care under this model, he said.

"The patients in this new model are happy and also the doctors who are practising this new model are also happy," he said.

The model allows patients to be seen on weekends and evenings, and to communicate with doctors electronically to change or cancel appointments.  

"If the family doctor of that patient is away, then that patient can be seen and taken care of by other doctors in that group," he said.

"More and more groups will be announced in coming weeks and coming months."