Family doctors in N.B. slow to embrace practising as part of a team

Implementing the province's new health plan will come with an overhaul of how we think of family doctors, according to the health council.

The number of people on the primary-care-provider wait list has grown from 40,000 to 63,000, all the while more doctors are retiring and more people are moving to New Brunswick.

Stéphane Robichaud, CEO of the New Brunswick Health Council, said for the province's health plan to work, the medical community and the public need to move past the idea that primary care means a medical doctor with a solo practice.

"New Brunswick has one of the highest [proportion] of family doctor practices that practise as solo," he said. "That needs to change."

Health Minister Dorothy Shephard introduced the health plan last November, promising that by the second quarter of this fiscal year, the wait list for doctors would be eliminated, replaced by a New Brunswick primary care network.

According to a 2021 New Brunswick Health Council report on access to primary care, the province has one of the highest percentages of citizens who have a primary care provider in Canada. But people who have a family doctor or nurse practitioner were still ending up in the emergency room for care, the report said.

Ninety-one per cent of New Brunswickers said they had a primary-care provider, but only 57 per cent of them went to their family doctor most often when they needed care in 2020, the report said.

The report and Robichaud both said the core of this issue is solo practice. Robichaud said solo practitioners end up filling in at the hospital, the clinic or a long-term care facility, meaning they're less available for their patients

The idea the province is proposing is a shift from "going to the doctor's office," to going to the health-care centre where you can be seen by a physician, a nurse practitioners, a nurse, a dietitians or social worker, depending on your needs.

"We need to move to switch the language. So it's not as much about a family doctor, as having a primary care centre," he said. 

"That's going to help with those patients that have those higher needs," he said.

Robichaud said during development of the plan, he did encounter some resistance from some family doctors. 

"There isn't a unanimous position among physicians on accepting that those changes need to occur," he said, "Part of the challenge of this is also putting changes in place when people are used to working a certain way."

New Brunswick Medical Society president Dr. Mark MacMillan said his organization supports this shift.

"Collaborative practice can better serve both health-care providers and our patients," he said in a statement.

He said it's not a new approach. There are nine clinics under the umbrella of Family Medicine New Brunswick that  already employ this idea.

The team doesn't have to share a physical space, MacMillan said. They can share patient records electronically and take on different aspects of the patients' health needs.

"Given the success of [family medicine], we agree that a more widespread adoption of this type of practice would be beneficial."