N.B. doctor says new report highlights need for a more integrated approach to health care
1 in 7 ER visits in Canada are for conditions that could be handled by family doctor, report finds
A new report from the Canadian Institute for Health Information about access to primary care and emergency department use underscores the need for a more integrated, data-driven approach to health-care reforms, says a New Brunswick ER doctor.
The report found nearly 15 per cent of visits to the emergency department in Canada in 2023-24 were for conditions that could have been managed by a family doctor or other primary care provider, such as a nurse practitioner or pediatrician.
Even among people with a family doctor, about 13 per cent go to the ER to get basic primary care, according to the Canadian Institute for Health Information, or CIHI.
And more than half of those visits could have been handled virtually, says the report, which was based on data from Prince Edward Island, Nova Scotia, Ontario, Saskatchewan, Alberta and Yukon.
Although no New Brunswick data is included, Dr. Fraser Mackay, an emergency physician in Saint John and chair of the rural, remote and small urban section of the Canadian Association of Emergency Physicians (CAEP), said the findings align with what he sees on a daily basis.
He believes the proportion of ER visits for conditions that could be handled elsewhere, such as ear infections and prescription refills, is closer to 25 per cent in New Brunswick, he said, citing the report's the findings for rural and remote communities and noting the rural nature of the province.
Any problems in health-care access are "magnified" in rural communities, said Mackay. There are fewer doctors in rural areas, so fewer citizens have access to primary care, he said. Emergency departments often end up being "the clearinghouse for all-comers," which is "not best patient care."
'Slow-burning disaster'
He described ERs as "a slow burning disaster." The most challenging part, he said, is dealing with patients who apologize for resorting to the emergency department out of frustration.
But patients who don't have a family doctor and seek treatment for minor ailments aren't the ones driving ER overcrowding and long wait times, Mackay said.
The bigger problem, he said, is ER patients who have been admitted but can't be moved to a hospital unit because too many beds are occupied by seniors and other patients waiting for a nursing home bed or other long-term care placement.
"That fundamentally isn't actually an emergency medicine problem," said Mackay. "It's a health-care problem, and that is a government policy, big-scale problem."
He said what's needed is an integrated approach to planning and management that recognizes the overlap between primary care, emergency care, inpatient care and long-term care.
As it stands, Mackay said there is "a series of different departments and programs, but there is no overarching system" in health care.
He also called for more accountability for how health-care dollars are spent, including patient outcomes.
Not all doom and gloom
However, Mackay acknowledged there are "a lot of positive changes" underway in New Brunswick.
He cited Premier Susan Holt's pledge to open "at least" 30 collaborative health-care clinics, including 10 in 2025. These clinics, which will bring together doctors, nurses, nurse practitioners, psychologists, physiotherapists, pharmacists and others to provide a "health-care home" for patients, have been shown to increase access, satisfaction and overall quality of care, said Mackay.
Virtual care models are "another piece of the puzzle," he said.
Medical schools have also increased enrolment for students as well as residents.
"I think there's a lot of things [that] are moving in the right direction," said Mackay, adding that "it's going to be slow and it's going to be hard for a while."
'Big' changes a decade away
He estimates "big" changes are about 10 years away — the time it will take to train more doctors and nurses.
There are, however, opportunities to increase efficiencies in the shorter term, according to Mackay.
He said he's hopeful the new Holt government will engage with the various areas of health care through organizations, such as CAEP, the College of Family Physicians and the New Brunswick Medical Society, he said.
Data collection, analysis and dissemination is a "key building block," said MacKay, pointing to population projections and human resources planning as an example. But New Brunswick has been "subpar" in that regard to date, he said.
"That's why things like the CIHI report are so critical."
Province committed to improving access
The Department of Health did not respond directly to any of Mackay's comments. But spokesperson David Kelly said the government is committed to increasing the percentage of New Brunswickers with access to a primary care provider, which will ease pressure on our hospital emergency departments.
"Collaborative care teams are a key part of the solution," he said in an emailed statement. "To make that happen, recruitment and retention of health-care professionals, will be a top priority."
The government is working to deliver retention payments to permanent full-time and part-time nurses, and is "committed to creating a multi-pronged plan to improve the working conditions of health-care workers and prioritize their wellness," said Kelly.
It has also implemented short-term solutions such as NB Health Link, he said.
People talk about … the impending health-care system collapse. We're right in the middle of it.- Fraser Mackay, Saint John ER doctor
That program, which provides New Brunswickers with access to a network of family doctors and nurse practitioners while they wait to be matched with a permanent provider, has more than 64,000 people eligible to receive services, said Kelly. An additional 38,000 people are waiting for more clinics to open or for existing clinics to expand, he said.
More than 12,500 patients have been placed permanently with a primary care provider through NB Health Link.
New Brunswickers can also use eVisitNB or Tele-Care 811, he said.
Mackay said it will take "political courage because it's a very big, daunting task" to improve the system.
But the situation is "urgent," he said, noting health-care professionals have been warning about the health-care crisis for about 15 years.
"People talk about … the impending health-care system collapse. We're right in the middle of it."
With files from Shift