Given how complicated and advanced health care has gotten, I think the best solution is the integrated care office. GP's just can't know or do it all. Having in office resources to pass patients to, even before an appointment, can free up their time. I'm in one of these and as a patient, it is so much better. They have a "forms department" who handle the paperwork, so doctors have reduced time spent on it. All the office management is handled, so they concentrate on patients.
I just don't think the one or two Dr's running a practice on their own is all that achievable these days given the levels of complexity in care, nor is it going to lead to the best outcomes.
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And the difference is even more stark for family physicians. 6-7 years ago, BC and Alberta had identical family doctor per 100K numbers (129 and 130 respectively); now BC has 19% more than Alberta (138 and 116 respectively).
Two things that make the comparisons murky are virtual visits in BC being covered and BC having an older and therefore higher need population.
Anecdotally, a lot of my patients are frustrated because they only get phone calls from their GP and many of the GPs work 2-3 days in clinic and 2-3 days from home, and many are just part time. The number of GPs is difficult to draw conclusions from when many in this province (I don't know how many), are very part time.
My favorite example of the law of unintended consequences is building a turn key clinic for physicians. The catch is you can't bring existing patients, so local physicians fire all their patients and move in. There's an interesting story on the same issue we're discussing now, but from almost 9 years ago:
Nurse Practitioners will also play a role and they don't show up in doctors per 100K numbers. I have a good friend who is one in BC and 5 years ago he had to move across the province to get a job, but now they're everywhere and they're creating more positions every month.
They're not necessarily significantly cheaper than GPs, but they're definitely easier to train. Any practising nurse with 3 years experience can do 2 more years of school to become one. And they can cover a lot of the walk-in clinic type roles.
Nurse practitioners can 100% handle at least half of the patients that GPs see.
They are also allowing pharmacists to give out more basic prescriptions.
Given how complicated and advanced health care has gotten, I think the best solution is the integrated care office. GP's just can't know or do it all. Having in office resources to pass patients to, even before an appointment, can free up their time. I'm in one of these and as a patient, it is so much better. They have a "forms department" who handle the paperwork, so doctors have reduced time spent on it. All the office management is handled, so they concentrate on patients.
I just don't think the one or two Dr's running a practice on their own is all that achievable these days given the levels of complexity in care, nor is it going to lead to the best outcomes.
A lot of older doctors who have had practices for years have also grown tired of the government bureaucracy and are retiring early. Both my and my gf’s GP pulled the pin in the last year.
Hard enough to find doctors to begin with without scaring or frustrating them out of the pool.
Some more clarity, I guess "no widespread safe supply diversions" and a "minority of drug seizures" meant 49.99%.
The testimony in front of the House of Commons Committee seems to be consistent with the original BC RCMP public statements and seems to fly in the face of the what the BC Minister of Public Safety claimed. From the news report, the government seemed to be "caught off guard" by the testimony.
While addressing a House of Commons committee Monday, Deputy Chief Fiona Wilson claimed about 50 per cent of hydromorphone seizures were diverted from safe supply drugs.
“That’s just in recognition of the fact that someone who’s on a bonafide safe supply program has a more regular significant supply,” said Wilson, who was speaking in her role as the president of the B.C. Association of Chiefs of Police.
Premier David Eby was asked about these comments Tuesday, and said that this was the first time his government had heard these numbers from the VPD.
B.C. investigates 'significant' prescribed drug diversion, including international trafficking
A recent B.C. Ministry of Health document says a "significant portion" of prescribed opioids is being diverted and that prescribed alternatives are being trafficked provincially, nationally and internationally.
Sturko says the province has gone out of its way to minimize the issue of safe supply diversion, and she says prescribed alternatives and opioids should not be handed out without their consumption being witnessed by a health professional.
It says some pharmacies are alleged to be "offering incentives to clients," with more than 60 pharmacies identified, and that some "community housing staff" require tenants to go to certain pharmacies for their prescriptions.
Other participants in the alleged schemes, according to the document, include doctors, assisted living residences, and organized criminals.
The document has emerged as Canada faces the threat of a trade war with the United States, which demands efforts be made to stop fentanyl from crossing the border.
These pharmacies have been a problem for a while that no one seems interested in addressing. The BCPhA has been aggressive in asking for these Pharmacies to be held to account, but neither the College nor Ministry have been willing to look like they're reducing access to medicine for people at risk of overdose.
Essentially, what's happening in these cases that they're talking about is pharmacies profiting off of vulnerable people. It's definitely not completely black and white, but there's some clearly illegal stuff, some clearly legal but unethical stuff, and some good work all mixed together.
Here's the background: the most effective treatment for people with Opioid Use Disorder is replacement opioids to prevent morbidity (overdose, law breaking behaviours, etc). Abstinence breeds more overdoses, not less. To that effect, pretty much every health jurisdiction offers methadone, Suboxone, programs etc.
The way these programs work is a patient receives a prescription with a defined date period with a certain number of witnessed doses per week. Patients will go to their pharmacy of choice and receive a dose of methadone, Suboxone, or long release morphine and will ingest it in front of the pharmacist and that's documented. If they've gained the trust of the prescribing physician through not missing doses, not testing positive for substances, etc, then they'll be given "carries" to take home. So when they witness one dose they could be given one or more further doses to go home with and take at home. These programs are wildly successful and this is NOT safe supply.
Safe supply is a relatively new program where patients at higher risk that are inadequately controlled on the above programs are given medication to control additional cravings. Remember that the above programs never dealt with people using the crazy amounts of opiates that fentanyl has now created. Because it's hundreds of times more potent people get stuck on insane doses. This was meant to give them something to use that wasn't street drugs that are often tainted or of unknown potency.
In most areas of the province many pharmacies offer Opiate Agonist Therapy (OAT) and they are not a big money maker. The program is offered because most Pharmacists want to help make a difference. If you do it in bulk, it can be a business you could make money in, but again, that's rare. The Lower East Side/Hastings in Vancouver is one place where there's a bunch of Pharmacies that do almost zero other business. It's cutthroat.
What's really fueled this issue is delivery. During the pandemic, the government loosened the rules on OAT delivery. Previously, delivery was only to be an exception, not routine. You had to document the reason each time and the physician had to order it on the prescription. Only a pharmacist could deliver and witness it and that's crazy expensive at $50-60 an hour. It rarely happened. The pandemic essentially required delivery because people would get mild colds and not be allowed into a pharmacy. Add the crazy rise in overdose deaths and the government desperately wanted to increase access to OAT. So the new rules were just any regulated health professional could witness and delivery was at the discretion of the pharmacy/patient. Suddenly you have new pharmacies popping up making most of their money by hiring an LPN to go deliver OAT. Now, you're still not going to make much money on a $10 dispensing fee and pay someone $30/hour to deliver it. But what if they were also on daily safe supply? That's now $20 a day per patient. And because these patients often suffer from mental illness, they may be on antipsychotics, or antidepressants, antianxiety meds, etc. Suddenly it becomes a gold mine.
Now for some patients, this is lifesaving. Having to go to a pharmacy every day and witness their opiates is not only difficult logistically, is also humiliating for some. But there's obviously a Pandora's Box and grey area where promoting this becomes unethical. Where it becomes outright illegal is where these pharmacies are giving cash to these patients with incentives to increase the number of meds. Then there's pharmacies doing that plus not using any health professionals to witness or even giving it the meds at all.
The college could investigate and take away their pharmacy licenses and sanction the pharmacists signing off on this. The ministry could remove their ability to bill pharmacare which would essentially shut them down. Yet here we are...
Last edited by Street Pharmacist; 02-08-2025 at 12:04 PM.
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I know when I graduated university back in the 90s all of the people that moved to BC for work eventually moved back to AB due to cost of living. I think only one or two stayed in BC.
That’s why they moved back. No way to afford a house. Since the AB has been catching up on that front.
Lol yep, over $2 million for a house from the early to mid-1900s that backs onto a cemetery. If anything signals a housing market correction in Canada, it’s this.
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Lol yep, over $2 million for a house from the early to mid-1900s that backs onto a cemetery. If anything signals a housing market correction in Canada, it’s this.
My brother died from Meth. Its an awful drug. The stuff he would do and his mind state was like an animal morso the college grad he was.
Honestly we were caught in a bind at the end from allowing him to keep using vs. drawing a line in my parents house. We drew the line. It just wasn’t safe. Was it the right call? Eff who knows, my super bright brother became something else despite lots of treatment.
I tell you that because nurses, especially after COVID should not have to deal with a person like that. We need to respect a person doing a job more than a moron who made a choice to do a drug like meth.
I am disappointed when these Liberal theory people infect government and apply book science without any personal experience.
Live with a sibling on hard drugs for a year and come back and tell me front line staff should deal with them. Honestly lets see if any do.
Quote:
Originally Posted by squiggs96
I texted my brother and told him he was going to need to start doing meth and that I would have to live with him. He was taken aback, but when I told him it was to see if front line staff should have to deal with him after I've lived with him for a year, he was in. I will report back to you on April 16, 2025.
Well, it's been a year of my brother doing meth and me living with him. I still think the front line staff should deal with him, because I am ill equipped to deal with him, and frankly, I am a terrible influence on him.
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He just seemed like a very nice person. I loved Squiggy.
Housing costs are really the only major difference, besides the PST on some larger purchases.
Gas is more expensive. Plus Alberta now has guaranteed cheap daycare at $325/month. BC has some $10/day but it's very hard to get into and probably only about 10% of spots are that cheap, with the rest Vancouver being $1100-1300/month.
Calgary also has higher wages than Vancouver. That's a big kicker in Vancouver. Same prices as Toronto, with about 70% of the pay.
Gas is more expensive. Plus Alberta now has guaranteed cheap daycare at $325/month. BC has some $10/day but it's very hard to get into and probably only about 10% of spots are that cheap, with the rest Vancouver being $1100-1300/month.
Calgary also has higher wages than Vancouver. That's a big kicker in Vancouver. Same prices as Toronto, with about 70% of the pay.
Well no wonder they're lagging behind in life satisfaction!!
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My brother died from Meth. Its an awful drug. The stuff he would do and his mind state was like an animal morso the college grad he was.
Honestly we were caught in a bind at the end from allowing him to keep using vs. drawing a line in my parents house. We drew the line. It just wasn’t safe. Was it the right call? Eff who knows, my super bright brother became something else despite lots of treatment.
I tell you that because nurses, especially after COVID should not have to deal with a person like that. We need to respect a person doing a job more than a moron who made a choice to do a drug like meth.
I am disappointed when these Liberal theory people infect government and apply book science without any personal experience.
Live with a sibling on hard drugs for a year and come back and tell me front line staff should deal with them. Honestly lets see if any do.
Wow, that is a horrific way to feel about a brother who passed away from addiction. I can't even comprehend how someone could type that. I hope others in his life felt better and supported him more than you. Those are ugly feelings even towards a stranger let alone a brother.
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Well, it's been a year of my brother doing meth and me living with him. I still think the front line staff should deal with him, because I am ill equipped to deal with him, and frankly, I am a terrible influence on him.
PM me if you need some help in this department.
EDIT: That goes for anyone else on the site, too. If you need some advice or assistance navigating this stuff, I'm available for a chat.
Last edited by rubecube; 04-26-2025 at 05:29 PM.
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