Opinion: Diluting health care in Alberta with pharmacy clinics

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By Edward Les

In my youth, I was an avid football fan at a time when future Hall of Fame quarterbacks Warren Moon and Joe Montana were shredding defences with ease. I don’t follow the sport much anymore but I know that good QBs are key to gridiron success, which is why teams invest so much in that position.

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None of which is to say that other positions aren’t important: without receivers and running backs, linebackers and defensive tackles, a team wouldn’t get very far. But how the action unfolds — and whether points get scored — comes down to the calls made by the QB.

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My trip down football memory lane was triggered last week by the fanfare surrounding Shoppers Drug Mart’s announcement of a $77-million investment in expanding “pharmacy care clinics” in Alberta — endorsed by Premier Danielle Smith and Health Minister Adriana LaGrange.

Health care is in crisis in Alberta, not least because of a critical shortage of family doctors. It’s a crisis, to be clear, that is playing out right across Canada, no matter the government in charge. None has managed to craft effective solutions. And there are not likely to be effective solutions until Canadians realize that a system that keeps everyone equally miserable needs to be blown up and rebuilt.

In the meantime, the provinces have mostly busied themselves applying useless Band-Aids to a system in need of radical surgery.

In Alberta, former premier Jason Kenney declared war on doctors by painting them as greedy fat cats responsible for health care’s shortcomings, before tearing up the doctors’ contract with government. His successor followed up by dismantling Alberta Health Services: one organization will be sliced into four, each with its own board of directors — the solution to bureaucracy, it seems, is more bureaucracy.

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But nuttier by far is the move to enable ancillary health personnel such as nurse practitioners and pharmacists to function independently as de facto family doctors.

One would think, in the face of insufficient family doctors, and considering the fact the ones we do have are overworked, underpaid, buried by administrative work and staggering under burgeoning overhead costs, that we would train more doctors and labour mightily to make their working conditions conducive to them being able to remain in practice.

Because family physicians are, without question, the quarterbacks of the health-care system; and attempting to deliver quality care to patients without them at the helm is a prescription for failure.

This is not to say the other talented players — nurses, nurse practitioners, respiratory technologists, dietitians, physiotherapists, social workers, and pharmacists — aren’t critical to the delivery of top-quality patient care. Of course, they are. But they’re not family doctors — and thrusting them into that role makes about as much sense as it does to ask receivers to function as quarterbacks.

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Expanding “pharmacy care clinics” as a gambit to “improve access to care” — rather than properly focusing on fixing family medicine — is destined to fail. But the consequences will be more dire than losing a football game: patients’ lives and well-being are at stake.

And when the inevitable happens; when patients are misdiagnosed or underdiagnosed; when they’re injured by side-effects from drugs they don’t need (drugs prescribed by pharmacists from their own supplies — conflict of interest?); when that happens, then all the PC Optimum points in the world won’t make amends.

Our family doctors aren’t asking for football-star pay. They’re simply looking for practice viability. They’re looking to be able to deliver the complex care they’ve been trained to deliver — and to deliver it by working closely with all members of the health team.

As it stands, 61 per cent of the province’s family physicians are seriously considering leaving, either by early retirement or by moving to another province or country to set up practice.

And the way things are going, who can blame them?

J. Edward Les is an emergency physician at the Alberta Children’s Hospital.

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