The sight Thursday of Premier Danielle Smith and two of her ministers struggling to pump up the tires of a corporate scheme to pass off pharmacists as practitioners of family medicine and their drugstores as clinics was as embarrassing as it was disturbing.
No slur on pharmacists, who are an important part of our provincial health care team, but there’s just no way redecorating part of their stores as medical clinics is going to somehow make up for a shortage of family physicians in primary health care, as Smith and Health Minister Adriana LaGrange valiantly tried to imply during a news conference in a Shoppers Drug Mart in Edmonton.
This strongly suggests two things about Alberta’s United Conservative Party (UCP):
1. It remains as committed as ever to the idea of introducing pay-to-play medicine to Canada, even if it has to slip it through the back doors of a drugstore chain.
2. It has finally sunk into the skulls of members of cabinet that given the UCP’s spectacular mishandling of the health care file over the past five years there is no simple way this government can fix the growing crisis in family medicine without a hell of a lot of embarrassing backtracking.
Plenty of Albertans have been reeling from the revelation by Alberta Medical Association (AMA) President Paul Parks three days ago that a survey indicates more than 60 per cent of the province’s family physicians are thinking of retiring, moving or just quitting if the province won’t come up with a way to make their practices financially viable.
If anything remotely like that happens, it will be Albertans who pay the price for former UCP premier Jason Kenney and his former UCP health minister Tyler Shandro’s brilliant scheme to squeeze physicians till their pips squeaked and replace them with tele-docs from Babylon, Vancouver, or wherever.
So when Brampton, ON-based Loblaw Cos. Ltd., the owner of Shoppers Drug Mart Corp., waltzed into someone’s office with a scheme to re-brand drugstores as medical clinics, Smith and her political brain trust obviously saw an opportunity to try to persuade the rest of us that her government is actually doing something about the possibility the province may be about to start hemorrhaging docs.
With Shoppers CEO Jeff Leger in town for the newser – which appeared to have been organized by Invest Alberta, a provincial Crown corporation – Smith, LaGrange, and Jobs, Economy and Trade Minister Matt Jones sang harmony to the pharmacy chain’s announcement it plans to spend $77-million to open “clinics” at 44 drugstore locations in Alberta.
Premier Smith’s claim the planned clinics “will be a step forward for primary health care” was repeated several times by several actors with slight variations.
Invest Alberta put out a news release with a few details and some anodyne quotes, and a strangely fact-free release, presented as a “joint statement,” was posted on the government’s official website featuring a couple of boosterish quotes from LaGrange and Jones, who remembered during the newser to mention Invest Alberta didn’t put any money into the plan.
Of course, there are plenty of things to worry about with such a scheme, as critics were quick to point out.
University of Calgary Professor John Meddings, former dean of the Cumming School of Medicine, listed several concerns in an informative thread on social media.
Pharmacists “do not have the training to develop a differential diagnosis for a presentation and to take active steps to narrow this down,” he said. “They have not been taught how to do a proper physical exam and elicit clinical signs.”
“The risk of course is misdiagnosis,” he noted, giving the example of a child who might have fallen or might have appendicitis. “Children used to die of appendicitis and its complications. We may be returning to that in AB.”
“This is simply ridiculous, incredibly risky and once again a higher cost alternative than fixing the system properly,” Dr. Meddings said in another tweet. “We need team based care. It can/should include pharmacists but not as alternative providers. Family MD’s can and should run these teams.”
He asked: “What is it with our government and its adamant refusal to admit that family docs are deserving of respect? … This pandering to private h/c is going to make things so much worse.”
Another U of C professor pointed out, “there is a risk of moral hazard, in which the pharmacy finds it in its interest to make a particular clinical finding that happens to result in a sale. This is a retrograde step in healthcare and in the management of healthcare resources.”
Alberta pharmacists, who already have a slightly wider scope of practice than in other Canadian provinces and territories, now offer plenty of health care advice to their customers and do sometimes act as a stop-gap family medicine providers when no doctor or even a nurse practitioner is at hand.
Which raises another question: Other than the ability to bill the government directly for a few additional services provided by pharmacists, in what ways will these newly branded corners of Alberta pharmacies actually meet the definition of “clinic”?
Will Shoppers be hiring nurse practitioners or staff physicians to be on site, or is this simply a matter of opening some new stores, adding a couple of consultation rooms, and calling it a clinic to keep the suffering masses quiet when what they really need is a doctor?
My guess is that all we’re going to see here is new furniture and a coat of paint. Don’t expect pharmacists to start practicing family medicine.
The UCP printing up signs that say “Improving access to health care” just isn’t going to do the trick.
But never mind the steady commercialization of public health care and the risk of misdiagnosis, I’m sure the burning question for many of us is, can we now get Optimum points for health care?
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