Proposing a New Model of Healthcare in British Columbia

Physiotherapist and co-owner of Envision Physiotherapy, Brent Stevenson discusses the current challenges with the Canadian healthcare system and how allied healthcare professionals should be part of the solution.

Brent Stevenson

As a physiotherapist and the co-owner of two multidisciplinary healthcare clinics in Vancouver Canada, I am getting very frustrated reading the endless cycle of news talking about how our healthcare system is broken followed by discussions focussed primarily on money.  More money is usually helpful, but it also has the tendency to create short term fixes for long term problems.  I treat a lot of medical professionals and hospital administrators in the Vancouver area and am witnessing their physical and mental burn out due to them being caught in a triage loop of too many patients and not enough staff.  I also help a lot of clients that do not have family doctors (GPs) and are lost in a system that is built around GPs being the gaiting mechanism for testing, referrals and insurance company paperwork.  The purpose of this article is to highlight how the problem is all of ours to fix and not just offer more finger pointing at the government’s inadequacies.  The public needs to take more responsibility for their own health, the government needs to open the scope of what is covered by the public system, and be willing to work together with an established privatized system to share the burden of the current healthcare crisis.

The crushing immediate need for healthcare services is actively detracting from the development of a new thoughtful, proactive, and preventative approach to health in Canada.  I believe that we need to try and bolster the current medical system with more money and more resources to try and help it survive through the triage nightmare that it is caught in, while at the same time start developing a parallel healthcare system that more appropriately addresses the needs of the younger generations.  As the child of baby boomers, as long as I can remember, there has been a dialogue about how our parents’ cohort was going to break our medical system when they all retire and age into their eighties, but as far as I can tell, no one has really been able to prepare for the inevitable.  

From my perspective the root of the problem stems from the baby boomer’s mantra of “doctor knows best,” an approach to health that delegates one’s own wellbeing to a third party in a white coat.  They grew up in a simpler time with well intentioned family doctors, different social norms and the marketed belief that pills and medications were the solutions to most health-based problems; their health was heavily manipulated by the tobacco and pharmaceutical industries, not to mention the “war on drugs.”  Today they are the parents of our working class and the grandparents of the next generation that are being manipulated by misinformation and are having a hard time figuring out who to trust.  Large, bureaucratic entities like governments and corporations are progressively losing the faith of individuals and unfortunately both health and education are caught in the conundrum of a rapidly changing world.

I hear politicians and health professionals saying that we need to invest more money into mental health, but I question where is that money currently going, and what is the best long-term use of it.  I believe that the root of a lot of people’s physical and mental health issues stem from our society’s ignorance of how our bodies actually work, our inabilities to understand our emotional needs, and the subsequent passing down of intergenerational stresses and anxieties.  We are emotional beings that need to understand the messages of our bodies as we grow up, to help us not be scared of them, and allow us to effectively look after our own needs.  Unfortunately, we have not done a very good job of supporting young families or schools to teach this information and the result has been an ever growing population of anxious, stressed-out people that overly depend on pills and the doctors that dispense them.    

Health should start at home and at school, not in a doctor’s office, which is why I believe that a major facet of fixing our broken system is not just finding more doctors, but teaching people that they don’t need doctors as much as they think they do.  Don’t get me wrong, we have a current crisis that demands doctors and nurses, but we also have a huge number of people that are seeking out doctors that would be much better served by visiting a physiotherapist, counsellor, and/or dietitian instead of walking into an emergency room.  We have a wealth of highly trained allied health professionals, who’s services are not covered by our provincial health plans and are much better trained to help many of our population’s needs than our medical counterparts.  A comprehensive solution should involve early childhood education, the diversion of funding and people to the allied health system, credentialing foreign trained physicians and nurses, and creating a team-based environment for family doctors to work in.  

Young families and school teachers need the resources to help middle school children understand how their emotions affect their physical bodies, develop knowledge of basic injury and healing, learn about healthy food choices and who is available to help them beyond their parents.  We need to promote health through a variety of channels and remove the bottleneck that is created by the current system’s role of GPs and better inform the public’s expectations of their doctors.  Physiotherapists have much more extensive education and experience in assessing and treating physical dysfunctions, pains, and injuries compared to family physicians, but most people will visit their GP first because it is covered by their provincial health plans and visits to their physiotherapists are not.  The doctor’s approach usually involves writing a prescription, ordering a test, and hopefully making a referral to someone like a physiotherapist, which can be a helpful process, but can also be entirely unnecessary, quite expensive for our medical system, and very stressful for the patients.

I believe that a huge number of patients looking for help from their family doctors can be effectively diverted to physiotherapists, clinical counsellors and registered dietitians as part of primary care, especially if they are working in a team-based setting with a physician.  Funding and incentivising community based multidisciplinary clinics would provide a better patient experience, a better working environment for our doctors, and most likely a more cost-efficient model for our provincial governments.  We currently have university trained health professionals that have been pushed into a privatized health system that we should be looking to blend back in to create a hybrid system that parallels the current medical system.

As a clinic owner of two multidisciplinary private health clinics, I am not interested in moving my business into a government regulated funding model, but I believe the provinces could act as a large insurance company and provide various levels of extended benefit coverage to select groups like new mothers, seniors and marginalized, low-income individuals that are currently very demanding on our overwhelmed medical system.  The allied health system is already operational with regulated health professionals ready to help and billing systems in place that could simply add another insurer to direct bill.  The provinces could determine who qualifies for extended benefits, and clinics like mine could bill the medical services plan directly through our clinic management software.  Increased coverage for physiotherapy, counselling and dietitians should translate into far less inappropriate emergency room visits, less strain on family doctors and a better supported population that is struggling with mental health concerns.

British Columbia will likely attract far more medical students into family practice if they move away from the current fee for service model and instead offer a higher flat fee salary to physicians that work in multidisciplinary settings.  Private clinics like Envision Physiotherapy would happily incorporate GPs into our space and our team for the benefit of everyone; the doctors wouldn’t have to run a business, would have lower overhead and shared administrative support while the allied health team would become more efficient at helping their clients navigate the medical system.  Having publicly and privately funded services in the same space would allow flexibility for entrepreneurial people looking to improve services, patient care and business models while allowing people of different socioeconomic backgrounds to utilize the same facilities.  

I appreciate that our health ministers have a very challenging job to try and fund a system that looks after all of us, which is why I believe that individuals need to take the initiative to learn about their own health, how the current system works, and what services are available beyond the public model. My writing is an attempt to educate the general public on health related matters and advocate for a more efficient way of doing things.

I am currently working on my second book titled Why We Hurt: Understanding How to Be Comfortable in Your Own Body, to act as a resource for people to learn how life and health interact.  I discuss how stress and anxiety can and do manifest themselves physically in the body, and how a person’s story tends to impact the care that they receive from others.  I paint a picture of what our health and education systems could be while providing guidance of how to exist in the imperfect world that we live in.  I provide some context on mental health as it relates to “small T traumas” in our day-to-day lives and tell stories of my clients’ successes and failures on their own health journeys.  My goal is to continue to build educational resources for teachers and parents to help young families develop a better and more mindful relationship with their own bodies and minds. 

Learn More About BrentClick Here 

Brent’s first BookClick Here  

Brent’s IMS Online Mentorship Course- Click Here

Brent's Recent Articles:

The Myth of Normal: My Take Aways from Gabor Mate's New Book

How to Change Your Mind: Books, Physio & Psychedelics

What Happened to You: A Discussion on Trauma

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