Alan Ruddiman, B.C.’s top doc, on why the province needs more GPs

The president of Doctors of BC on foreign-trained physicians, overhauling MSP and the future of health-care delivery

Credit: Lionel Trudel

The president of Doctors of BC on foreign-trained physicians, overhauling MSP and the future of health-care delivery

Born in Dundee, Scotland, and raised and educated in South Africa, Alan Ruddiman moved to Canada in 1991—practising rural medicine on the Prairies for five years before settling in bucolic Oliver, where he continues a general practice to this day. Ruddiman was elected president of the rebranded Doctors of BC (formerly the B.C. Medical Association) in June 2015, after having held positions within the organization for 20 years. His opponent, Dr. Brian Day, promoted a hybrid of private-public health care options while Ruddiman ran on a platform of reducing bureaucracy and overcrowding in hospitals. The contrast between the two doctors drew a turnout of 50 per cent of the 11,000-strong membership in the runoff election, with Ruddiman prevailing by 603 votes.

The 52-year-old GP faces a host of challenges in his new job, which began June 4— including the need for primary-care reform, a doctor shortage and an aging population (Ruddiman’s own patients average 76 years of age, he says). But Ruddiman insists that with consistent management practices, and by learning success stories from other jurisdictions, there are brighter days ahead.

Why did you choose to get involved in the political side of medicine?
It traces right back to my early days of residency in rural Manitoba. I saw that doctors’ voices were not resonating with government, and important issues were going unheard. I saw a need for a bridging voice, a connective tissue to bring government, citizens and doctors together.

For those who might be confused, what’s the difference between Doctors of BC and the College of Physicians and Surgeons of B.C.?
Doctors of BC is a medical association whereas the College of Physicians and Surgeons of B.C. is the regulatory body that oversees licences, practices and discipline. Our mission is to work for a social, economic and political climate that creates the conditions allowing members to provide a high level of care to their patients. Our membership is voluntary—about $2,000 per year for a general physician—and we provide a wide range of services, including negotiating the Physician Master Agreement with the provincial government, as well as leveraged physician insurance and even discounted hotel rates for our membership. We have also arranged targeted funds for rural physicians, specialists and initiatives.

Why is it still so hard to find a GP in this province?
There are a number of factors. Certainly much blame can be attached to the infamous 1991 Barer-Stoddart Report that said we were graduating too many doctors for the Canadian market. The message to universities and government was: cut back. Unfortunately we’re still paying the price, but we are now turning out more general physicians than ever before. Canada has never been self-sufficient in doctors; we rely very heavily on supplementing our workforce with internationally trained physicians, and now properly credentialed doctors from the U.S., the U.K, Ireland and Australia are accepted at par.

Premier Christy Clark said recently that the Medical Services Plan needs an overhaul. What is your position?
How we derive revenue to support our health-care system is best left to cabinet. We must bear in mind that federal-provincial transfer payments for health care have shifted from 50:50 to 25:75. We also, as Canadians, need to ask ourselves what scope of health care we want and to recognize that when the Medicare system developed 60 years ago was first initiated, the average age of recipients was 32. It is now 52.

A study published by UBC’s Centre for Health Services and Policy Research recently took to task the supposed failure of B.C.’s incentive-based fee system to improve primary care. You disagreed.
We think that the study was deeply flawed: it only used two years of data for a program that has been in place for nine years. Further, it missed a significant number of programs. We believe that it’s too early to tell final outcomes, but we remain positive that we’re on the right track—one example being that this regime has seen 160,000 patients linked to primary-care providers.

What is the chief challenge that you and Doctors of BC currently face?
We need more doctors, especially general physicians and doctors in rural communities. Twenty-five per cent of our provincial population lives in rural communities, but only about 14 per cent of our doctors do. We are working hard to cure this inequity, but it’s a perfect storm: the average age of GPs is 54, and specialists 52. And when we recently polled our membership, fully 25 per cent said that they plan to retire within five to seven years.

Where do you see things going in terms of health-care delivery?
I think that, in the future, we will see team-based health care —multidisciplinary practices where a doctor, nurse, nurse practitioner, clinical pharmacist, social worker and physiotherapist might all work together to provide patient primary care. A team-based approach means more capacity and more time for doctors to provide the highest quality of health care. As a province, we simply must address growing patient wait times, improve access at all levels, and enhance patient and public safety. A strong health-care system remains a foundation of our society, and I remain optimistic that the health-care partners will do the right thing to get us back on track.

  Percentage of internationally trained physicians (2015)

  Canada 25.6%
  Quebec 9.9%
  Saskatchewan 52.5%
  B.C. 29.5%

  Number of physicians per 100,000 population

  2011: 210
  2015: 228

  Nova Scotia
  2011: 241
  2015: 261

  2011: 179
  2015: 196

  2011: 216
  2015: 232

  Source: Canadian Institute for Health Information, 2016