Dr. Brian Day @DrBrianDay

Private clinic offers quick access to specialists

Apr 02, 2002

The Vancouver Sun

Private clinic offers quick access to specialists
Patients who pay up to $500 can jump waiting lists

Pamela Fayerman
Vancouver Sun

Tuesday, April 02, 2002

A group of specialist doctors is banding together to open a clinic where -- for a fee of $350 to $500 -- patients can bypass their family doctors to see a specialist without waiting the weeks or months it usually takes to get such appointments.

The Specialist Referral Clinic, which begins limited operations this week, is believed to be the first such clinic of its kind in Canada.

Dr. Brian Day -- Dr. Profit, as he was recently labelled on a magazine cover -- is the inspiration behind the clinic and is no stranger to private medicine.

A high-profile orthopedic surgeon, he is one among several doctors who own the Cambie Surgery Centre on Ash Street, a private, soon-to-expand Vancouver hospital that caters mainly to people who have third-party insurance coverage for their operations.

Day said the new clinic will be loosely based on a model operated by the B.C. Workers' Compensation Board where injured WCB claimants can arrange speedy appointments with specialists.

While the Canada Health Act permits WCB claimants to jump waiting lists, it is not clear what position the federal and provincial authorities will take on the latest private clinic incarnation when it comes to other patients referring themselves to the clinic.

"We're just going to be offering the rest of the community the same rights that injured workers have," Day said.

Day said legal opinions he has obtained indicate that there is nothing actionable about what he and his medical colleagues are going to do, even though the Canada Health Act prohibits doctors from billing patients for medically necessary services that would normally be paid by the publicly funded system.

Day, who will spend a week at Yale University as a visiting professor, contends that people who self-refer themselves to specialists are not insured by the public system.
The act does not define what medically necessary means, however, and the whole area of what is and isn't covered by medicare is the subject of much debate as officials seek to cut costs by de-insuring some of the services that doctors provide.

Federal and provincial health ministers could not be reached for comment Monday.

The number of doctors at the The Specialist Referral Clinic, or their exact areas of expertise, has not yet been determined, Day said. There are currently a half-dozen doctors at the clinic, including Day, another orthopedic surgeon, a hand surgeon and a spinal specialist.

But 36 specialists have expressed a preliminary interest and they will come from a range of disciplines, such as orthopedics, neurosurgery, general surgery, vascular surgery, plastic surgery and rheumatology -- all areas in which patients must wait up to several months for a consultation, depending on their doctor's patient load.

Day said in his own practice, patients referred by a family doctor to him must wait more than a year for an appointment. Because he is given only four hours of operating room time per week at the University of B.C. Hospital, he can only operate on a few patients each week in the public system.

At the new clinic, the waiting period for an appointment would be a week or two and if patients require surgery, they could be booked quickly through the private hospital.

Day said most of the patients who book appointments at the clinic will be those not covered by the government-funded Medical Services Plan. Paying clients will include private insurers, but it will not be limited to them alone. He expects a bustling business with law firms seeking expert opinions in legal cases from doctors.

While he concedes the cost of seeing a specialist at the clinic is going to be prohibitive to all but the most well-heeled, he said individuals can claim the visits as a tax-deductible medical expense and the costs are not out of line with what top lawyers charge on an hourly basis.

B.C. residents who head to the United States for consultations can save time by remaining in the province.
Wait lists depend on many variables, especially the popularity and reputation of individual doctors. But the Fraser Institute found that across Canada, waiting times between referral from a family doctor to a specialist grew significantly in 2000/2001.

According to the report, which is based on surveys of doctors, B.C. residents face an average wait of 6.5 weeks from the time a family doctor makes the referral to the time the patient sees the specialist. An even longer waiting period, however, is from specialist to treatment, when the average waiting time is 12.3 weeks, according to the report, entitled Waiting Your Turn.

A brief description of the Specialist Referral Clinic, at 501-1367 West Broadway, can be found on the Internet at: www.specialistclinic.ca