Dr. Renée Hall, medical co-director of the Willow Clinic, in Vancouver on May 5.JENNIFER GAUTHIER/The Globe and Mail
Weeks after B.C. made prescription birth control publicly funded, women are flooding health care clinics requesting IUDs, leading to waiting times of several months because of a shortage of clinicians available to insert them.
The province became the first to cover the cost of most forms of prescription birth control as of April 1, a move that was hailed as an important step in providing equitable access to contraception. But B.C’s heath care system is being overwhelmed by the rush to take advantage of the new policy.
In the case of intrauterine devices, women used to have to pay an upfront fee of up to $400, but now it costs them nothing, prompting the high demand.
Boris Henriquez, a family physician who performs IUD insertions at several Vancouver clinics, said waiting times before the universal coverage took effect could stretch up to three months in some places, but now they are getting worse.
“It’s concerning,” he said. “An IUD in a box is useless.”
Dr. Hall says the province needs to take action to address the problem of long and growing waiting lists for IUD insertions.JENNIFER GAUTHIER/The Globe and Mail
Renée Hall, medical co-director of the Willow Clinic, which provides birth control, abortions and other reproductive health services, said that on April 3, the Monday after B.C.’s new universal birth-control policy took effect, the clinic received 350 calls from people looking to make an IUD insertion appointment, a huge increase from the usual patient volume.
A year ago, the typical wait for an IUD appointment ranged from one to two weeks at Willow. Now, the next available appointment is in July, she said.
The waiting time for an abortion at the clinic, by comparison, is about two weeks. It’s medically irresponsible and unethical to extend abortion waiting times in order to meet the growing demand for IUD insertions, Dr. Hall said. Clinics like Willow are already so busy and can only offer a certain number of appointments for their services each day. That’s why she and others say the province needs to take action to address this growing problem.
“We just have to have the ability to provide people with the option they like,” she said.
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Intrauterine devices are among the most effective forms of birth control and the Society of Obstetricians and Gynaecologists of Canada and the Canadian Paediatric Society say they should be the first option offered. Once inserted into the uterus, IUDs can safely remain there for years, making them a much more reliable method than birth control pills or patches.
In B.C., the challenge for patients is to find a clinician who can insert them.
One reason for the shortage is how doctors are compensated for insertions. Physicians at clinics like Willow work on a fee-for-service basis and can only bill the province $40 for an IUD insertion, said Dr. Hall, who works at clinics offering reproductive services throughout B.C’s Lower Mainland. She also trains clinicians on IUD insertions.
She said the compensation is far too low for a procedure that can be difficult and time-consuming. Dr. Hall noted she can charge the province $60 for excising a mole, a procedure that is typically easier and faster to perform.
“The way that they value certain procedures doesn’t make a ton of sense,” she said. “Women’s health is definitely something that’s on the bottom of the list.”
While compensation for IUD insertions is higher for family physicians working under B.C.’s new payment model, the training requirements and need for specialty equipment, including in-office sterilization machines, mean many aren’t offering the service. Add to that pandemic-related shortages of health care workers and it creates a situation that is forcing women to scramble to get an IUD appointment, Dr. Hall said.
Some primary-care providers refer people to gynecologists for IUD insertions, where the wait can be as long as eight months, she said.
A copper (left) and two hormonal IUDs. After B.C.’s new universal birth-control policy took effect, the Willow Clinic, which provides birth control and other reproductive health services, saw a huge increase from the usual patient volume.JENNIFER GAUTHIER/The Globe and Mail
Joshua Greggain, president of Doctors of BC, said the association is in the midst of talks with the province over how to better compensate IUD insertions. He said the issue also speaks to the much broader problem of lack of access to primary-care providers.
The province’s recent move to modernize and improve payments to family physicians is expected to help attract more people to the profession, Dr. Greggain said. But so far those incentives aren’t leading to a big uptick in doctors choosing to offer IUD insertions, he said.
Dr. Henriquez said the problem won’t be solved simply by increasing the amount of money physicians earn for IUD insertions. There also needs to be more accessibility for training, as well as support for doctors who decide to provide the service. For instance, a family doctor who runs into a problem during a challenging insertion needs a place to turn for help, he said.
In an e-mail statement, B.C. Ministry of Health spokesperson Hope Latham said the government is aware of the issues involving IUDs and is in “active discussions” with Doctors of BC and BC Family Doctors to find a solution.
The delays have also led to a handful of unintended pregnancies, Dr. Hall said, because people are being forced to rely on less effective, non-prescription contraceptive methods while they wait for their IUD insertion appointment.
“They arrive with the IUD in hand and pregnant,” she said, adding that she’s seen several patients in recent weeks who have tested positive on the routine pregnancy test they give everyone before their IUD appointment. “They’re shocked.”