The B.C. government will spend $3.46 million to keep five south Island walk-in clinics open, but the money won’t save three others set to close this month.
The short-term stabilization funding announced by Health Minister Adrian Dix on Friday will go to hire more doctors, nurses and other health-care workers to support walk-in services at Esquimalt Medical Clinic, West Coast Family Medical Clinic in Sooke, West Saanich Medical Clinic, and Shoreline Medical clinics in Brentwood Bay and Sidney.
“This gives significantly more options to those providers to recruit people and to recruit people with the types of contracts people are trying to seek,” said Dix. “We’re confident we’ll have success with it.”
The clinics are part of what’s called a Primary Care Network — clinics that get support to provide team-based care — and the funding comes through the South Island Primary Care Network walk-in clinic task force.
The $3.46 million will support about 10 full-time equivalent family doctor positions across all five clinics through Dec. 31, about six registered nurse positions, and other health-care professionals.
Money is also available for overhead payments and a steering committee to support the work over the next nine months. The funding will not, however, stop the closure this month of View Royal’s Eagle Creek Medical Clinic walk-in, the Colwood Medical Treatment Centre, or Cook Street Village Medical Clinic.
Dix said only five of seven clinics in the South Island Division of Family Practice Primary Care Network accepted the offer of short-term funding to keep their walk-ins open. Eagle Creek Medical and Colwood Medical remain set to close April 15.
Matthew Ward, medical director of Eagle Creek, said he doesn’t have the doctors to replace a wife-and-husband physician team leaving this month, who helped serve patients who didn’t have their own doctors via the walk-in clinic, and had a patient load of about 1,500 each.
“The reason I am closing the walk-in is I don’t have the doctors for it and I cannot take on — safely — all these orphan patients that are being lost because of the two doctors that are leaving,” said Ward, noting he has hired a high-priced recruiter to search for physicians internationally.
“There’s just no one who want to come and practice family medicine in Victoria,” he said. “We need to really incentivize doctors back into community longitudinal family practice, understand what the market forces are, and really push for this.”
Compensation for a family doctor in traditional practice is probably insufficient by $100,000 annually, said Ward. The average overhead is about $85,000.
The Cook Street Village Medical Clinic walk-in clinic is part of the Victoria Division of Family Practice PCN, which is also in talks with the province.
While Dr. Ian Bridger, medical director for five family-practice walk-in clinics in the region, including the Cook Street clinic, didn’t get short-term funding for his clinics, he found Friday’s announcement promising.
“It’s fantastic,” said Bridger, who wants to see the province do everything it can to attract physicians. “I think to step in with some interim funding while they try and sort out the long-term answer is so smart.”
Dr. Ramneek Dosanjh, president of the Doctors of B.C., said she welcomes the “short-term fix” by the provincial government, but many communities around our province are experiencing the same problems as the south Island. “Every week we are learning more doctors that are closing their practices and more patients are scrambling, quite honestly, to find primary care.
As the province and Doctors of B.C. negotiate the Physician Master Agreement, doctors are in part looking for alternatives to the fee-for service plan — which pays physicians about $31 per patient visit — such as contracts and salaried work, as well as more payments for work that is currently not in the fee code.
“We need to appreciate the high costs of running clinics,” said Dosanjh. “It must be addressed because business costs are rising quickly and doctors can’t keep up.
“We are at big risk that doctors might just fold and close their practices and so we need a strategy to retain the doctors that are doing longitudinal primary care right now.”
Victoria family physician Dr. Jill Norris recently wrote to a letter to Dix, co-signed by thousands of primary-care physicians, asking for urgent measures to address “inequitable pay for family physicians,” saying there isn’t time to wait for the Physician Master Agreement to be concluded.
Norris pointed to colleagues closing their practices, missed or delayed diagnoses because of the growing number of unattached patients, ER physicians and specialists faced with cases that could have been prevented with primary care, and increased hospital admissions.
“The morale of family medicine, for those that do longitudinal, full-service family practice under fee-for-service, is decimated,” she wrote.
The ministry is looking at piloting an urban locum program, where new doctors are given incentives to provide coverage within their local primary care network. It’s also examining an after-hours call coverage service supporting local clinics.
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Earlier story
A Cook Street Village walk-in clinic has closed its doors, citing a lack of physicians.
It’s one of three clinics shutting down this month in the capital region.
Dr. Ian Bridger, medical director for five family-practice walk-in clinics in the region, said it was a difficult decision to close the Cook Street Village Medical Clinic walk-in, which serves about 5,000 patients as an urgent clinic.
“Without some kind of miracle, it will be permanent,” Bridger said. “We’ve only just closed and we’ve closed very reluctantly … we’ve just run out of physicians willing to do that job.”
About 900,000 people in B.C., including about 100,000 in the south Island, are without a family physician.
James Bay Medical Treatment Centre in Victoria closed in late February to all but complex-care and vulnerable patients, Eagle Creek Medical Clinic in View Royal and Colwood Medical Treatment Centre have both announced plans to close their walk-in services on April 15, displacing thousands more patients.
Some doctors leaving private primary-care practices cite rising operating costs and a lack of alternate forms of payment — such as salary and contracts — to the traditional fee-for-service model, where a physician bills the Medical Services Plan $31.62 per patient visit. The average doctor might pay about $85,000 to $100,000 annually in overhead.
The medical director for Cook Street Village Medical Clinic said he’d reopen the clinic tomorrow if he could find a doctor who would work there. “Those 5,000 [patients] now have nowhere to go.”
On Wednesday, Dr. Katharine Smart, head of the Canadian Medical Association, called on the federal government for a plan to address the “human health resource crisis” of doctors, nurses and other health-care professionals leaving or retiring “in droves.”
The Canadian Medical Association and other groups want a federal strategy, or even agency, to count, track, train and retain health professionals to keep Canada’s health-care system afloat.
Smart said the initial cost to get the idea off the ground would be as little as $2 million.
Provinces have clamoured for a sustained increase in federal health transfers so they can make more systemic improvements to their systems, asking the federal government to grow its share of health-care costs to 35 per cent from 22 per cent — an increase of about $28 billion annually.
B.C. Green Leader Sonia Furstenau said the health care system is at a “breaking point” and called on the provincial government to modernize it by funding more alternate payment models, providing “immediate relief” for existing primary-care family practice doctors, and recruiting more physicians into family practice.
“We need an all-hands-on-deck approach to supporting physicians currently providing that longitudinal care and we need to know that when they retire, their clinic will continue to care for patients,” Furstenau said at a news conference.
There’s currently a generation that has never had the experience of having a family physician or nurse practitioner, she said.
“People have been without access to consistent quality health care for quite some time, and it’s reaching a breaking point.”
The provincial government has been opening Urgent and Primary Care Clinics, which provide care needed within about 48 hours to take pressure off hospital emergency rooms, and aim to attach some patients with family physicians. The clinics offer doctors the option of being paid a salary or employed on a contract basis.
B.C. Health Minister Adrian Dix said alternate payment arrangements with physicians have risen from $500 million in 2017-2018 to $758 million today. “We have been working in that direction, working with the Doctors of B.C., working with family practices to do so.”
Many younger doctors want to be paid a salary or other non-fee-for-service form of payment, making it hard for family practices working under a fee-for-service model to recruit them, he said.
The province is working with physicians in the Victoria area on the issue, said Dix.
