Vaughn Palmer: Short-term fix for long-term illness

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VICTORIA — Health Minister Adrian Dix rolled out an additional $3.5 million last week to stave off further closures of walk-in medical clinics in the provincial capital region.

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The stopgap funding for the remainder of the year was announced a day after news of the latest of three clinic closures.

The Cook Street Medical Clinic, in the Fairfield neighborhood not far from the legislature, has been serving about 5,000 patients. The operators were reluctantly forced to close its doors last week because of a burgeoning shortage of doctors.

“We’ve just run out of physicians willing to do that job,” medical director Ian Bridger told reporter Cindy Harnett of the Victoria Times Colonist on Thursday.

Next day, Dix called a news conference to announce the bailout for five other clinics in the capital region, where an estimated 100,000 residents lack a family doctor.

The New Democrats hold six of the seven constitutions in and around Victoria. One of the five clinics targeted for rescue is in Premier John Horgan’s riding.

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The $3.5 million will be used to hire nurses and other staff and to retain 10 doctors on contract to provide medical services to Dec. 31.

Dix is ​​“confident” the plan will work, despite the shortage of family doctors that prompted all three of the clinic closures announced this year.

Many younger doctors “vastly prefer to work on alternative payments,” Dix told reporters Friday.

He expects they will be attracted by the offer of salaried work on contract, as opposed to the fee-for-service model that has long dominated physician compensation.

The New Democrats have increased annual funding for alternative payments by 50 per cent to $760 million from $500 million the year they took office.

In addition to the five clinics on the receiving end of last week’s money, Dix said talks continue on possible assistance to reopen the doors at the Cook Street clinic and one in suburban Colwood.

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But Dix had to admit that the nine months temporary funding is “short term as we work toward longer-term care solutions.”

For the longer term, Dix remains wedded to a mix of urgent care clinics and teams of primary care doctors working through clinics with shared services and overhead costs.

The urgent care clinics take the pressure off emergency rooms.

The primary care teams will make up for shortages of family doctors, especially for patients with several medical conditions.

Propping up the existing clinics is part of a transition process until the new model is fully operational, said Dix.

“We have been working in that direction with Doctors of BC, ” said the health minister. “The system we have is much a co-managed system with doctors.”

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The road ahead is not an “either-or” says Dix — the new clinics and doctors on salary will coexist with stand-alone family practices on the fee-for-service model.

To that end, the province is in talks with Doctors of BC, formerly called the BC Medical Association, about a new master fee agreement.

With 80 per cent of doctors still on the fee-for-services model, there are calls for an increase in the basic fee of $31 for a patient visit.

There is also a need for relief from overhead costs, estimated at $85,000 a year for a stand-alone medical practice.

“There’s just no one who wants to come and practice family medicine in Victoria,” says Matthew Ward, director of Eagle Creek, another of the clinics that closed its doors in the capital region recently.

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“We need to really incentivize doctors back into community longitudinal family practice, understand what the market forces are, and really push for this.”

Ward has hired a recruiting firm to try to search for physicians on the international market.

The president of Doctors of BC, Dr. Ramneek Dosanjh, welcomed the health minister’s “short-term fix” for walk-in clinics in the capital region.

At the same time, she emphasized that clinics elsewhere in the province face similar challenges.

“Every week we are learning about more doctors that are closing their practices and more patients are scrambling, quite honestly, to find primary care,” she said.

“We need to appreciate the high costs of running clinics,” said Dosanjh. “Business costs are rising quickly, and doctors can’t keep up.”

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Moreover, it remains to be seen whether the new model’s mix of urgent and primary care clinics will be the panacea that some expect.

There are concerns that doctors working in clinics on salary won’t be as productive in seeing patients as those paid on a fee-for-services model.

All this comes at a time when the New Democrats are trumpeting the news that 100,000 people moved to BC last year.

While putting pressure on the inadequate housing stock, the newcomers are also adding to the demand for family doctors.

“After having a vacation home in BC for 25 years we retired here full-time last year,” a reader wrote to me recently.

“My wife and I are not going to find primary care any time soon. We are on a massive waiting list.

“Is access to a family physician not a right in Canada?” I have challenged.

Instead, he says, after a turndown at one doctor’s office recently, a receptionist bluntly told him: “You should have thought about this before you moved here.”

Not a nice way to put it.

Still, something for folks to think about before moving to a place as short of family doctors as BC

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