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Where are all the family doctors

Whistler's family doctor shortage is acute—but efforts are underway to change that

Having one's own doctor holds numerous benefits.

They know your particular constellation of ailments, you develop a rapport, and you don't have to explain your issues to a new doctor every time you visit the clinic.

Moreover, research has shown that access to family physicians leads to better health outcomes for patients and cost savings for healthcare systems.

Yet like other communities across the country, Whistler had a dearth of family doctors even before the current health crisis, counting about 10 operating in the community (with some working on a part-time basis or splitting their time between family practice and emergency room care).

Experts say the community needs about 15 operating on a full-time basis.

For people with serious ailments, access to a family doctor is critical.

"You want to feel taken care of. You want to have a doctor that understands you and respects you and has compassion," says Linda Epp.

A longtime local who is battling cancer and awaiting surgery for a brain aneurysm, Epp says she struggled to find a family doctor earlier this year. (While Epp technically has had a family physician since 1997, the walk-in clinic doctor was often unavailable, she notes.) Epp believes walk-in clinics are challenged to provide the type of care that she needs.

"It's pretty much get them in, get them out," she says. "I'm not a robot. I'm human. I feel like it's not personal."

According to the local physicians Pique spoke to, Whistler's family doctor shortage has been exacerbated by the province's current fee-for-service model and rates. 

Under the current framework, doctors looking to work in a family medicine practice are effectively small-business owners, responsible for a host of overhead costs (from IT to administrative personnel) associated with running a clinic.   

"The cost of operating a practice has far outpaced the fee structure," says Dr. Karin Kausky, a family physician at the Whistler Medical Clinic who also practices sports medicine. 

Over the years, family medicine has become far more complex and costly, says Kausky.

"For example, 10 years ago we did not have electronic medical records," she says.

And while this advancement has been "very good for patient care" and a positive development overall, maintaining good records and infrastructure is time consuming and adds "another level of complexity" to one's practice, she explains.  

With a growing (at least before the COVID-19 pandemic) and aging population, Whistler's doctor shortage isn't set to improve anytime soon.

But luckily, the issue has been identified as a real problem, and a group of well-placed stakeholders is pushing for change.

Though still in its early stages, there are even discussions underway to potentially build a new local healthcare facility they hope will serve as a major draw for young physicians looking to practice family medicine.

Family doctors are business people, too

One might think that Whistler—with its endless options for outdoor recreation, laidback lifestyle, and educated, progressive population—would be an ideal place for a newly minted doctor to move.

But according to Dr. Cathy Zeglinski, the finances of operating a clinic in the community are challenging.

In 2017, Zeglinski closed the medical clinic she founded in 2005.

The cost of rent and staffing made it impossible to carry on, she says.

"I did not want to close my practice," says Zeglinski. "I thought I was going to end my medical life as a doctor in Whistler."

Moreover, recruiting doctors to work at the clinic was a problem.

"What's specific to Whistler is the cost of living here is exceptionally high by any Canadian standards," she says. "And doctors cannot charge ... in order to compensate for that extra cost of living. So attracting new doctors has always been a challenge."

Zeglinski adds that the pace doctors are forced to work at under the current model—seeing four to five patients an hour—can be gruelling.

Zeglinski describes a tension between her desire to provide "patient-centred care" and the efficiency needed to run a medical practice in a business market that was as hot as Whistler's.

"I never made a lot of money as a doctor. That was not the point of it," she says. "But I also couldn't afford to keep my staff happy. I couldn't afford to pay the payroll taxes, I couldn't afford to rent the building."

With the closure of Zeglinski's Northlands Medical Clinic, Whistler now has just two clinics dedicated to family medicine and long-term longitudinal care: Town Plaza Medical Clinic and the Whistler Medical Clinic.

Dr. Diane Patterson, a family physician at the Whistler Medical Clinic, agrees that the current fee-for-service model that most family doctors operate under is problematic.

Young doctors, she says, recognize this, and are attracted to other types of practices where they are not responsible for the same overhead costs.

"Over the last 10 years in the province, there have been fewer and fewer medical-school graduates who want to go into family practice," says Patterson.

"You combine that with the economic difficulties that we have in Whistler—with housing and recruitment and retention of staff—and we've kind of got a perfect storm."

According to Dr. Kathleen Ross, president of Doctors of BC, it isn't so much that young doctors don't want to work in family medicine—it's that they want to work in a different manner.

"What we're seeing is new graduates want to work differently—they would prefer to set up in a situation where they have lots of support."

According to Doctors of BC—a voluntary association comprising 14,000 physicians—residents and medical students spend, on average, 40 to 50 per cent of what they bill on overhead costs, money that goes towards office rent, equipment purchase, utilities, administrative staff, salary and benefits.

Ross says that this proportion of income has risen over the years. "We have seen a rise in the percentage of family physicians' income that winds up going towards overhead costs, because those office costs are rising at a rate higher than physician salaries."

Doctors of BC was unable to provide an average salary for family doctors working in the Sea to Sky. But in an email to Pique, the organization noted that Whistler physicians are eligible for "Rural Isolation Points," which marginally increases what they are paid over their counterparts in urban centres.

"Whistler currently gets 11.4 Rural Isolation Points," reads the statement. "This means that they receive 7.98 per cent on their [fee-for service] billings plus an annual flat fee of approximately $8,000.

"They are eligible for a number of other Rural Programs including (but not limited to): Rural Emergency Enhancement Fund ($200,000 for the group of physicians working in the Emergency Department), Recruitment Incentive Fund, Recruitment Contingency Fund, Rural [Continuing Medical Education funding] (up to $4,400 for GPs and $6,000 for Specialists), etc."

Workable models do exist

Though still in its early stages, an effort to address Whistler's family doctor shortage is underway.

Launched a little more than a year ago, the Primary Care Task Force was set up to look at various models that could attract more family doctors to Whistler and create an environment in which they want to stay in the community on a long-term basis.

As part of this work, the task force is looking at clinic models around the province, focusing on those that offer a team-based approach to healthcare and alleviate the administrative costs facing family physicians.

The task force features representatives from the Whistler Community Services Society, the Whistler Community Foundation, the Whistler Health Care Foundation, medical officials and the Sea to Sky Division of Family Practice, as well as political representatives at both the municipal and provincial level.

Kausky says research has shown that access to longitudinal care is tied to better health outcomes for patients and is cost-effective for the overall healthcare system, but that reforms are needed to attract more people to family practice.

"The complexity and cost of operating [a family medicine] business has really blown up, and that seems to be the reason that people are hesitant to enter into this," she says.

As part of her work with the task force, Kausky has looked at the Gabriola Community Health Centre, which is owned and operated by the non-profit Gabriola Health Care Foundation, as a potential model.

She visited the clinic and says she was impressed with what she saw, saying that it has helped attract three or four new doctors to the small island with a population of around 4,000.

Kausky was also impressed with the clinic's collaborative approach to medicine.

"They are part of a bigger island wellness collaborative, so that they're linked in with other wellness provided on the island," she adds.

Bringing various service providers under one roof is greatly beneficial to patients, Kausky notes.

"Right now, if I have a person struggling with housing or mental-health issues, it's difficult to look after that on your own," she says. "But when you're part of a team with people that specifically do that, it's much easier."

Kausky adds that having administrative duties taken over by a non-profit is also an attractive prospect.

"Could we see more patients if we weren't doing all of those things? Maybe. Are there people that are better at it than us? Probably.

"It just seems that a lot of the younger physicians graduating are not interested in being small-business owners."

Whistler Councillor Jen Ford—who also serves as chair of the Sea to Sky Regional Hospital District board—said Victoria's Rebalance MD musculoskeletal clinic offers an attractive model.

The publicly funded healthcare clinic, founded by surgeon Patrick McAllister and physiotherapist Stefan Fletcher, is a one-stop shop for people's surgical needs, bringing orthopedic surgeons, physiotherapists, and sports medicine physicians all under one roof.

The centre has been widely praised for cutting down on surgical waitlists and streamlining the surgical process.

"It's a model that works really, really well for the doctors so that they can practice and not be bogged down with administration and cost of staffing and all of that," says Ford.

Ford notes that traditionally (pre-COVID-19), the majority of people visiting Whistler's food bank did so because of injuries.

Local MLA Jordan Sturdy says that building a new facility where doctors can work in a team environment is a "fundamental objective" of current discussions and that he is impressed with the Rebalance MD model, saying that it can be tailored to fit Whistler's specific needs.

Like Ford, he thinks a focus on addressing musculoskeletal injuries could be a good route.

"The question that I've posed is, 'What do we want to excel at?' Yes, we need to have more family physicians—but should we be a little more ambitious in what we want to try and achieve as a community?"

The provincial response

B.C's family-doctor shortage is nothing new to the province.

To address the issue, Victoria is investing in primary care networks—networks that operate at a regional level, streamlining the referrals process between them—and hiring family doctors and nurse practitioners to work within them. It has also introduced a payment method for new doctors that allows them to be paid on a salary basis, rather than under the traditional fee-for-service model.

"To address the gap in primary care, we are recruiting 200 nurse practitioners and 200 family doctors, including new graduates and residents of family medicine," Minister of Health Adrian Dix said in a May 2018 release. (Dix was unavailable for an interview due to the ongoing COVID-19 situation.)

"Through implementing team-based practices, we're making sure new doctors are supported to focus on diagnostic medicine and developing strong relationships with their patients, and receive a good salary while they are also paying down their student debt. This kind of support can encourage more residents educated and trained in B.C. to stay and serve in the province's primary-care system."

In a statement to Pique, a spokesperson for B.C.'s Ministry of Health said that the province understands the burdens placed on family doctors.

"Patients want to get their health care where and when they need it," reads the statement. "Doctors want more manageable patient loads and a shared responsibility for the business and costs of running a practice.

"Through the province's primary care strategy, we are working to address the needs of patients and care providers."

Loose timeline for change

While formal planning for a Sea to Sky primary care network is yet to get underway, Kausky notes that discussions are moving forward, and that Whistler is already benefiting from them.

A new nurse practitioner was recently added on to the Whistler Medical Centre's team. The position was created in partnership with Vancouver Coastal Health as an "early ask" of a primary care network, says Kausky.

Kausky adds that the ethos of the primary care network—which underlines the importance of a team-based approach to medicine—will be baked into any facility that's eventually created.

"Poverty is the single biggest determinant of poor health across the world," she says, addressing the need to tie in social-services workers.

Speaking of her difficulties with the current healthcare model, Epp says she hopes that her story can help shed some light on the current situation.

"I think that the doctors want to continue being doctors," she says. "They don't want to be businesspeople [and] take care of the clinic and the overhead and the cost of rent."

The COVID-19 situation has, of course, forced the stakeholders involved in the Primary Care Task Force to put their planning for any new clinic on the backburner.

But according to Ford, in the long term, the crisis we are collectively going through could help galvanize the community to move forward with a solution at a quicker pace.

"I think it will shine a light on some of the gaps [in our healthcare system]," she says.

"People understand better than ever how important our healthcare system is."