After nearly three years of work toward establishing a new primary care model in Whistler, the new year is finally bringing about a major shift in the resort’s health-care landscape.
On Jan. 1, the Whistler Medical Clinic will transition to a non-profit financial model, as the resort’s last remaining and longest-standing family medicine practice officially merges with the Whistler 360 Health Collaborative Society to form Whistler 360 Health. It is the first of many changes set to get rolling in the coming months, with new spaces and new health-care staff both expected to start welcoming patients by the time the snow melts.
Whistler 360 stems from a Primary Care Task Force formed in early 2019 to explore the impacts of Whistler’s family doctor shortage—exacerbated when longtime local practise Town Plaza Medical Clinic closed its doors last spring—and to investigate how access to primary care in the community could be improved.
Ultimately, after reviewing a variety of successful models in other B.C. communities, the task force came up with the vision for a non-profit, community-governed, team-based primary clinic that could provide longitudinal care to a greater number of patients, while simultaneously addressing many of the issues that deter doctors from pursuing careers in family practice.
“The Whistler 360 model really alleviates a lot of that burden” on family physicians, explained Whistler 360 chair Carol Leacy. “[With] the society running the administrative operations of the clinic, the doctors can focus on health-care delivery and not on running a small business.”
The Whistler 360 Health Collaborative Society swiftly gained charitable status in 2021.
“By implementing this model, we’ll be able to both stabilize our current level of providers, which is the Whistler Medical Clinic… and also be able to attract and retain more physicians and nurse practitioners in full-service family practice,” Leacy told Whistler’s mayor and council during a Committee of the Whole meeting earlier this month.
Renovations are currently underway on two new primary care rooms within the Whistler Health Care Centre’s walls, provided by health authority Vancouver Coastal Health (VCH), while the Town Plaza clinic’s previous home on Main Street—about a five-to-seven minute walk from the health-care centre—will become a satellite space for Whistler 360 this spring.
The satellite clinic comes courtesy of “the generosity of the new landlord, who wanted to see the space used for medical [purposes],” Leacy told council during the meeting. Whistler 360 officially took over the space on Dec. 1.
Before those spaces can open their doors, Whistler 360 hopes to add those new care providers to its team by February.
“We’ve got some interested physicians and we also have put in a request through the Patient Care Network … for two nurse practitioners, so hopefully we’ll have those by February,” said Dr. Karin Kausky, a family doctor at the Whistler Medical Clinic and founding director of Whistler 360.
“That will really, I think, help with addressing capacity of primary care,” she added. “It’s a pretty big problem and a pretty big project.”
This represents the second phase of Whistler 360’s three-phase plan. Down the road, Whistler 360 also envisions growing its team and widening its mandate to include “a wellness collaborative,” Kausky explained. “Everybody’s health and wellness is really determined by a range of social, economic, [and] geographic factors, so we want to be a part of that and really understand our community and what the community needs.”
By the numbers
About half of Whistler residents do not have a family physician, by Whistler 360’s estimate, and those who do often suffer lengthy waits for care.
That is significantly higher than the one in five Canadians and the approximately 23 per cent of British Columbians who say they do not have a family doctor, according to a Sept. 2022 Angus Reid poll.
The shortage also affects urgent care in the resort, with the Whistler Health Care Centre’s emergency room regularly accommodating a significant number of patients with non-urgent needs, “because that’s the only access they have to medical care right now,” Kausky explained.
Currently, the Whistler Medical Clinic counts five full-time equivalent (FTE) physicians and one nurse practitioner. With the two additional exam rooms and new satellite space already secured, Kausky believes Whistler 360 can scale that number up to 10 FTEs in 2023.
But with B.C.’s Ministry of Health recommending between 800 and 1,000 patients per practitioner, Whistler really needs closer to 16 FTEs. Moreover, Whistler’s fluctuating population, tens of thousands of daily visitors and high number of seasonal employees makes the resort “a really hard place to estimate for,” Kausky acknowledged.
Still, “The space we have clearly doesn’t get us to even the 16, so Phase 3 of our plan is to have a space that is big enough for at least 16 full-time equivalents, plus whatever allied health-care providers we have in our team-based care,” she explained. “So we definitely need more space.”
There are two options, said Kausky: a standalone building, or carving out and renovating more space within the existing Whistler Health Care Centre, a possibility VCH is reportedly exploring.
At a recent medical conference, Kausky learned that while Canada is positioned to need about 10,000 new family physicians within the next five years, there are only about 2,000 currently in training.
“That’s a pretty big gap,” she said.
Operating as a society with a steady influx of funding allows Whistler 360 to trailblaze an innovative new way of providing care, she said.
“The model that I’m used to … is having a panel with 1,000 or 1,500 patients and knowing them all, and being responsible for them,” she explained. “But if we’re going to be 8,000 [family doctors] short over the next 10 years, I think we have to operate differently. So we’re really exploring ways of having family physicians and nurse practitioners be part of a real team [of allied health-care providers like, for example, mental health nurses and physical therapists] that can perhaps look after quite a few more people.”
That could mean a group of health-care providers overseen by a physician or nurse practitioner could treat 100 patients each day, compared to the 30 Kausky typically sees during a workday.
What will change for patients?
Immediately? Not much, at least from a current patient’s perspective. The care centre will remain in the Whistler Medical Clinic’s existing space on the second floor of the Whistler Health Care Centre, while staff, phone numbers and emails will not change.
Kausky said Whistler 360 staff are currently working to increase walk-in and day-of appointment availability, as work to recruit new staff continues. Locals looking for a family physician, meanwhile, should stay tuned for upcoming announcements about how to make that desire known before Whistler 360 begins accepting new patients around February.
Once the team-based operation gets up and running, patients likely won’t be attached one-to-one with a physician or a nurse practitioner, but to a team of providers depending on that patient’s needs.
Among the most important long-term impact this new care model will bring is improved outcomes for patients.
“There’s so much evidence for the fact that people that are attached to a family physician and nurse practitioner have better personal health outcomes … and for the provincial health-care system, it’s also the most economical way to provide care,” Kausky explained.
As B.C. looks to invest in that kind of health-care, family physicians are due to receive a significant bump in compensation this winter. Additionally, doctors only need to work one full day in family practice each week in order to be eligible for the new payment model, announced by the province last year and set to go into effect Feb. 1.
While that new payment structure won’t change anything with Whistler 360’s finance model—aside from a raise for physicians—Kausky is hopeful the strategy will help with recruitment and retention.
“The problem was that [physicians] could choose to do family practice, or you could choose to be a hospitalist or do emergency medicine, and those paid significantly more,” she said. “So it’s kind of levelled the playing field so [doctors] can actually choose what [they] want to do, not based on the business model or income… I think it’s going to help a lot to keep people practicing in full-service family practice.”
Community funds making vision possible
From transitioning to a non-profit finance structure to creating new spaces to recruiting new staff to developing and piloting new operating processes, making the kind of changes Whistler 360 has already set in motion takes significant funding. Outfitting the two new exam rooms, for example, comes at a cost of $20,000.
Luckily for Whistler 360, the society is launching in 2023 with a significant base to draw from. The Whistler Blackcomb Foundation announced earlier this month that it was doubling its popular Founders Pass Program, thanks to a donation of 50 new season passes from Vail Resort’s EpicPromise, and directing the resulting $500,000 sum to Whistler 360. The Dr. Rob Burgess Primary Care Fund, meanwhile, raised $205,000 for the initiative, and delivered that contribution to Whistler 360 the week before Christmas. “We’re just incredibly thankful for their support,” said Leacy.
The funds are also “really going to allow us to make an investment in the digital space, equipment, technology and support services that are required to really support those additional doctors and nurse practitioners,” she added.
Those new care providers will follow in the footsteps of Burgess, Whistler’s first family practitioner and Whistler Medical Clinic founder who served the community as a physician for 43 years. The Whistler Health Care Foundation set up the fund in Burgess’ honour shortly after he died of cancer in September 2021, at the age of 71.
Burgess’ daughter Micky said that $205,000 was, remarkably, raised from $0 with minimal fundraising over the last year. “It was honestly mostly from our friends and family and people that really felt connected to my dad, and a lot of personal donations from a lot of people in the community; a lot of his patients,” she said.
“It feels amazing to know that he will stay in the community, because it’s such a growing place and you know, names can be forgotten. He really pioneered primary care and medical care in Whistler … so just to have him be a part of the future of it is really important to my family.”
She said her dad was always “so proud” of the patients he saw grow from babies into parents themselves, and would be passionate about keeping that same opportunity alive in Whistler for more doctors in the future.
Micky said she hopes the Primary Care Fund will continue to grow in the coming months and years as more people learn about Whistler 360, and about the impact Burgess left on the community. “It’s just nice that that he can be recognized for the work that he did and all the lives that he changed and helped,” she said, while supporting “keeping family doctors in town, because it’s so needed … You can get lost in the system without someone looking out for you.”
As for Kausky, the family physician said she feels “a real obligation” to make good use of those funds, “to be able to take some leadership on really figuring out how to operate differently so that we can increase capacity.”