A University of B.C. professor who studies public health is himself having trouble finding a family doctor.
“I’m actually in the camp of not being able to find a GP,” said Jason Sutherland, a professor at UBC’s centre for health services and policy research.
“I see the irony — it’s not lost on me.”
Sutherland , 44, grew up in the Okanagan and studied in B.C. He taught at American universities before getting his job at UBC about five years ago.
“I did look (for a family doctor), and the only openings were more over toward Boundary Road (in Burnaby), quite a ways away,” he said. “I live on campus and walk in to work. It just wasn’t making sense for me (to go out to Burnaby), so I just found this walk-in clinic where there’s only a couple of physicians.”
For a single, healthy guy with nothing more than the odd sports injury to deal with, that arrangement worked well.
But Sutherland is now married and became a father last fall. The birth of his child coincided with an opportunity to work in Washington, D.C., for just over a year to study the effects of U.S. President Barack Obama’s Affordable Health Care Act.
Sutherland and his family had no trouble finding a family doctor in D.C., but they’re coming back to Vancouver in January, when Sutherland will resume his teaching duties.
And that’s when they’ll renew their search for a family doctor.
“We’ll want the continuity of care that a single doc provides. For pediatric-based care you’re going to want that kind of doctor,” he said.
But Sutherland doesn’t expect to find one close to his Vancouver home.
“I phoned quite a few clinics to see if they were accepting patients and they were not. Around UBC, Point Grey, even in south Vancouver, it’s hard to get in.”
Family doctors typically take on from 1,200 to 1,500 patients, he said.
“Once their roster is full they do not want to take on more patients,” he said.
People with uncomplicated health issues turn to walk-in clinics, which can work for generally healthy people, he said, but not so well for those with chronic or complex conditions.
“These walk-in clinics are doing a barn-burning business,” said Sutherland, whose specific area of study is how financial incentives affect hospitals and doctors.
“The physicians are paid on a piecemeal basis. They spend approximately six minutes per patient and they just grind through. There’s a huge demand for the services. I just think, ‘What a great business model.’”
SHORTAGE IS GROWING
Doctors of B.C. (formerly the B.C. Medical Association) estimates that some 220,000 British Columbians don’t have a family doctor, up from 176,000 in 2005.
“About half are actually looking for a physician, half don’t really care because they’re young and healthy,” said association president Dr. Bill Cavers, a 63-year-old family doctor in Victoria.
“But the half that are looking are desperate, because many of them are at the age where they’re starting to get chronic ailments and some problems.” Cavers, who co-chaired a BCMA committee on family practice from 2002 to 2010, has been part of the effort to address the shortage of family doctors.
He was in the audience at a press conference in 2010 when then health minister Kevin Falcon promised a family doctor for every British Columbian by 2015.
“I was there with my co-chair,” Cavers recalled. “We looked at each other and said, ‘Oh, I guess we’re committed now.’ After our dizziness and light-headedness stopped, we realized there’s nothing like working under a deadline.”
That deadline has arrived but the shortage of family doctors persists.
A study by UBC public health researchers Kim McGrail and Ruth Lavergne noted that the province has spent $1 billion to improve primary care since 2006, with more than $700 million of that going to incentives for doctors to encourage the traditional family practice model.
Those incentives include additional payments — on top of regular fees — to doctors for providing mental-health care and palliative care, and for the management of patients with chronic diseases.
Despite those incentives, family doctors already in practice are turning away new patients because their rosters are full. Many new doctors are choosing to join walk-in clinics rather than taking on the responsibility and costs of setting up a family practice.
“There’s a whole skein of different issues in there,” Cavers said of the family-doctor shortage, adding that there’s an increasing demand for medical services by aging boomers.
And family doctors aren’t working the kind of hours they once did, said Cavers.
“Gone are the days when a doctor worked outside of the house and the doctor’s spouse worked inside the house. We now have two-career families,” said Cavers, who worked a 50-hour week as a doctor before he became head of Doctors of B.C.
“Now physicians are trying to balance that. They’re not working the total number of hours that old guys like me used to work.”
The committee Cavers helped start in 2002 was aimed at increasing the number of doctors in family practice. That year, only 23 per cent of B.C.’s medical school grads chose family practice, he said. The latest numbers show 40 per cent of today’s grads are choosing that option.
The University of B.C. medical school has expanded from Vancouver to train doctors in Victoria, Kelowna and Prince George, with graduate numbers rising from 128 in 2003 to 288 each year since 2011. UBC has the fifth-largest medical student population in North America. Residency spots in B.C. for international medical grads went up from six in 2003 to 50 this year, and will rise to 58 next year.
“The bad news is, we estimate we need about 450 new physicians in B.C. per year to meet demand, and we’re only graduating 288,” Cavers said.
B.C. Health Minister Terry Lake acknowledges the continuing shortage.
“Even with more doctors, accessibility seems to be reduced,” he said. “And, of course, we’ve got an aging population so the demand is higher.”
Referring to the 2015 deadline, Lake said, “We’re maybe not as far ahead as we wanted to be at this stage, but I think we’re on the verge of some real positive changes now.
“We won’t get the 2014 numbers until June from Statistics Canada. If we see the needle start coming down on the number of people without a doctor, that will be a good sign that we’re on the right track.”
As for all those patients still looking for doctors — and those retiring doctors who can’t find younger colleagues to take over their practices — Cavers admits there’s going to be more of a wait.
“I’m going to say keep your eyes peeled for changes in the next 12 to 24 months,” he said. “We do expect there will be significant improvements in the next couple of years.
“Although we found that 2015 was an ambitious goal, it certainly did assist in helping us to giddy-up.”
‘I HAVE TO WAIT FOR UP TO THREE HOURS SOMETIMES’
Louise Setchell had the same family doctor her whole life while growing up in England, but since she moved to B.C. in 2009 she’s had a revolving door of at least 12 different physicians.
When Setchell, 31, gave birth to her son Mateo five months ago, her partner’s doctor agreed to accept the baby as a patient, but wouldn’t take Louise because the doctor was nearing retirement.
“I’ve been trying to get a family doctor since I moved here. Every time I’ve managed to find one — it has happened three times now — they’ve up and left,” Setchell said.
Her last family doctor confirmed Setchell’s pregnancy, after which Setchell had a midwife attend the birth. When Setchell sought to make a post-pregnancy appointment at her practice, she found that her doctor had had a baby and moved to Toronto.
Setchell, who is on maternity leave from her job as a psychiatric nurse, hasn’t been able to find a new family doctor since. The B.C. College of Physicians and Surgeons has a website (cpsbc.ca) that lists doctors accepting new patients, but it’s frequently out of date. Setchell has been relying on walk-in clinics, as many do, but said she misses the continuity of seeing the same doctor every time.
“It’s ridiculous that I don’t get to see the same person,” she said. “It is causing me hardship because there are cancer issues in my family, so I have to go to the doctor every year without fail to go and get checked out.”
She needs an annual exam to renew her contraceptive pill prescription and it’s done by a different doctor every time, she said.
“So I have to see a strange female,” she said. “One time I had to see a male doctor that I’d never seen before. I was told at a walk-in clinic that it was a female doctor I’d be seeing.”
Setchell and her family live in New Westminster and she goes to a walk-in clinic at the Vancouver-Burnaby border.
“I have to wait for up to three hours sometimes for the chance of seeing somebody,” she said. “They need more doctors who are willing to take on a family practice rather than working in a walk-in clinic.”
‘IT’S ABOUT HAVING SOMEBODY REGULAR THAT WE CAN SEE’
Natalie Kootchin hasn’t had a family doctor since she left her Vancouver Island home for the mainland as a teen.
“I haven’t had anyone since my childhood family doctor,” she said.
Now 32 and living in Vancouver, Kootchin got through her 20s by using walk-in clinics when she needed to see a doctor.
But when she got pregnant last year, Kootchin started looking for a family doctor close to her home for herself, her husband and their baby, due this May.
So far, she’s come up empty.
“I have found it difficult,” she said. “I only have a couple of months left to try to find a family doctor that I can see with the baby.”
She has arranged midwives and a doula, and is registered to give birth at B.C. Women’s Hospital, but she wants a family doctor for after the baby is born.
“It’s about the ongoing care afterwards, having somebody regular that we can see,” said Kootchin, who works as a human resources consultant.
“My plan in the meantime is, there’s a walk-in clinic near me and I know there are family doctors there that are good. I can call ahead, find out when they’re working and try to get in to see them,” she said.
“They don’t take appointments. It’s not ideal.”
Ironically, Kootchin and her husband live a five-minute walk from the cluster of doctors’ offices around Vancouver General Hospital.
“You would think it would be easier,” she said. “There’s so many medical offices in the Broadway-Cambie-Williow area.”
‘I’M NOT A ONE-ISSUE PERSON’
Barbara Bird has to drive an hour-and-a-half from her Chilliwack home to see her family doctor in Vancouver.
“I would not travel to Vancouver to see a doctor if I didn’t have to,” said the 58-year-old Bird, who suffers damaged joints from rheumatoid arthritis. “I’ve been trying to find one in Chilliwack. I’ve been living here for about four-and-a-half years. Still haven’t been able to find one.”
Bird worries what will happen when her family doctor of 40 years retires.
Bird was diagnosed with rheumatoid arthritis in 1997. Three years ago she had to quit her desk job because of complications from the condition and side effects of the medication she takes to treat it.
“You should see how thick my file is,” Bird said.
The medications she takes to ease her symptoms leave her susceptible to infections, including bouts of pneumonia so severe that the coughing has given her broken ribs. She also suffers from asthma.
“I’m not a one-issue person,” she said of her health. “I can’t help that. It’s just my life.”
Bird said her GP, who has been treating her since she was 19, takes the time to discuss her myriad health issues at appointments, while doctors she has seen at walk-in clinics in Chilliwack and Surrey often refuse to discuss more than one health problem per visit.
“My doctor is an old-school doctor. If you see the newer ones, you can only come in for one issue. You’ve got 15 minutes and you’re out of there,” she said.
“The fact that I have RA means that I have more issues when I do get sick. So if I have a doctor who has an understanding of RA, the medications that I take for it and the side effects of those medications, it makes a huge difference. Otherwise, I’m the one who has to go in and educate them.”
The typical wait time of more than an hour at walk-in clinics is hard for Bird because sitting still that long aggravates her condition.
“When you’re sitting for a long time you can barely walk afterwards.”
PRACTISING OUTSIDE THE FEE-FOR-VISIT BOX
Dr. Mitchell Fagan and his colleagues at Langley’s Murrayville family-practice group don’t charge for every patient visit to their office.
“We instead get paid to look after people,” said Fagan, who is also in charge of training family-practice residents at Langley General Hospital.
Murrayville’s four doctors, two registered nurses and several nurse practitioners care for nearly 9,000 patients in what started as a pilot project 11 years ago.
Each of the patients is assessed by the Medical Services Plan based on age, sex and complexity, after which the practice is paid a straight annual fee for each patient based on that assessment.
The pilot funding arrangement has allowed Fagan and his partner to hire a mix of doctors, nurses, therapists and nurse practitioners out of Murrayville’s annual budget. The arrangement would have been impossible under the traditional MSP system that pays doctors a fee for each patient visit.
At the Murrayville practice, a patient might be seen by a registered nurse (RN) or a nurse practitioner rather than a doctor, depending on the specific reason for the visit.
Nurse practitioners, a relatively new class of health provider first regulated in B.C. in 2005, are able to perform 80 per cent of the services done by doctors, including diagnoses, writing prescriptions and ordering lab tests.
“It’s helped us to do more in the day more effectively,” he said. “For us, we were able to bring in an RN who is an expert in diabetes. Things that might have taken me half an hour to do, I can now do without ever having to see the person, because she’s responsible and we’re able to receive remuneration for it.”
The model could also help encourage younger doctors to go into family practice by giving them an alternative to setting up a practice of their own, which involves office costs and responsibility for the ongoing care of patients with complicated health issues.
“It’s really germane to the whole future of primary care,” Fagan said. “It’s about partnership. It’s about young docs who are coming out from training who are not yet comfortable with the idea of being on their own, but there aren’t a lot of other practice opportunities for them.”
The pilot funding model isn’t available to other doctors in B.C. beyond five practices in Langley, including Murrayville, and two in Vancouver where it’s already in use, but the Doctors of B.C.’s general practice services committee is studying it.
“We’ve really been privileged to be partners with the health authority and the government ... being allowed to do this,” Fagan said. “It’s given us the opportunity to show you can do health care differently.”
BY THE NUMBERS
• As of 2014, the B.C. College of Physicians and Surgeons listed 11,361 doctors: 5,875 of the total are GPs and 5,486 are specialists.
• The usual fee for an in-office visit to a family doctor for a patient between the ages of two and 49 is $30.15.
• Doctors of B.C. says that for GPs, about 45 per cent of money collected from fees goes to covering the doctor’s overhead costs (staff salaries, insurance, office lease, utilities, equipment).
There is a daily limit on how many patients a doctor will be paid to see. Doctors receive:
• Full payment for each of up to 50 office visits per day;
• 50 per cent payment for 51 to 65 office visits;
• No payment for 66 and more office visits.
