Northern B.C., like the rest of the province, is grappling with an expected wave of retiring doctors, even as the region struggles to recruit and retain physicians to address ongoing shortages.
Doctors of B.C. predicts 25 per cent of family doctors will retire in the next five years. About 10 per cent of the north's 502 physicians are over the age of 65, compared to 14.5 per cent of the 10,337 doctors practicing in the province, according to data pulled from Medical Services Plan claims files and the Alternative Payments Program. But the numbers only include known age and location, so they could be even higher.
"We can't let those numbers that show that we're a little bit younger in the north let us off the hook in terms of being vigilant about all this stuff," said Dr. Garry Knoll, Prince George Division of Family Practice physician lead.
Looking at the north's numbers in the context of an existing shortage of doctors can be daunting.
"Does it keep me up at night?" said Knoll. "Yes it does.
"I know docs in town who have been trying to recruit, to find somebody take over their practices, who just can't find anybody and so they work longer," he said, because they feel a duty to those clients.
"After you work with a panel of patients for 20, 25 years, you kind of get attached. It's sort of a codependent relationship...You really want the best for people. You feel like you really need to provide that kind of care when you retire."
In the north, general practice doctors are on average 48 years old, three years younger than the provincial average. For specialists, the north matches B.C.'s average of 50 years as well as the average age - 70 - for doctors still practicing above retirement age.
"There likely is going to be a significant shortfall, but the Ministry of Health, the Minister (Terry Lake) in particular it seems are very aware of the issue that's facing us and working collaboratively with Doctors of B.C. to solve the problem," said Dr Charles Webb, the organization's president.
"We're working on areas to accommodate shortfalls wherever we can and also to stretch older doctors tenure by incorporating through divisions in various programs to increase the locum capacity... so that they can fill gaps when people are away on holidays."
A second solution is through matching older physicians with incoming doctors.
"The divisions are pairing them up with younger physicians and helping them transition," Webb said.
The matching approach has worked quite effectively in Vancouver, he said, but Knoll knows of several physicians in the north who are having no such luck.
Recruitment and retention has been an issue since the Prince George division's inception in 2009, said Knoll, who remembered having such discussions in the 1990s, and pointed to the development of the Northern Medical Program as a key driver.
"So much of the work is upstream work. It's about trying to develop a medical community that young doctors in medical school would think is attractive and a good place to live and to work," he said. "Their experience all along the way that influences whether or not they'd be a candidate for recruitment.
And although the province has almost doubled the number of medical graduates, it can't keep up with the number of retirees or the manner in which medicine is now practiced.
Webb called it the compounding factor.
"Twice as many only takes up the slack for the retiring and doesn't take into increasing complexity of the older patients," Webb said.
"B.C. always relied on a net inflow of physicians to meet its needs," Knoll added.
"I think we've ridden on the coattails of other jurisdictions that have been supplying doctors for us and that's drying up," said Knoll, pointing to a shift in approach by the College of Physicians and Surgeons of British Columbia. "They've restricted surgeon recruitment of South Africa because ethically is it right that we should recruit all the South African doctors to British Columbia?"
"I think we have to as a province decide are we training enough docs? Do we have them in the right places?" Knoll said.
The conversation around aging doctors also needs to address the changing needs of the population as well as the changing approach to medicine by its practitioners - one that's leaning towards better work-life balance.
It's not necessarily a one-to-one replacement, either. Doctors in previous years might have thought nothing of committing 70 hours in a week but that is no longer the norm.
"The way that we do business now is quite different than when I began that's for sure," Knoll said. "We have lots of people who live longer and better and with more complicated diseases and that takes more time to organize, more time to support for a better lifestyle."
Those younger doctors aren't necessarily working to their full capacity, either.
"The health authorities have been really good in trying to increase OR time in the public facilities through reducing seasonal closures, and extending the hours of service as well as contracting significant amount of patients to private surgical sites," Webb said, for procedures like cataract or knee surgery.
"To provide greater access it's no question we're going to need to work in multidisciplinary clinics."
The Prince George division has been working with Northern Health to reform primary care services to create a team-based approach.
"A team can be looking after a panel of patients in a meaningful way so that everybody is working to the top of their license," Knoll said.
"There's no doubt that we've had challenges about patients not being able to find family doctors or even having delayed consults with specialists and not having access to the kind of care that we would hope for, but I think the whole system has to change to accommodate that."
The hope is that new system of solutions can both be more efficient and offer a better experience.
