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Shortage of maternity doctors leaves pregnant women scrambling

The number of maternity GPs has shrunk to about 25 from 48 over the last two years in south Vancouver Island, with another two scheduled to leave in September
Danielle Garber, pregnant with twins, searched for months for a maternity doctor before finally being referred to Victoria General Hospital's urgent antenatal care clinic for pregnant patients without a maternity care provider. DARREN STONE, TIMES COLONIST

The south Island has lost about half its family doctors who specialize in maternity patients, leaving at least 100 pregnant women scrambling to find care, says a former View Royal maternity doctor.

The number of maternity GPs has shrunk to about 25 from 48 over the past two years in south Vancouver Island, with another two scheduled to leave in September, said Dr. Shana Johnston, who left her family and maternity practice after six years in 2021.

“I was one of the first ones to go down — there’s epic burnout happening everywhere,” said Johnston. “I burnt out before everybody else and I left my practice a couple of years ago.”

Johnston said the shortage of maternity doctors amounts to a crisis that needs to be addressed immediately.

Danielle Garber, 37, the mother of a three-year-old, who is now pregnant with twins due in the fall, said when she found out she was pregnant, she phoned every maternity care provider she could find in the capital region.

One clinic agreed to take her when she was 16 weeks pregnant, but later said they were too busy. “I called every office that at some point in the last five years offers or offered maternity care,” said Garber. “There isn’t a list to refer to — even just trying to find who to call was a lot of work.”

Finally, last week, Garber was given the number of a clinic set up at Victoria General Hospital to help care for pregnant patients who don’t have a maternity care provider. The recently established Urgent Antenatal Care Clinic at Victoria General Hospital offers a rotation of maternity doctors, and has provided care to 84 pregnancy patients since March 9, according to the Health Ministry.

Dr. Hayley Bos, medical director of maternity for Island Health, said pregnant patients can leave their contact information with the clinic and Island Health will aim to get them into an established maternity clinic.

“The turnaround time can be longer than we want it to be, but we are increasing capacity,” said Bos. “However, maternity care is primary care, and we have a primary care crisis here in south Island, and this is part of a bigger problem.”

For family physicians who specialize in maternity patients, the main problems include compensation and workload. Johnston said she loved maternity practice but found it too much work for too little compensation.

A healthy pregnant mom with no issues might require 12 to 16 in-office visits during pregnancy, a number that is far higher for a complicated pregnancy. Maternity care includes prenatal visits, labour and delivery, postpartum visits, and new baby visits.

“It requires big energy and a big time investment — we all love doing it — we definitely don’t do it for the money, it’s because we care — but it’s a lot.”

In addition to running a community maternity clinic, and maybe a family practice, maternity doctors do 12- or 24-hour maternity hospital shifts delivering babies and caring for anyone admitted with a pregnancy complication, Johnston said. “We are the emergency department for women who are 20 weeks [pregnant] and over,” she said. (Obstetricians care for patients with high-risk complicated pregnancies and perform Cesarean sections.)

But when family doctors specializing in maternity head into the hospital, their pay reverts to the fee-for-service model, even if they registered for the new Longitudinal Family Physician payment system. That system, introduced Feb. 1, can better compensate family physicians for their work than the base fee-per-patient visit, depending on the practice. About 3,027 of roughly 4,000 eligible family doctors have signed on to the new system.

The Health Ministry said it’s working with Doctors of B.C. and maternity care providers on the south Island to address compensation issues and come up with a new system that will help recruit and retain physicians.

“Discussions are actively underway, and all parties are committed to finding a solution as soon as possible to avoid disruption of services,” the ministry said in a statement.

It’s doing the same for family physicians who provide other facility-based services, including in-patient care, long-term care and palliative care.

The ministry said while work to improve compensation models is underway, the province is looking at offering “stabilization funding” for physicians who provide maternity care in hospitals.

“The funding will provide a bridge until permanent solutions are identified through our work with Doctors of B.C.,” it said in a statement.

That help can’t come soon enough, said Johnston.

In addition to the GP departures, Access Midwifery on Tillicum Road is closing its doors in September after 18 years in the Victoria area, after founders Heather Wood and Lorna McRae both retired from clinical practice, although many of the midwives are expected to continue to practise.

Johnston said the clinic serves a diverse population that includes vulnerable, complex and high-risk pregnancies.

“They are going to be the most impacted because the higher-resourced women will call around and they’ll figure something out,” she said. “Lower-resourced women are just going to show up at labour and delivery at the hospital with no prenatal care, probably with some big complications.”

Melanie Mason, a midwife at Access Midwifery, said following the retirement of the founders, there weren’t enough other midwives to cover the clinic overhead. “We couldn’t float the practice on the amount of midwives we had left and we couldn’t find another space that was affordable.”

Mason, who is moving on to be part of a federal research project working in sexual health through the youth-clinic Foundry.

Access Midwifery had sub-specialized in people who face substance-use disorder or have multiple barriers to accessing health care; Mason is concerned for their welfare — and that of their babies.

“I have extreme moral distress about what’s happening in our community,” said Mason. “The fact that I’ve been told that a lot of people who present at the Urgent Antenatal Assessment Clinic at VGH are unattached or that primary care providers are saying they’re seeing a lot more Indigenous people having to take that pathway, that’s just not appropriate.

“Being Indigenous myself and being an Indigenous midwife, we need to do better and we’re just not there yet,” said Mason. “I think we forget when we’re talking about the provision of maternity services that one patient turns into two.”

Island Health said it is working with the Divisions of Family Practice, which are community-based non-profit groups that bring family doctors together to address local health goals, Perinatal Services B.C. which leads strategic planning of perinatal services in B.C., and the College of Physicians and Surgeons and the Health Ministry to stabilize maternity care on the south Island.

Pregnant patients who don’t have a primary maternity care provider can contact the Urgent Antenatal Care Clinic at VGH by calling 250-727-4187 and leaving a voicemail.

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