Fed up with rolling emergency room closures, some rural B.C. mayors are calling on the province to end the vaccine mandate for health workers as a way to get sidelined nurses back on the job.
Health Minister Adrian Dix said that option is not on the table, but the province has a range of other tools to boost the health-care workforce in rural parts of B.C.
Merritt Mayor Michael Goetz said the Nicola Valley Hospital has been temporarily closed four times since Christmas.
He said with 80,000 vehicles a day passing by Merritt on the Coquihalla Highway, “there’s always going to be an incident somewhere along the way where somebody may have to go to the hospital. And if the ER is closed, they have to go to Kamloops or Kelowna.”
Goetz is one of 37 mayors in the B.C. Rural Health Care Alliance, a group that aims to present a collective voice in pushing the Health Ministry for solutions to the health care shortage.
During a conference call between rural mayors and Interior Health Authority officials on Monday, Goetz said one of the first questions asked was: “Can we look lifting the vaccine [mandate] for nurses?”
B.C. is one of the few provinces to maintain vaccine mandates for health workers.
A provincial public health order requires the approximately 190,000 health care workers in hospitals, long-term care homes and community health centres in B.C. to be vaccinated for COVID-19. The B.C. Public Service Agency also requires its 30,000 employees to be fully vaccinated.
Nearly 2,500 health-care workers in hospitals have been fired for not being immunized against COVID-19, according to the Ministry of Health. Almost half of them worked in the Interior and Northern health authorities, which is where staffing shortages have forced the persistent closures of emergency rooms.
But Dix told Postmedia News on Tuesday that he was firm that the province has no plans to lift the vaccine mandate.
“The issue on health-care staffing challenges is COVID-19, it’s not the mandate,” he said, explaining that staffing shortages are primarily due to people not coming into work when they’re sick. Dix said that 99 per cent of full-time health care workers have been vaccinated for COVID-19, so the number unable to work because they’re unvaccinated is relatively small.
B.C. Nurses’ Union said in a statement the union encourages nurses to be “vaccinated against communicable diseases as a preventive measure and in accordance with the most recent scientific evidence.” The union said the decision to revise any public health order “rests entirely with our elected officials.”
B.C. Liberal health care critic Shirley Bond said it’s time for the province to lift the vaccine mandates for health workers.
“We’ve looked across the country, British Columbia is certainly standing on its own,” she said. “There should be a very significant conversation about what a pathway back to employment looks like in British Columbia,” for unvaccinated health workers.
Goetz said rural mayors would also like B.C. to licence physician assistants, which could help fill vacant positions in small communities. Physicians assistants are permitted in four provinces and another two, Nova Scotia and Newfoundland, are running pilot projects. The assistants work under a doctor and assist with tasks such as examining patients, writing prescriptions and assisting during surgeries. Physicians assistants also work in the Canadian military.
A Port Hardy physician, Dr. Alex Nataros, has said he’s prepared to pay out of his own pocket for a physician assistant because he’s months away from being the only emergency department physician in Northern Vancouver Island town of 4,000 people, as his three colleagues have announced their departure.
Dix said B.C. does not have a physicians assistant training program and, as a result, the province has put its focus on helping internationally-trained medical graduates become licensed as “associate physicians.” Associate physicians are not licensed for independent practice but can work under physician supervision.
The province is also tripling the number of seats in the Practice Ready Assessment Program, a licensing requirement for internationally-trained doctors which Dix said has been a successful tool in providing doctors in rural communities.
However, Elkford Mayor Steve Fairbairn said it’s “immoral” to be poaching health care workers from other countries to shore up this country’s health system. Instead, the province should focus on removing the barriers for Canadians to train as health-care workers, he said.
Fairbairn is frustrated that the community’s emergency room has been closed since Sept. 29, 2021, a measure that was supposed to be temporary. A medical clinic remains open in the community of about 3,000 people which is 161 kilometres northeast of Cranbrook.
Fairbairn said he’s been living in the community for 33 years and “we’ve never before not had family doctors and I’ve never in this town seen as little health care as we have in 2023.”
Jude Kornelsen, co-director of the centre for rural health research at UBC, said while it’s always been difficult to sustain rural health staffing levels, the challenge became more acute during the pandemic as more people called in sick and some left the profession entirely because of burnout.
This has created “a lack of redundancy” that has hit rural communities harder than urban areas because “when one person leaves a community … for personal or professional reasons it destabilizes the whole community,” she said.
Kornelsen, who has studied the inequities in access to health care between rural and urban residents, conducted a survey of 381 rural citizens and found they spent on average $856 for transport and $674 for accommodation for a medical need, such as a surgery, once pre-surgery consultations, post-surgery care and other steps are included. This increased stress on patients and reduced the likelihood of seeking medical care for serious health issues.
For example, Kornelsen spoke to a woman who opted not to get cancer treatment because it would mean travelling far outside her community once a week for six weeks.
Kornelsen said she was happy to see Jennifer Rice, the B.C. NDP MLA for the North Coast, named the parliamentary secretary for rural health.
She would like an expansion of publicly funded virtual health care so that people in remote communities can do a telehealth visit, for example, for a consultation in advance of a surgical appointment.
When people do have to travel long distances for health care, Kornelsen said, the province should fully cover their travel and accommodation expenses up front to ensure people living in rural and remote communities do not face a financial burden for seeking health care.
“When we start seeing the dissolution of primary care, like in Port Hardy, we start actually seeing situations where community members have to leave just to access basic services,” Kornelsen said.
However, travel should be a last resort, she said. “We need to be strengthening and supporting primary care in rural communities because we know that strong primary care leads to better health outcomes.”
— With files from the Times Colonist