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Two doctors' frustrations a sign of turmoil in health care; 3,000 of their patients displaced

Family-medicine practice in View Royal will temporarily close its walk-in clinic in April; departing doctors explain their reasons

A View Royal family-medicine clinic is losing two physicians in the spring, forcing the displacement of 3,000 primary-care patients and temporary closing of a walk-in clinic catering to about 1,500 patients.

View Royal Mayor David Screech said “it’s a blow to the community.” Council is considering a motion to the Union of B.C. Municipalities asking the province to acknowledge that the doctor shortage is a crisis and solutions are badly needed, he said.

Once the physicians leave April 15, Eagle Creek Medical Clinic at 120-27 Helmcken Rd. will close its walk-in clinic.

The primary-care clinic will be left with five family physicians and two nurse practitioners — each with about 1,500 patients — and 12 medical-office assistants, as well as a separate high-complexity practice catering to 600 vulnerable patients, including people with mental health and addiction challenges.

Clinic medical director Matthew Ward said the clinic owners are devastated by the departures, which will affect any expansion plans and mean that for now, it’s neither sustainable nor safe to operate the high-demand walk-in service.

“I can’t tell you how much sleep I’ve lost over this, but I just have to close the walk‑in — I just can’t run it safely,” said Ward.

“The walk-in clinic closing is obviously devastating to our community and for that I am so sorry.”

The doctors’ departure will have a personal impact for Ward, whose wife and two young children are patients of the departing physicians.

Husband and wife doctors George Zabakolas and Chelsie Velikovsky, each with a caseload of 1,500 patients, said the ­decision to leave was difficult. “We did explore any [and] all possible options to find a replacement provider for affected patients,” the doctors told patients in a letter on Jan. 10.

In a phone interview, the pair cited burnout, lack of adequate compensation and support, overhead costs, inefficient use of their expertise, and trying to balance the demands of parenting toddlers with the need to work unpaid hours each day.

“We obviously have talked about this and thought about it a lot — it’s a principle, it’s the fact that we are so undervalued — it’s not the price,” said Velikovsky. “At the end of the day, it’s just that you feel so taken advantage of and used.”

Having done their medical residencies in the United States, the couple said they jumped through many hoops to work in Canada and settle at the Eagle Creek clinic about three years ago. Velikovsky grew up in Victoria and her family is here, while her husband is an American citizen.

The couple bought a house and are raising two toddlers. Velikovsky said her reservations about working in B.C.’s health care system began “almost immediately,” but she stuck it out because of family. “Otherwise I would have given up a long time ago.”

“It’s very difficult because of the guilt that we feel,” said Velikovsky. “And to be honest, coming back here, I feel a bit of embarrassment. I feel like our citizens of Canada, which is an otherwise great country, we’re getting like third-world health care, you know?

“Having to tell patients, ‘Sorry, there is not currently a psychiatrist accepting new patients right now’ or that ‘you’re going to be waiting 18 months to see this type of specialist,’ that is just embarrassing. I don’t know how else to say it.”

Zabakolas said he’s not suggesting U.S.-style private care is better, nor does he support doctors being paid on salary, because he thinks without the incentive of the fee per patient, doctors are less productive.

But the doctors also say the fee of $31.62 per patient visit is insufficient, pointing out there’s no fee code for a number of duties, from paperwork to reading lab reports, and there’s a shortage of people to do tasks that don’t require a medical degree. “We’re not working to our full potential here.”

Screech said if a new clinic in a prime location with an innovative model of care is struggling to recruit and retain doctors, something is very wrong. “The health-care system is crumbling and if we don’t have a real conversation about it, asking tough question about what we can do to make it more attractive to get doctors here, then we’re going to be in real trouble.”

Eagle Creek is less than a five-minute drive to Victoria General Hospital, adjacent to a surgical centre and beside a pharmacy. In 2020, it became part of the Western Communities Primary Care Network, one initiative in a provincial approach to attach more patients to family doctors and to support team-based care.

In partnership with the Ministry of Health, Island Health and the Division of Family Practice, the clinic expanded its space by just over 2,000 square feet and hired two new doctors and nurse practitioners.

“We were making really good headway,” said Ward. “It’s pretty cool what we’ve done here.”

He was eyeing expansion into a nearby tower. “I’m sure glad I didn’t sign a lease.”

Ward said he wants to work with all levels of government and the community to improve family medicine. “But we’re dying out here. We just cannot get doctors to come in and take on patient panels right now.”

He has looked as far away as England and Australia for a new physician. “I’m trying to look at this as a pivot but that doesn’t mean a lot to patients who have lost a family doctor — it’s very difficult,” said Ward.

If he can get another doctor, he hopes to reopen the walk-in clinic and continue to plan for expansion.

“Victoria is on fire right now when it comes to longitudinal primary-care patients who don’t have a family doctor — it’s well over 100,000 in Greater Victoria without a family doctor.”

Despite the area’s charms, candidate doctors are deterred by high residential and commercial property prices and the “inadequate” fee-for-service system, said Ward.

Ward said doctors are well paid but overhead costs eat up a fair amount of their take-home pay. With the $31.62 general fee billed to the Medical Services Plan to see a patient, at four patients an hour, that’s $120. Subtract $40 an hour for overhead and that’s $80, with no pay for paperwork, he said. To make more money means to spend less time with patients, said Ward, suggesting alternative funding models are needed.

“Mark my words, you are never going to see a new privately built family practice in Victoria again,” said Ward.

The province and Doctors of B.C. have just started to renegotiate a Physician Master Agreement that expires March 31. A new agreement isn’t expected to be signed until the fall. The Doctors of B.C. said amongst the most pressing concerns from doctors is the need to address the “continually increasing cost of running a business” and for the government to fund online services permanently.

Zabakolas and Velikovsky plan to continue with in-office and telemedicine until April 15, after which they will explore some combination of walk-in clinic and telemedicine work.

“We are not planning to pack up and move to the U.S.,” said Velikovsky. “We have our kids here and family support here, which obviously matters when you have two demanding professions. We hope to practise medicine in some shape or form in Victoria, but at this point, with the way the system is, it will not be longitudinal care. If there would be some serious changes in the system, we would revisit that.”