The province-wide doctor shortage is causing a medical clinic in Gordon Head to close at the end of August after half a century in operation.
Patient files and the four remaining doctors at the Gordon Head Treatment Centre at 1595 Mckenzie Ave. will move to Lansdowne Medical Clinic on Hillside Avenue in late August.
The Gordon Head clinic lost five doctors to retirement in 2019, but the final straw was this month’s departure of Dr. Daniel Mendrek, 34, who is moving to Prince George, where his partner will do her residency. The house doctor, Mendrek sees the most patients and covers 42 per cent of the hours at the clinic.
His departure leaves doctors Layne Woodburn, Ellen Marie Skinnarland and Robert Shepherd, along with Michael Greenwood, 72, who started at the clinic in the 1980s.
“We’re just absolutely swamped the whole time and the phone is ringing off the hook and people are coming in with multiple co-morbidities because they don’t have a family doctor,” said Greenwood.
About 920,000 people in B.C., or 17.7 per cent of people age 12 and older, are without a regular health-care provider, according to a Statistics Canada 2019 report. The national average is 14.5 per cent. Only Quebec has more patients without family doctors.
The Victoria Division of Family Practice is advertising for doctors to staff 11 clinics in Greater Victoria, while Health Match B.C. has 118 family-physician positions posted for the Island.
As of Feb. 28, B.C. had 6,943 active family doctors, up from 6,251 in 2017. In the same period, however, B.C.’s population grew to 5.15 million from 4.89 million.
Woodburn, 66, said the Gordon Head clinic has “advertised for somebody, anybody,” with no success.
“There’s nobody else apparently interested or they’ve had several better offers.”
The doctors are worried about uprooting their patients, some frail seniors and some with mobility issues.
“We all feel really bad, as though we’re dealing a blow to the community by abandoning them,” said Woodburn. “We have patients phoning in tears every day talking to our staff saying: ‘I can’t find anybody to replace my family doctor.’ ”
Skinnarland, 64, has worked as a family doctor at the clinic since 1998 and was a part-time palliative-care physician for almost 20 years at Victoria Hospice.
Before the loss of physicians in the past three years, the Gordon Head clinic was open year-round, 12 hours a day, seeing about 100 patients a day.
Increasingly, the clinic has been overwhelmed by patients orphaned by other retiring doctors, said Skinnarland.
In 2019, the doctors would arrive to find 25 to 30 people at the door before opening, with as many turned away during the day. “It was absolutely awful and demoralizing — all of us began to dread to go to work,” she said.
In recent years, Skinnarland said she has seen far too many cases of late diagnoses of cancer and other serious diseases due to the physician shortage and resulting lack of care.
If the Gordon Head clinic had a nurse practitioner, part-time mental health worker and social worker it would be able to provide primary care to “thousands of patients who consider us to be their family doctors,” Skinnerland said.
Mendrek, who studied in the Caribbean, worked from 9 a.m. to 3 p.m. as a family doctor in Duncan to complete what’s called a “return of service,” which follows a residency for foreign-trained doctors. He typically did hospital work over his lunch period, and most nights drove to the Gordon Head clinic to help cover a walk-in shift. He has since reduced his schedule.
“The burnout was real,” said Mendrek. “But the lack of coverage for these patients is what drives me to do these shifts. I feel guilty, as if I’m abandoning them if I close down for a Saturday.”
He has adopted a “hybrid” approach, performing urgent care while also ensuring patients get appropriate follow-up. He said he sees evidence of the gaps in patient care every day — tests not performed, diagnoses not followed and redundant tests performed, wasting diagnosis and treatment time and money.
“A lot of family doctors are retiring and there’s not enough coming in to take over the spots,” said Mendrek.
Dr. Benjamin How, 63, who with three other doctors runs a full-service family practice with a walk-in clinic at Oak Bay Medical Clinic on Oak Bay Avenue, said every time one clinic closes, “the remaining clinics have more pressure to see more patients and patients wait even longer.” He knows of 20 doctors in the region who have closed practices without replacements in the past two years.
Primary care doctors offer care where one practitioner sees a patient and ideally their family over their lifetime, seen as the best way to prevent and manage disease. Walk-in clinics offer episodic care, but a patient who regularly uses such a clinic essentially becomes a primary care patient.
Urgent and primary care centres provide services similar to what private physician offices provide, according to Island Health, but offer weekend and evening hours, same-day mental-health and substance-use services, and contracts for doctors rather than fees for service.
In 2018, the province promised funding for 200 additional general practitioners to work in team-based care, and for 200 nurse practitioners.
It announced a three-pronged approach to address the doctor shortage: Primary care networks to co-ordinate health-care providers; urgent primary care centres to offer care that’s needed within 24 hours and to give ongoing care to patients without family doctors; and community health centres tailored to broader social services and preventive care needs.
Most doctors seem to agree a team approach is desperately needed, but doctors interviewed by the Times Colonist don’t see evidence that it’s happening.
“I could see a lot more patients if I had a nurse working with me,” said Skinnarland. Most family practices need at least a nurse and mental-health-care worker, she said, but that would cost another $150,000 on top of other overhead, including rent.
“If I’m getting $20 per patient I can’t possibly fund a nurse,” said Skinnarland. “If I had a nurse who could help my diabetic patient, that would be more cost-effective for the government than spending millions on these urgent primary care centres, which are not providing longitudinal care.”
The added expense is small compared with the extra cost of even just a few patients ending up in ER, said Skinnarland.
Woodburn said one colleague’s request for a registered nurse from Island Health came with a condition the practice take on an additional 500 patients, so instead of relieving pressure, it would add it.
Greenwood, who trained at St. John’s College in Cambridge and St. Mary’s Hospital in London, England, had his own practice in the region from 1977 to 1992 and was medical director of the Victoria Pain Clinic, where he worked from 1993 to 2009. He’s still practising because he loves the job — he had wanted to follow in his father’s footsteps since age two.
“I can’t imagine doing anything else,” said Greenwood. “It’s just the most rewarding job you can possibly imagine. It’s just too much at the moment.”
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