In May 2021, Debra Barlee and her husband, Ron, decided to sell their home in Maple Ridge, British Columbia, about an hour’s drive east of Vancouver, and move to the rural town of Creston, near from the Canada-US border in the southeast of the province.
They left everything behind: their friends, their family, their jobs.
Everything, that is, except their family doctor, who still resides in Maple Ridge, eight hours away.
Since moving, the 66-year-old retiree, who suffers from rheumatoid arthritis, said she hasn’t made the long drive back for an in-person appointment, relying instead on phone calls with her doctor , visits to the Creston Valley Hospital and Health Center Emergency Room and Specialty Clinics.
“It’s a downside,” she said. “An eight-hour commute is a big deterrent to going to see your doctor.”
But Barlee has also tried unsuccessfully to find a GP in Creston as the town – like many others in British Columbia – struggles with the demands of a strained healthcare system.
As an estimated one million British Columbians struggle to find a family doctor, health care providers say they are providing more remote health care to patients, thanks in large part to advances in telehealth spurred by the COVID-19 pandemic.
Telehealth services allow patients to receive medical care remotely, using phone calls, text messages, emails, online videos, and other digital tools. Patients do not need to have a pre-existing relationship with the practitioner to access services or make an appointment.
Data from Canada Health Infoway shows that virtual care utilization in Canada increased from 10% in 2019 to 60% across all provider categories in April 2020. In 2021, the same analysis found that the number had decreased slightly, with 40% of all virtual visits.
The Canadian Institute for Health Information, meanwhile, found that the percentage of physicians in British Columbia who provided virtual care services increased by nearly 20% between February and September 2020.
But while advances in technology have helped provinces speed up virtual care during COVID, doctors say telehealth appointments aren’t a permanent solution to BC’s doctor shortage and can have far-reaching implications. on patient health over time, such as increased morbidity and mortality rates for those who cannot find a dedicated family doctor.
“Family doctors have the ability to build a long-term, lasting relationship, so they get to know you and understand how your body works,” said Doctors of BC President Ramneek Dosanjh. “Patients have the opportunity to talk with their family doctor about everything that concerns them, especially if they have this long-term, trusting relationship.”
“Virtual care can be a mutually beneficial way for family physicians to see patients,” she added. “But it needs to be clear that virtual care is a complement to in-person care, not a replacement.”
There are no rules governing how close a patient is to their doctor. The College of Physicians and Surgeons of BC states that it is appropriate for a college enrollee to end their relationship with a patient if, among other examples, a “patient moves to another community, making in-person assessments impossible. required person”.
However, this same standard of practice states that physicians should carefully consider ending a relationship with a patient and “first make every reasonable effort to resolve the situation.”
Weigh the worst-case scenarios
Like Barlee, Rick Merrell, 71, kept his family doctor in White Rock – a town south of Vancouver near the Canada-US border where he spent most of his adult life – after being returned to his hometown of Creston to live out his final years.
“If it was serious then, I should definitely go [to White Rock]”said Merrell, who is also currently looking for a new family doctor.
“I’m trying to kill two birds with one stone with other appointments, but I’m juggling some of my medical needs to account for gas prices.”
Dr. Carllin Man of the Lower Mainland, meanwhile, said the cost of travel is only part of the equation when it comes to a patient’s worst-case scenario.
“When they are sick, even if they can come to see me, is that a good idea?” he said.
Man, who offers both telehealth and in-person care at the Welcome Medical Clinic in Burnaby, estimates that 15 to 20 of his approximately 800 patients live outside the Lower Mainland, in places like Courtenay, on Vancouver Island, and Hope, about two hours drive east of Vancouver.
He said the costs associated with family medicine are to blame for the lack of general practitioners in British Columbia.
“If I wanted to do just family medicine, it would be hard to make a living and pay the bills,” said Man, who also works in a nursing home and does occasional locum work in Alberta.
“[B.C.’s] the fee for service system is visit based rather than time based so you have to spend more time which means we either have to rush [a patient’s] problems…or see them longer and basically take a pay cut. »
A cost for the health system
Although the economics of family medicine are difficult for health care providers, doctor shortages tend to cost the entire health care system more, says Dr. John Pawlovich, clinical professor in the Department of Medicine. family from the University of British Columbia.
“It’s very expensive. Every time a patient walks through the door of an emergency room, the cost is immense compared to the care provided in a family doctor’s office,” he said. .
Pawlovich says patients with a family doctor not only get better health outcomes, but health care providers can also benefit from providing long-term care.
“It’s arguably much more rewarding to follow people over time and share a patient’s life journey.”