Nearly one million residents of British Columbia do not have a family doctor. Many blame the province’s fee-for-service system


Camille Currie has less than a year of autonomy on her pacemaker and does not have a family doctor.

The Greater Victoria resident and mother of two says she also suffers from bleeding and connective tissue disorders which would make post-operative care difficult when she has the battery replaced. If she is having trouble healing, she is afraid of having to wait in line at an urgent and primary care center (UPCC).

Currie also says her two children have a rare autoinflammatory disorder.

Yet she and her family are among nearly a million British Columbians without a family doctor. According to the BC College of Family Physicians, only 80% of residents of the Capital Regional District have one, compared to 84% of the province’s population.

According to Canadian technology company Medimap, which publishes wait times for walk-in clinics online, residents of British Columbia are waiting an average of 58 minutes in walk-in clinics — more than double the national average. Victoria had the longest average wait time in the country at over 2.5 hours.

CBC spoke to patients, doctors and others affected by the shortage for a special series titled “A crisis of care: the shortage of family doctors in Greater Victoriato look at the roots of the problem, and one issue that came up repeatedly was BC’s fee-for-service system.

Current system leading to physician burnout

Fee-for-service is a system of care that pays physicians for each office visit.

People familiar with how it works say the high volume of paperwork required for doctors to get paid – combined with the low take-home pay it generates – discourages doctors from practicing family medicine, creating an urgent need for family physicians. and use of emergency rooms and clinics.

“British Columbia doesn’t provide us with universal health care,” Currie told the CBC show. All points west tuesday.

New research shows that residents of the Greater Victoria area wait on average longer than anywhere else in the country to access walk-in clinics and, on average, are less likely to have a family doctor than Britons. Colombians living elsewhere in the province. (Mike McArthur/CBC)

11:12Crisis of care: consequences for patients of the closure of family medicine practices

Camille Currie is one of thousands of people who lost their family doctor when two doctors left the Eagle Creek Clinic in View Royal. This experience inspired her to become, champion and create the BC Health Care Matters Facebook page and website. She spoke with Robyn Burns. 11:12

However, Greater Victoria doctor Jennifer Lush is trying.

Lush has been a family physician for 20 years and understands why others would choose not to be. Most doctors are paid around $30 per patient visit, and from there, Lush pays for staff, medical equipment, and office space.

She says she works 70 hours a week and struggles to balance work and personal life.

Half of Lush’s hours are unpaid, she says, because they’re spent on paperwork.

“As soon as my kids are in bed, I pull out my computer and start tracing. A lot of times I trace until two or three in the morning,” Lush told CBC. On the island tuesday.

Comparable to minimum wage

A report published in the Canadian Family Physician Journal in November 2021 found that promising physicians are more likely to choose hospital work and specialty practice over family medicine – in part because they are concerned about the implications of pay at the British Columbia act. service model on work-life balance.

Alicia Pawluk became a doctor in 2018 and works at the hospital in addition to treating patients at the Cool Aid Community Health Center in Victoria.

She says that under the current system, the net income of a family doctor is comparable to the minimum wage.

“The average licensed doctor has about $200,000 in debt. The minimum wage will not be able to cover the kind of payments we have to make,” Pawluk said.

In May 2020, the College of Family Physicians of Canada called for alternative funding models to replace the fee-for-service method to recruit and retain more family physicians.

British Columbia Health Minister Adrian Dix said connecting people to a family doctor has been his “highest priority” since taking office in 2017.

To reduce the administrative burden on doctors and help those who don’t, Dix’s ministry has invested in UPCCs to provide same-day emergency and non-emergency support. He said the province was also increasing the use of alternative payment methods to attract more family physicians.

“The willingness of doctors and others to work with us to reform and improve the system is there, and we need to do that,” Dix said. told CBC On the island Thursday.

On the island11:21Today we launch our series ‘A Crisis in Care – the Shortage of Family Doctors in Greater Victoria’. This morning we will hear why family physicians are abandoning private practice in our community.

Gregor Craigie spoke with CBC feature producer Jean Paetkau about the challenges of being a family doctor under the fee-for-service system. 11:21

“I only received this care too late”

Change can’t come soon enough for Joy Williamson, who has been without a doctor for eight years. Diagnosed with breast cancer in 2020, she thinks it would have been caught earlier if she had had one.

“I didn’t get this care until too late,” said Williamson, who explained that the cancer had spread to her lymph nodes by the time it was detected and she had to have her whole breast removed instead of a lumpectomy.

Joy Williamson believes that not having a family doctor delayed her diagnosis of breast cancer. (Submitted by Joy Williamson)

The day before her operation, Williamson was worried she had a blood infection and says she traveled Greater Victoria with her husband and two children for hours looking for a UPCC that was not full. She ended up waiting five hours in the emergency room for a diagnosis.

Currie hears how frustrating this is. She created British Columbia Health Care Issuesa website where patients can request a change and share their stories.

These stories include parents who waited eight hours in the emergency room with sick children and an elderly couple with mobility issues who stood in line for hours, several days in a row, at a UPCC that was constantly full.

As the time draws closer to Currie’s ongoing surgery, her own fear grows.

“This pacemaker is going to wear out and I can only pray that I can trust the system,” she said.