The Vancouver Island doctor shortage, explained

In the lead-up to Election Day, Capital Daily brings you a series of explainers breaking down the issues that you have told us matter most to you in the 2020 campaign. Today, Solon Dolor explains why Vancouver Island seems to have such a critical shortage of family doctors.

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It’s no secret that for newcomers to Vancouver Island, it is basically impossible to find a family doctor. And for thousands of others, the retirement of a family physician can often leave them with no place to turn. In a BC Medical Journal editorial published just before the onset of COVID-19, recently retired Parksville doctor Jonathan Winner wrote that the local doctor shortage has reached crisis proportions.

But while it’s not much comfort to those without primary medical care, the situation on the Island isn’t actually that out of step with the rest of the country. “The doctor drought in the Island’s communities is symptomatic of a problem felt by the whole nation,” says Dr. Kathleen Ross, president of Doctors of BC, a group comprising 14,000 physicians, residents and medical students across the province. “We hear these same concerns echoed, across the province [and] across Canada actually, where we just simply don't have enough bodies.”

“Some provinces fare much worse than BC and Quebec is an example,” said Damien Contandriopoulos, a University of Victoria School of Nursing professor. The situation in Victoria, he said, is about close to the Canadian average. Across Canada, 15.3% or about 4.7 million people do not have access to primary healthcare providers including family doctors, according to 2017 Statistics Canada data released last year. While BC’s 18.2% was higher than the national average (and means about 900,000 in the province had no access to primary healthcare providers) it was not the highest. Quebec and Saskatchewan were at 22.3% and 19.4%, respectively.

Physicians have a right to decide where they want to practice, which means supply will not be equal among places. As Winner pointed out in his March editorial, it’s been apparent for decades that BC doctors are increasingly staying away from family practice. As early as the 1980s, he wrote, “the family practice model we were all working in was becoming less attractive to the next generation of doctors, who were able to work in walk-in clinics.”

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Again, it’s no comfort to the thousands of Islanders with minimal prospect of finding a family doctor, but Contandriopoulos estimates that about 70% of Vancouver Islanders had a regular family doctor. However, this does not necessarily mean that the doctor is readily accessible. In a study of 11 developed countries in 2016, The Commonwealth Fund found that a fifth of Canadians waited more than seven days to see a family doctor. Seeing a specialist, meanwhile, can take four or more weeks.

For Southern Vancouver Island in particular, the problem is exacerbated by a disproportionately elderly population. The 2016 census found that Vancouver Island had a higher median age (47.8) than the province (43), and old people, on average, visit the doctor more often than young people. “As our population increases and the number of seniors with complex medical conditions increases, the medical needs of our population outpace our human resources,” says Ross.

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A health crisis like COVID-19 can largely be battled without the need for family doctors; health histories and longstanding patient relationships are less critical when dealing with a highly infectious, fast-acting disease.

But when it comes to cancer or heart disease — by far the largest killers in BC — relying on walk-in clinics can have deadly consequences. Contandriopoulos said that relying on this kind of ad-hoc medical care can delay the beginning of treatment for weeks or months. “Longitudinal” care is also particularly valuable in addressing BC’s other ongoing health crises: Mental health and addictions.

Statistics Canada says that Canadians who lack a regular health professional are much less likely to engage in routine health prevention measures. In 2017, 35.9% of Canadians aged over 12 with a regular provider got the flu shot, compared to just 14.7% for those who did not have a regular provider. The same pattern is observed in cancer screening and mammograms. Canadians aged 50 to 70 who have a regular provider were more than twice as likely to adhere to colorectal cancer screening guidelines than those without (45.6% vs. 19.2%). Women in the same age group who had regular providers were nearly twice as likely to have a mammogram within the last three years (80.7% vs. 49.1%).

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For years, BC family doctors have been disproportionately aged 50 and up. And as more and more of them neared retirement age, it was clear that very few would be in line to take their place.

The problem, as experts told Capital Daily, is not necessarily a shortage of qualified professionals graduating from med school; Ross noted that BC has already upped its intakes of med students and residency spots. Rather, as family doctors age out, a more realistic solution may be to reform the province’s decades-old model of family doctors as the primary gatekeepers to healthcare. Instead, Ross argues, BC could do well to pursue coordinated teams of nurse practitioners, midwives and other professionals taking on the role of primary care; lightening the load on the Island’s physicians.

Contandriopoulos says Canada has been sedate in making the shift to these “intraprofessional teams,” despite vast scientific evidence showing their success in other countries. A key change, he said, is shifting the “fee for service” model, in which physicians are paid by the visit. Whether a doctor visit is for a sore throat or for the first stages of leukemia, they’re all paid the same. As one doctor told Capital Daily, it’s akin to a dentist charging the same for a tooth polish as for complex dental diagnostics.

“Unfortunately, you can't take a tired horse and whip it harder to make it work,” said Ross. “We can't look at our beleaguered primary care system in the community and continue to push harder for it to work in a way that's not working.”

With files from Tori Marlan