North Vancouver Island doctor says 2 resignations mean he'll be working solo in local ER

A doctor working in a northern Vancouver Island emergency room says two of his colleagues will be resigning at the end of June, leaving him as the only emergency physician in Port Hardy, B.C.,  unless the province answers his call for support.

On Jan. 20, Dr. Alex Nataros posted on social media that two other physicians will be leaving their posts this summer.

"This week TWO #PortHardy doctors announced their resignation effective June 2023," read his post. "I will be the only doctor left in Port Hardy emerg on July 1. I need help."

This forthcoming staffing shortage has prompted Nataros to reinforce his calls to the province to allow him to hire a physician assistant, which he spoke to the CBC about in December.

It's a call the Canadian Association of Physician Assistants echoes — on Jan. 24, the association said it had submitted a proposal to the province asking for physician assistants to be introduced into B.C.'s health-care system, particularly in rural and remote areas. 

"[Physician Assistants] will alleviate the stresses imposed on the system," the association said in a statement. 

Physician assistants work under a doctor to perform many of their duties, such as conducting patient interviews and exams, assisting in surgery and writing prescriptions under the name of the doctor.

Unlike nurse practitioners, physician assistants do not practise independently — all the work they do is in the name of the doctor they work for. 

Nataros said the population his hospital cares for is largely Indigenous. He believes it "amounts to systemic racism" that the province has yet to approve his physician assistant to help care for this population.

"Not a day goes by that there aren't poor outcomes in the health of our Indigenous population on the North Island because the provincial government is not allowing me to hire a physician assistant," he said.

The Ministry of Health responded by stating that creating equitable health outcomes for Indigenous and First Nations communities is a priority. 

"Through our primary care strategy, we have been rolling out Primary Care Networks across the province that includes budgets for elders, traditional healers, mental health professionals, and First Nations-specific primary care clinics," a spokesperson for the ministry said.

Port Hardy Mayor Pat Corbett-Labatt has written a letter to Health Minister Adrian Dix asking him to introduce a trial project for physician assistants. Hundreds of physician assistants are employed across Canada, according to the Canadian Association for Physician Assistants; the position has been used by the military for decades and is regulated in Alberta, Manitoba, Ontario, Nova Scotia, and New Brunswick — but not B.C.

In its response, a Ministry of Health spokesperson said the province will have more to share on this issue "in the coming days" but is working to recruit doctors to fill vacancies in the region. They also recognized the use of physician assistants. 

"We continue to monitor their implementation in other provinces and are actively exploring the potential for their inclusion as a new classification of health-care worker in British Columbia," wrote the ministry spokesperson. 

"With that said, introducing a new health profession requires careful consideration, management and significant resources to properly understand and address the inevitable team function issues that emerge from overlapping scopes of practice."

'Lone country doctor'

The Port Hardy community is home to a population of around 4,000 people and sits at the northern tip of Vancouver Island.

"For a population of our size, we should have seven full-time doctors," Corbett-Labatt said. "This is just adding to the concern and the worry."

She says a new doctor will arrive in Port Hardy in August, but the system will remain strained as the hospital is also short seven nurses.

In a statement to CBC, Island Health said it has not received any official resignations at this time. It said in addition to one recently added doctor in Port Hardy, two new doctors have relocated to the nearby community of Port McNeill and another new physician began working on Cormorant Island in the fall.

"Recruitment and retention of health care workers and physicians to the Mt. Waddington region is a key priority," the health authority said.

For the past 18 months, Port Hardy's hospital has faced ongoing emergency room closures due to staffing shortages.

Corbett-Labatt said that due to staffing shortages among physicians and nurses, Port Hardy Hospital's emergency room was closed 1,274 hours from July 2022 to January 2023, roughly 25 per cent of the time it should have been open.

Just this past Friday, Island Health announced that the emergency room would remain closed overnight from 5 p.m. to 7 a.m. until Feb. 6.

Island Health said patients requiring emergency care during that time should go to the emergency room at the Port McNeil Hospital, a 30-minute drive away. According to Corbett-Labatt, the drive between the two hospitals is remote and not consistently covered by cell service.

Nataros said he has spoken with North Island MLA Michele Babchuk, who told him she has met with Minister Dix on the issue. A spokesperson for MLA Babchuk said she was unavailable to comment.

The ministry also reiterated its announcement from November, when it created a new health worker category called "associate physicians."

It covers internationally-trained doctors who are not yet qualified to practise as fully-fledged doctors in B.C. and allows them to do work similar to a physician assistant.

Nataros would be happy to have an associate physician or a nurse practitioner join his team in Port Hardy if he's unable to get a physician assistant, as he needs "all hands on deck."

On Feb. 1, the Ministry of Health is introducing a new payment model to support team-based care, which Nataros believes is a cornerstone of rural medical treatment. 

"No longer can you run a health-care system just with a lone country doctor. We need to make sure we're creating sustainable health-care teams," he said. 

"The new payment model being introduced by doctors of B.C. and the Ministry of Health is a big step in the right direction, but to really make that work in rural B.C., we need physician assistants."