Why Victoria is losing so many family doctors and struggling to recruit new ones

The closure of another walk-in medical clinic in the Greater Victoria area is prompting calls for change. 

The Colwood Medical Treatment Centre said it will shutter its walk-in clinic on April 15.

In a statement on its website, the centre said a "chronic physician shortage in the Greater Victoria area" has made it impossible to sustain walk-in services seven days a week, adding that one of its family physicians will be retiring on March 1.

The announcement comes after two doctors at the Eagle Creek Medical Clinic in View Royal said they will be closing their practices on April 15. Its walk-in clinic will close and transition to "an in-house 'doctor of the day' program."

LISTEN | Why Victoria is losing so many family doctors

Lisa Jarvis, the clinical manager of the James Bay Medical Treatment Centre, says it is closing next month as its family physician is stepping away after putting off retirement for years. 

"We've been searching for a replacement for him, but unfortunately we just haven't found anybody that wants to take over ownership of a clinic like ours," Jarvis said. "He had been deferring it for so long that eventually he just had to make the hard decision and commit to a retirement date." 

While the centre has been able to find doctors willing to work shifts, it has not found someone willing to take over a clinic that operates on a fee-for-service model, which sees doctors and hospitals paid by the province for each office visit, test or operation. To stay afloat, they need to work through a high-volume of patients and run a business at the same time.

"As a walk-in, there's often a lot of overhead," Jarvis said. "When you take on the ownership, you're responsible for that and have to work quite a few shifts in order to cover the costs. We're walk-in as fee-for-service so you have to see a specific amount of patients, bill a specific amount in order to cover that overhead."

Province focuses on team-based care strategy

In a statement, B.C.'s Ministry of Health said it is developing a strategy to address the issues on southern Vancouver Island.

It noted that recent closures involve privately-run clinics where operational decisions are made by clinic managers.

The ministry said it launched a team-based care strategy in 2018 designed to change the delivery of primary care services. Under this approach, the province will establish 85 primary care centres, 40 urgent and primary care centres, and 15 First Nations primary care centres in the province.

The province said it is also committed to community health centres, including one set to open in Westshore this spring, which will serve families in Colwood, Langford, Highlands and Metchosin.

The new Westshore Community Health Centre, the ministry said, will serve as an example of its "approach to ensuring sustainable primary care that is not purely reliant on private clinics" and will include family doctors, nurse practitioners, registered nurses, social workers, and community health workers.

Addressing burnout

Dr. Ramneek Dosanjh, president of Doctors of B.C., said the closures are a symptom of a lack of support to keep clinics running, a problem that has only been amplified by the COVID-19 pandemic. 

"We've known for quite a while that we've had this broken system that we've been trying to work at collaboratively to fix and to keep people that are in practice to keep practising," Dosanjh said. 

While there are no easy fixes, Dosanjh said the focus should be on making family practice more attractive to more doctors while enhancing patient care. 

Doctors are keen to explore different ways to be compensated for their work, Dosanjh said, and Doctors of B.C. is working with the province to find alternatives to a fee-for-service model. 

"Our goal is to provide a range of ways for doctors to receive their compensation so they can choose which one works best for them," Dosanjh said.

"For some people, the existing fee-for-service structure works wonderfully and they make their clinic work, so we're not looking to change that." 

Retention is key, Dosanjh added, and efforts should be made to offset things like business cost premiums for physicians in existing offices. 

Dosanjh said she agrees with the idea of a team-based approach, but more needs to be done to address doctor burnout. 

Assistance with administrative duties and the adoption of new technology – Dosanjh noted that fax machines are still in use in doctor's offices – could reduce stress and allow doctors to focus on patient care. 

"I think when we spend time on … tasks that don't require our skillset, it is again a factor that leads to burnout."