By Melanie Law
Special to the Observer
If you don’t have a family doctor in Quesnel, you are not alone.
According to the organization Family Doctors for Better Patient Care in B.C., 900,000 people in B.C. don’t have access to a family physician.
Quesnel has approximately 25 full-time-equivalent (FTE) primary care providers – this includes doctors and nurse practitioners, according to Eryn Collins, the regional manager of media relations and public affairs at Northern Health. The city also has seven FTE specialists.
While Collins said Quesnel requires another 7.5 FTE primary care providers, Northern Health is currently actively recruiting for 4.5 FTE vacancies.
This is because some positions have been filled: Collins told the Observer that an international medical graduate, as well as two Practice Ready Assessment physicians, have been secured to move to Quesnel in 2022. (B.C.’s Practice Ready Assessment program gives internationally educated physicians an alternative avenue to gain their licence in the province.)
The City of Quesnel supports Northern Health’s recruitment efforts and employs a health care recruitment co-ordinator to help physicians who are new to Quesnel settle into the community.
The co-ordinator helps with things like accommodation or some of the needs of the physician’s partner or children.
Beverlee Barr, who holds the position, said she’s in contact with recruits before they arrive, and then supports them through their move and beyond. “I’m always available as a resource. This type of support can improve retention of healthcare professionals,” said Barr.
Short-terms are a long-term issue
While this is all good news, Dr. Gavin Grapes, chief of staff at G. R. Baker Memorial Hospital, outlined some of the major factors in recruiting doctors to Quesnel – and to rural British Columbia in general.
He said that the relatively short term that international doctors must serve in rural communities is a hindrance to maintaining stable care for residents.
International graduates and Practice Ready Assessment physicians must commit to spending two to three years in rural areas. And during that time, they are not necessarily able to take on the same kind of workload as a doctor who has been in the community long term.
“If a physician is only here for two or three years, they are going to spend the first six to 12 months getting to know the patient panel, which means they have little capacity to take on extra work,” explained Dr. Grapes. A stable, long-term practice can handle upwards of 2,000 patients, but a new physician will handle 80 to 90 per cent of what a more established doctor can take on.
And Dr. Grapes said many doctors choose to leave smaller cities after their term has finished. If doctors leave after just three years, the cycle begins again. And Northern Health can do little to change this: “This is a political piece this is not within our power to resolve locally,” explained Grapes.
Quesnel, and rural B.C. centres, have long relied on international medical graduates to staff their facilities. Doctors in communities like Quesnel will have a family practice and must also staff the hospital and provide emergency services after hours. “[In rural sites] we really have to do it all. But that just cements local [Canadian] graduates not wanting to come to work here,” Grapes noted.
And there are other factors at play in discouraging Canadian medical graduates from taking positions in rural areas. In B.C., doctors are paid a flat rate regardless of the type of appointment. As Dr. Grapes noted, the fee for a telephone appointment and an in-person appointment is the same.
He said that the increase in virtual and telephone services since COVID began have been helpful in getting Quesnel residents access to care, in some respects: routine appointments, or simple things like prescription refills, can be outsourced as telephone appointments.
But Dr. Grapes explained that this, too, can put more pressure on physicians in rural centres: if fees for simpler appointments are being paid to doctors providing virtual care from anywhere, then Quesnel residents are mainly going to see local doctors for more complex, time-intensive appointments. Some rural doctors are doing more work for the same pay.
“The benefit to the public is you can access virtual care,” Grapes explained. “The downside to that is it is taking away some of the simpler, easier visits from longstanding family physicians, which actually makes our work more difficult because now we’re engaging with the more difficult work showing up in office. That takes more time, but only gets paid the same as a virtual visit.
“When you have a flat-rate service, irrespective of how it’s delivered or how long it takes, there’s an incentive for newer doctors to go with the simpler stuff,” he noted. All of these factors contribute to the difficulty of bringing experienced doctors to a rural community.
“Doctors don’t work in a vacuum”
And the issues with staffing are not just for physicians. “Doctors do not work in a vacuum… all specialty services in the hospital are linked to the availability of nursing services. They are all interconnected and can’t work without one another,” said Dr. Grapes. He said that the intensive care unit was shut down for about a week in June due to lack of nursing and ancillary staff.
The construction currently going on at G. R. Baker Memorial Hospital, in fact, is meant to help with some staffing issues. “After hours, we have two critical care nurses in the hospital. One in intensive care and one in the emergency room. [Currently] these areas are three floors apart. So they are not able to physically cross-cover each other when one wants to take a break,” explained Grapes.
“We are hoping this is going to make things more sustainable for our staff… We are trying to stabilize our services. We are not expanding, per se,” he said.
Urgent and Primary Care Centre
There have been attempts to try to change the medical landscape of Quesnel. In 2018, Northern Health opened Quesnel’s Urgent and Primary Care Centre (UPCC) as part of a Ministry of Health strategy to reduce the number of non-emergent cases in the hospital’s emergency room and to work towards increasing the number of patients attached to family doctors. Quesnel was an early adopter of the program, in the hopes the centre could take some of the pressure off ER staff.
“Overall, I think the Urgent and Primary Care clinic already has made a big difference to our services here,” said Dr. Grapes. When the clinic first opened, local doctors and nurse practitioners were staffing the facility beyond their usual duties. But a dedicated physician, Dr. Arman Tahmasbi, was eventually hired to staff the clinic.
But Dr. Grapes told the Observer that Dr. Tahmasbi has given his notice, and is leaving the clinic.
“Unfortunately, so far, we still have no interest in the full-time position,” said Dr. Grapes. If the position is not filled by the time Dr. Tahmasbi leaves, other local physicians will continue to staff some hours so the UPCC can remain open; but Dr. Grapes said it won’t be available full time until another doctor is hired.
He said it’s a worry for the community going forward since the UPCC was able to offer services to locals who are not attached to a family physician.
“In the past, before the Urgent Primary Care, people were trying to show up in the emergency room; but you know, when you’re dealing with someone with a heart attack and another person with a laceration and someone with a fracture, and someone’s showing up, knocking on the door, trying to get a prescription – it’s not the right place for that,” noted Dr. Grapes.
He said Northern Health is currently exploring a few options for a full-time staff member at the clinic.
Locals who don’t have family doctors can also visit the Goldcity Walk-In Clinic on Reid Street, which is not affiliated with Northern Health. The clinic, which is generally open Monday to Friday from 2 p.m. to 6 p.m., has one doctor.
Experienced doctors are a necessity
There have been recent recruitment successes, though: according to Northern Health’s Collins, a Practice Ready Assessment physician started in the community in March, and an international medical graduate arrived in April.
Other Northern Health successes include filling a full-time nurse practitioner vacancy and hiring a new ear, nose and throat (ENT) specialist who is now practising in the community.
While the recruitment of new doctors is good news, Dr. Grapes said losing more experienced physicians is still a big concern, and can have a huge effect on the stability of the medical offerings in the community.
More skilled physicians are needed to mentor newer doctors, he said. But as doctors achieve a higher level of experience, they take on more work – and this can lead to burnout.
“We have a small group of doctors providing specialist services with a high amount of calls,” said Grapes. “I’ve got two internal medicine specialists that are on call every second night… I’ve got three [general practitioners] at the moment providing C-section coverage, sharing with a specialist,” he said.
“The problem is that it is impossible to get someone with the same skills to come in and spell you [to take time off]. Those are the groups that I’m worried about,” he said.
Dr. Grapes, who has 28 years of experience as a physician, said he has only had one full week off since the onset of COVID in February 2020.
“We are holding it together as best we can,” Grapes said.
Nevertheless, Dr. Grapes said he’s cautiously optimistic. With family physician numbers down across the province, he feels Quesnel is, at least, in a good position. “We’ve always tried to be in front of the ball for a community of our size,” he said.
“I just worry about the sustainability of the specialist services and the interconnection with our like-skilled nursing colleagues,” he concluded.
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