By Vanessa Hammond

Beacon readers know that the Victoria Health Co-op was established in 2008 to provide services for members and community outreach. In 2010 we heard that the medical office at 541 Michigan would be closed. At a General Meeting, the membership of the Co-op decided to try to keep a much needed health presence in the community. We have worked endlessly, covered gaps in revenue and run the Co-op Health Centre (CHC), as part of the Victoria Health Co-op, for six years serving around 5,000 patients.

During the past year there have been many positive changes in the CHC: great team of Medical Office Assistants (MOAs) and family physicians, who are dedicated to their work in the Co-op, upgraded electronic medical records, etc. But there are still challenges. Pierre Dil, our Medical Director at the CHC gives us a summary of one of the most challenging issues. Over to Pierre -

“What do you mean I don’t have a doctor?” This is the heart-wrenching daily question our staff tries to answer!

The lack of full staffing at the CHC has led to stress for the patients whose doctors have left, retired, or moved, for the present doctors and MOAs, and for the Board and members to meet all the costs. Every day our CHC personnel and Co-op Board field questions about how to connect with a family doctor.

It is very understandable that this is an emotive issue, as we all need health care!

Family physicians strongly espouse the ideas of longitudinal, and “cradle to grave” care, but for various reasons there don’t seem to be enough doctors to go around

A web search of the College of Physicians and Surgeons of BC “find a doctor” link, reveals zero doctors accepting new patients in Victoria.

Dr Bill Cavers, past president of the “Doctors of BC” is on record as saying the family doctor shortage in Victoria has reached a critical level forcing closures at some clinics.

Anyone trying to access care through walk-in clinics knows the potential run-around some weekends and nights. There’s even a new phone app for finding wait times at clinics, in an attempt to beat the problem!

Why is there a critical and growing shortage of doctors in Victoria?

Victoria is an expensive place to set up practice, with the high cost of housing. Medical residents transitioning to practice are less likely to pick Victoria, burdened as they often are with debt from their medical studies (anecdotal evidence only).

A drift away from general practice with more doctors electing to only work in special areas of interest, such as at lucrative walk-in clinics, hospitalist work, or working part-time, working shorter days and specializing - only taking maternity patients or patients with few complications or, conversely, only patients with chronic illnesses age 70 and older, for example. Medical students are less likely to select Family Medicine than these specialities as their area of study. But this trend is slowing.

Aging demographics in Canada in general and in Victoria specifically, with resultant higher incidence of complex illness. Victoria has the second-largest percentage of seniors in BC — 19.5 per cent as of 2014, according to Statistics Canada. The average across Canada is 15.7 per cent.

Hundreds of family doctors in BC are expected to retire in the next five years, raising concerns about the province's ongoing shortage of family practitioners. "The doctors are becoming an older group and a number of them are ready for retirement," said Dr. Shelley Ross with Doctors of BC.

Political failure of policy might be posited. The province has abandoned its election promise to match every British Columbian with a family doctor by 2015. The “GP for me” programme and the Chronic Disease fee management schemes have failed to meet targets. The government has certainly worked hard to implement change, and possibly we need to give policies more time?

The switch from salary to fee-for service payment to doctors at the CHC makes new models of care problematic.

The difficulty in accessing funding for non-MD medical and health professions such as Nurses and Social Workers.

What are we doing about the problem of insufficient doctors at the Co-op Health Centre?

We advertise for new doctors on a continuous basis – websites and journals of Victoria Divisions of Family Practice, Doctors of BC, Victoria Medical Society, College of Family Physicians of Canada, the Canadian Medical Association, and informally through the listings for new UBC family medicine graduates, through our Board’s contacts across and beyond Canada.

Several of our CHC doctors teach Island medical students, and UBC residents, hoping to boost retention in Victoria.

All CHC doctors are members of the Victoria Divisions of Family Practice, which advocates and actively recruits doctors to the island. We have a voice at that table.

Our doctors have served on the Victoria Medical Society committee, which tries valiantly to match patients and doctors.

We’ve had doctor/patient/MOA and Vancouver Island Health Authority Co-op meetings looking at ways to transition to new models of care, which would be more team based and less doctor-reliant.

Our CHC doctors have taken on hundreds of orphaned patients, prioritized by medical need, and have valiantly maintained drop-in care for our existing patients.

The Good News

On the positive side we have had a number of positive enquiries from new doctors who might start work here soon, some already taking locum days.

Lisa Helps, the Mayor of Victoria, attended the 2015 Co-op AGM, as an indication of her solidarity with the cause.

Community residents, patients and the members of the Victoria Health Co-op can all make a difference. Please read and act on the next section!

The Victoria Health Co-op is a founding member of the Health Care Co-op Federation of Canada and very much involved in negotiations, advocacy and education across and beyond Canada.

We see the community recognizing that this doctor crisis is not a problem created by the current doctors, MOAs, or the board. In keeping with the co-op spirit, this is a problem that we can solve collectively!

Community Action

Join the Co-op. Many patients have received their medical care in the same physical location for several decades and do not realize that care would have stopped on August 31st 2010 if the members of the Victoria Health Co-op had not stepped in to establish the Co-op Health Centre. Join the Victoria Health Co-op ($50 lifetime membership) to enjoy the benefits of membership and strengthen our voice.

Attend any Board meeting – any member of the VHC can participate, anyone can observe. Dates are posted on the door of the Co-op Health Centre and on our Facebook page.

Attend our Community Update meeting in November. Dates are posted on the door and Facebook.

If you are offered an appointment with the learners at the CHC, please take it as this will encourage them to stay with us!

Pierre Dil, Medical Director, Co-op Health Centre.

Thanks to Pierre, our very busy and dedicated Medical Director (who is also Assistant Site Director of the UBC Family Practice residency programme, always advocating for learners to come to the CHC) for giving us this outline of the challenges faced and the actions we are taking.

Please call or email me to ask questions, share ideas, etc.

Chair: Vanessa Hammond 250.415.92