After multiple attempts to see a doctor to deal with the blisters forming under the cast on her six-year-old daughter’s arm, Julie Sidorak ended up using a clean sock and baby powder to try to fix the problem herself. She would have preferred to consult a professional, but staff at the emergency room where the cast was applied said she would have to go to her family doctor. That’s a major problem though, because almost a year after moving to Abbotsford from Calgary and looking for a family doctor, Sidorak still can’t find one.
ER staff suggested she go to a walk-in clinic, noting one which is equipped to deal with casts. Sidorak called. Despite an opening time of 9 a.m., she was told there was no doctor until after 1 p.m. That afternoon, she headed to the clinic with her family.
When they arrived, there was a note posted on the door. “Closed due to a lack of doctors.”
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Sidorak is far from unique in her search for a physician. About one in five people in Abbotsford do not have a family doctor. Five years ago, the former health minister promised that everyone in B.C. needing a family doctor would have one by 2015. In 2013, the government, in partnership with Doctors of BC, expanded a pilot program called A GP For Me province-wide, in order to try and make that a reality.
A GP For Me is designed to increase the capacity of the primary health care system, through efforts established by the local division of family practice, specifically geared to that community.
One of the main stated goals is to connect every patients who wants a family doctor, with one. In April of this year, Health Minister Terry Lake said in the legislature that while 20 per cent of Albertans and 25 per cent of Quebecers don’t have a family doctor, that number is only 16 per cent in B.C., adding that the A GP for Me program has made significant strides. The Abbotsford Division of Family Practice, a non-profit society with the authority to speak for Abbotsford family physicians, is implementing the program locally.
They’ve found that about 26,000 people in the city are not attached to a family physician, while 5,000 to 6,000 people are actively looking.
When health issues arise, those without a family doctor may go to walk-in clinics or even the emergency room – adding to the existing strain on those resources. With a population of nearly 140,000, Abbotsford has 126 general practitioners, but only 79 are family practice doctors who see patients in a clinical setting – the rest are hospital-based or work in maternity. When patient openings are available, it become a matter of connecting those who are looking with an available doctor.
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Bohdan Zajcew, strategic lead for the implementation of A GP for Me program in Abbotsford, said research has shown there are huge benefits to having a long-term family doctor, particularly for the elderly, or people with chronic health issues. Family doctors can help provide better outcomes for patients, with lower costs to the health care system. However, he said the number of doctors accepting new patients “shifts on a week-by-week basis.”
The College of Physicians and Surgeons of B.C. has an online search engine to find doctors who are taking new patients. Sidorak said at one point she was given an information sheet which pointed her to the website.
A search turned up the names of four physicians, but as Sidorak called, she was repeatedly told those doctors weren’t accepting patients. Zajcew said the site is “well-intentioned, but unfortunately, it is not kept current.” There is no organization charged with the role of connecting patients and doctors, which is why the Abbotsford Division of Family Practice hopes to create such a system. The organization will keep lists current by being in touch with doctor’s offices weekly, said Zajcew. However, connections are just one piece of the puzzle. More doctors are needed in order to meet the demand, both locally and provincially.
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Abbotsford has an existing shortage of general physicians. To complicate matters, more than half of Abbotsford’s doctors are more than 50 years old.
Twenty per cent – each with about 1,500 patients – plan to retire in the next four years. Communities around the province, particularly in rural areas, are facing the same issues. Dr. Justin Boparai, a lead physician with A GP for Me, has been a doctor in Abbotsford for about two years. After completing his residency at Abbotsford Regional Hospital through the University of British Columbia residency program, he decided to stay. The same program that brought him to the community is a great recruitment tool for other young doctors, he said, as it creates “net-new” doctors, says Zajcew, meaning it doesn’t take a doctor out of another community to fill a vacancy here. With more doctors set to retire, Boparai said there needs to be more succession planning.
“Really, we need to have new doctors to take over practices – and there is a shortage of new doctors to do that.”
In addition to med school grads, Zajcew said they need to work more proactively with doctors who have some interest in relocating to Abbotsford. Zajcew said there are expressions of interest provincially, nationally and internationally, and “we feel we can do a better job of landing those.
“To keep our heads above water, we need to be recruiting about five to six physicians a year,” said Zajcew.
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Sidorak said even people she knows with a family doctor can end up using walk-in clinics because they can’t wait for their own doctor to have an opening. “I’m just drawing a conclusion now that apparently, walk-in clinics are what people do around here.” Only 65 per cent of a doctor’s working hours in Abbotsford is spent face-to-face with patients. The remainder involves filling out paperwork, forms, and completing other administrative duties. Looking for efficiencies is one way of addressing the pressure on a GP’s time.
Dr. Bill Cavers, immediate past-president of Doctors of BC, said the provincial doctor shortage dates back to the ’90s, when the government reduced the number of medical school graduates by 10 per cent, based on a UBC report that said there were too many doctors per capita.
However, Cavers said what that report overlooked was the aging demographic of baby boomers. Now, age-related issues have hit patients who increasingly need treatment for chronic illnesses at the same time that doctors are slowing down as they near retirement.
More young doctors now have spouses who also have careers, and doctors are not working the same number of hours, and therefore are not putting in the same number of work years in return for their training. The younger generation is “more interested in having a better work/life balance,” and not working 60-hour weeks like older doctors did, he suggested.
But the solution is not having all doctors work an extra hour each day, said Cavers. Doctors’ offices need to be more efficient, with methods such as using computer records in order to increase doctors’ availability for patients. Doctors also need support so they don’t get burnt out and can keep working longer, particularly those who are nearing retirement age.
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Attracting new doctors and primary care to the community is essential to existing residents, as well as being vital to attracting new residents. Wendy Dupley (in photo at left), the city’s director of economic development, said they are working collaboratively towards that goal. Dupley sits on the recruitment and retention committee for a GP For Me, as she said it is “important that the city has skin in the game.”
GPs are a vital component of the workforce of the future – but “the pool, globally, of physicians is getting smaller, and the competition to attract those physicians is getting greater.”
Dupley said it’s about making sure Abbotsford is on the radar of the people who may be interested in what this city has to offer. It is “vitally important” to show the opportunities for a doctor’s spouse and family here, such as work and schools. She said government can’t do it alone, and there needs to be a “community table,” which is what the committee aims to do.
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As communities struggle for physicians in a global shortage, the reality of every Abbotsford resident having their own family doctor may not be resolved in the immediate future. The entire province needs 450 new doctors a year to replace the current outflow. UBC med school graduates 288 annually.
“It’s scary,” says Cavers. But pilot projects of the A GP For Me program have been successful, he said. In White Rock/South Surrey, everyone who wants a family doctor has one, following the implementation of the program. Cavers said the plans for Abbotsford and other communities have only been adopted in March, so results will still be forthcoming.
“Are we going to be able to provide a family doctor for every British Columbian? I don’t know, but that’s the goal and if you don’t aim for something you’ll accomplish nothing.” As patients continue to search in Abbotsford, Cavers has simple advice: “Do not give up hope, just wait for a little bit … and keep on trying.”
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But for a would-be patient like Sidorak, waiting and trying again is not a solution to the problem – at least not at this time. Instead, Sidorak has seen her former doctor when visiting Calgary, and plans to do so again.
As a mother of a young child, she wants to try and prevent serious health issue through primary care, before needing to use the emergency room. But now, her husband is also experiencing some allergies that are impacting his breathing, and she’s not sure what to do.
“I guess we’ll just wait until it’s really bad and then go to emergency.”
For now, she’s thankful her family is in generally good health, and not suffering from a chronic illness. But she remains concerned about not having access to a doctor.
“Everyone should have a family doctor, and you should be able to see them when you’re not well.”