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'Lot of burnout': Richmond doctors feel strained running private practices

Younger doctors are largely rejecting the old family practice model, not wanting to practice medicine and run a business.
Dr. Sharon Dodd is a Richmond family doctor, who is feeling strained by a system that she feels the government should support more.

Family doctors have long been considered the backbone of the health-care system, providing primary care to most British Columbians for decades at privately run practices.

But that backbone is strained and thousands of Richmondites currently don’t have a family doctor.

Many family doctors are carrying large case loads and can’t take any more patients despite daily calls from people desperate for a GP.

Dr. Sharon Dodd, who runs two medical offices, wishes the government would listen to family doctors on the front line to find solutions, including modernizing the payment system, compensating for complexity of care and after-hours administrative work, bringing in team-based care, supporting the business side as well as looking at how other provinces are dealing with similar crises.

“We just want to be able to sit down with government and come up with these solutions,” she said.

Young doctors steering clear of  private practice

Patients are aging as their doctors age, requiring more complex care, and few young doctors are coming into the system, Dodd added.

The fact fewer young doctors are going into family practice has also been noted by the health ministry.

While Health Minister Adrian Dix said family doctors have been providing “great care for a long time,” and the system has “real advantages,” younger doctors don’t want to work in this kind of business model.

“Overwhelmingly, when you poll younger doctors, they tell you, we don’t want to open our own business and take fee-for-service clients and operate the way family practice in the primary care was in the past,” Dix said.

In 2010, the BC Liberals launched “A GP for Me” to get a family doctor for every British Columbian, but the doctor shortage remained.

NDP challenges fee-for-service health-care model

When the BC NDP won the election in 2017, they took a different tack by introducing an alternative to the traditional fee-for-service funding system.

In fact, Dix recently called the private practice model a “very 1960s style” system. Instead, he touted solutions like “team-based” practice, primary care networks, nurse-practitioners and Urgent and Primary Care Clinics (UPCC).

Dix acknowledged “it’s not an easy challenge” but added he feels the action the province is taking now will help resolve the family doctor crisis.

Dix was recently in Richmond to announce the opening of the permanent location of the UPCC.

When he became health minister, B.C.’s primary care system had more fee-for-service practices than other provinces, he explained at the opening.

While UPCCs are currently set up to relieve pressure at hospital emergency departments and provide medical services to people who don’t have family doctors, Vancouver Coastal Health (VCH) said the emphasis starting this fall will be on “longitudinal” care, that is, looking after patients long-term like a family doctor does.

Since the temporary UPCC was set up in Richmond a year ago, it’s had 13,000 visits. The UPCC in Richmond has doctors, nurses and other health-care professionals as well as X-ray services in a “team-based” care environment. 

“This is not addition by subtraction — this is in addition to all the incredible work done by primary care doctors,” Dix said.

Family doctor the quarterback

But Dr. Angela Shen, a family doctor who runs Acqua Medical in Richmond, is skeptical whether UPCCs will be able to offer more than emergency care, whereas family doctors operate like “quarterbacks” for their patients.

“Basically, we’re losing the quarterbacks,” Shen said. “No one wants to do this job because you don’t get paid very well and… there’s a lot of burnout because we don’t feel very appreciated (by the government).”

Family doctors bill the government about $33 per visit, but many visits include a lot of administrative work and follow-up, she added. Furthermore, office rents are going up.

There will still be “quarterbacks” in the new Primary Care Network (PCN), according to VCH.

New primary care network to provide wrap-around support

However, the focus will be on “wrap-around care” with doctors, nurse-practitioners, social workers and other health-care providers working as a team, VCH explained.

When the first primary care network (PCN) was established in Richmond in 2019, VCH said it would “fundamentally” transform how services are organized and delivered and it “marks a significant departure” from how primary care has historically been delivered.

“This traditional approach is rooted in a strong sense of professional autonomy among family physicians, with the consequence that family practice clinics in some communities are not well-integrated with other parts of the health system,” VCH said in a statement.

Private practice doctors and government agree more workers needed

But regardless of approach, both private practice family doctors and the government agree more health-care professionals are needed to fix the system.

The Ministry of Health has increased family doctors by 10 per cent since 2016.

The annual budget for Richmond’s PCN is about $15.3 million to hire 70 full-time clinical staff and seven administrative support staff. So far, however, only 31.5 have been hired.

Dr. Julie Wilson, who owns and runs Terra Nova Medical Clinic, has tapped into some of these resources.

She recently hired four nurse-practitioners to work in her office, paid for through the PCN.

These nurse-practitioners, however, work separately from the GPs with their own caseloads.

While this offers more medical services to Richmond residents, it doesn’t help relieve Wilson’s workload as she continues to run her clinic and take care of her own full patient load.

“I think the system is so strained that the addition of these nurse-practitioners, while helpful, is not even the beginning of the solution,” Wilson said, adding more family doctors as well as more nurse-practitioners are needed.

Like other doctors, Wilson is constantly saying “no” when asked if she can take more patients. 

She likens her clinic to being the “medical home” for thousands of patients with the plethora of tasks that come with each patient.

“ never ever ends. It’s like being a parent to thousands of people,” Wilson said.

For those looking to connect with a family doctor, the Richmond Primary Care Network has provided a registration process