Ian Schokking says we’re already facing crisis with old doctors retiring and new ones unprepared to fill the gaps<\/p>\n
If you think it\u2019s difficult trying to find a family doctor in Prince George, get in line.<\/p>\n
You\u2019re not alone.<\/p>\n
It\u2019s estimated that one out of every three people in the city is unattached to a family physician. That leads to long lines at the two drop-in medical clinics in Prince George \u2014 and a crush of people regularly clogging the emergency ward at University Hospital of Northern BC.<\/p>\n
And the problem is expected to worsen with an aging population of both patients and care providers.<\/p>\n
Patients have more complex needs as they age \u2014 but if they aren\u2019t visiting a doctor regularly, that reduces the likelihood those conditions will be managed before they turn into serious health risks.<\/p>\n
It\u2019s estimated one in six doctors in the country are approaching retirement age. Those pending retirements \u2014 and a generational reluctance by new doctors unwilling to work the long hours of their older peers \u2014 could leave millions more Canadians without a primary-care provider.<\/p>\n
\u201cWe have a system that\u2019s in crisis,\u201d said Ian Schokking, a 64-year-old Prince George family physician and one of 15 doctors currently working at Northern Health\u2019s Urgent and Primary Care Centre (UPCC) at Parkwood Place.<\/p>\n
\u201cThe issue is that the system is built on people of my generation who work 24\/7 and are always available \u2014 and that\u2019s what the BC College of Physicians and Surgeons’ rules say we need to do. When I trained (40 years ago), we did 100- or 120-hour-a-week training, and that was the volume you got used to working. That\u2019s what you do and you don\u2019t doubt it.\u201d<\/p>\n
Since then, Schokking says physician unions have gotten stronger and have limited medical-student training and two-year residencies to 40 hours per week. They graduate with half or less the training doctors in his era had, when medical students regularly turned in 80- or 100-hour work weeks.<\/p>\n
\u201cThe first consequence is people are used to working that volume and don\u2019t want to work more \u2014 and the second is they\u2019re scared, they don\u2019t have enough experience and they don\u2019t have enough context,\u201d said Schokking.<\/p>\n
\u201cVirtually all the grads are limiting their clinical environments because they don\u2019t have the clinical experience in their training. They\u2019ve limited the amount they can train at the suggestion of their union \u2014 and the notion that if you don\u2019t sleep enough, you don\u2019t learn.\u201d<\/p>\n
That generational shift means doctors are less independent and aren\u2019t put in positions where they might be the only physician working a night shift \u2014 something Schokking looks back on as one of his most valuable learning experiences. He agrees a societal reset was needed so doctors could devote more time to their families, but says the pendulum has swung too far and doctor shortages are the result.<\/p>\n
Longitudinal care a requirement for BC doctors<\/p>\n
The BC College of Physicians and Surgeons policy is clear: all its registrants must provide longitudinal care for their patients. Family physicians and specialists are ethically and legally responsible to ensure patients have access to after-hours care for urgent medical issues, either in person or virtually.<\/p>\n
Longitudinal care means a family doctor who takes on a patient is expected to develop a primary-care relationship that offers continuous healthcare support over an extended period \u2014 basically until death. Familiarity with the patient generally leads to better management of chronic conditions, reduced hospitalizations and improved overall health.<\/p>\n
Schokking, who received the College of Family Physicians of Canada award as a family physician-of-the-year finalist, says the new pay structure introduced by the province in 2023 to increase the number of family physicians has removed the incentive for doctors to work in local walk-in clinics and cover hospital shifts.<\/p>\n
\u201cIt used to be everybody worked in the hospital \u2014 and gradually that has eroded, and now we have a big problem with only seven of us working in long-term care, when we used to have 15 taking on new patients,\u201d said Schokking.<\/p>\n
\u201cWe\u2019re about to get 200 new beds with the new facility at O’Grady\u00a0\u2014 but who\u2019s going to look after those patients when they build it? We\u2019ve got fewer and fewer doctors looking after their own patients, and we\u2019ve had four more bail in the last three months, and their work falls on the same few of us who do long-term care, urgent care and hospital work.<\/p>\n
\u201cThere\u2019s more and more work being dumped on fewer and fewer of us as the old docs age \u2014 and it\u2019s mostly the young docs who have been bailing. They\u2019re doing office practice only \u2014 they\u2019re not doing hospital\u00a0or nursing-home work anymore\u00a0and they\u2019re not working at the urgent-care clinic.\u201d<\/p>\n
The UPCC now has just 15 doctors \u2014 a staggering drop from the 69 physicians who used to fight for shifts when it was run by the Nechako Medical Clinic group at Spruceland Mall starting in 1991. Half of those doctors left when the clinic moved to Parkwood Place in 2019.<\/p>\n
The new service model means doctors at the UPCC who used to be paid per patient (fee-for-service) now receive a fixed hourly salary. So instead of seeing six to eight patients an hour, they\u2019re paid to see only four per hour. As a result, only 12 to 15 of the city\u2019s 100 family doctors work at the urgent-care clinic \u2014 meaning patients no longer have immediate access to a doctor. On arrival, people are triaged by a nurse and referred based on their urgency \u2014 not on when they arrived.<\/p>\n
Schokking has a solution that would restore quick access \u2014 though it would require a shift in thinking across the family-doctor community.<\/p>\n
\u201cIf we asked for four hours per month from all our docs in town, our urgent-care clinic would be open, our hospital work would be managed,\u201d he said. \u201cIf all the doctors who have stopped doing what they used to do gave me an hour a week, my urgent problem would be solved.<\/p>\n
\u201cI think if we could somehow encourage docs to look at their social responsibility and provide a little bit of time, then we could weave new grads into the system we have and we’d have less of a problem.<\/p>\n
\u201cWe have to figure out how to provide 24\/7 care in a way that works for Gen Z. The answer we’re using now doesn\u2019t work.\u201d<\/p>\n
The lack of access to urgent-care doctors at the UPCC and Salveo Medical Clinic at Real Canadian Superstore puts more pressure on the emergency ward at UHNBC \u2014 and patients are forced to go to hospital for minor ailments or to get a prescription filled.<\/p>\n
The province has tried to ease hospital pressure by allowing pharmacists to renew an existing prescription for up to three months and setting up virtual-video links to connect patients to doctors. But Schokking says that doesn\u2019t compare to a longitudinal doctor who knows you and your healthcare needs \u2014 and who won\u2019t bill the system for unnecessary scans or duplicate tests.<\/p>\n
\u201cPeople do not value longitudinal care, and data suggest having somebody in that relationship with you saves 40 per cent of health dollars,\u201d Schokking said.<\/p>\n
Province introduced new doctor-payment model in 2023<\/p>\n
The potential cost savings drove the province to introduce the Longitudinal Family Physician (LFP) blended-payment model in February 2023 to increase the pool of GPs and improve access to primary care.<\/p>\n
The LFP model streamlines administrative tasks and removes some of the burden so doctors have more time with patients. Doctors receive payments based on their panel size and the complexity of each patient\u2019s needs. Billing is simplified: visits are coded according to complexity and duration.<\/p>\n
Since it became a voluntary alternative to fee-for-service, more than 4,300 family physicians have signed on, but that didn\u2019t create more doctors. It meant many shifted from hospital and urgent-care work to office-based longitudinal care because of the financial incentive.<\/p>\n
Years ago, GPs working in hospitals treated less acute patients and referred complex cases to specialists. But when GPs left hospitals for office practice, they were replaced by hospitalists \u2014 who now make up about one-third of all family-medicine graduates \u2014 and these physicians do not provide longitudinal care.<\/p>\n
In June 2024, the province expanded the LFP model to include doctors working in hospitals providing inpatient, pregnancy\/newborn, long-term and palliative care.<\/p>\n
\u201cIf you get urgent care organized, then you\u2019d get all these people having somebody provide some care for them \u2014 there wouldn\u2019t be so many people who walk in with six problems and cancer that somebody has missed,\u201d said Schokking.<\/p>\n
\u201cWe\u2019re working in an under-resourced environment with no good model to pivot from a system run by doctors who worked everywhere always, to one where everybody is much more compartmentalized. Everyone\u2019s fighting each other for resources.\u201d<\/p>\n
LFP introduction prompted rural-doctor exodus<\/p>\n
Under the LFP model, doctors are paid more for office-based work than for clinics or hospitals \u2014 and that change has carried a heavy price for rural Northern Health.<\/p>\n
\u201cThe consequence was you now get paid quite a bit more to work in the city seeing patients, so places like Prince Rupert lost 10 doctors and rural medicine got killed by the LFP model,\u201d said Schokking.<\/p>\n
\u201cMany who moved to longitudinal care came from urgent care and hospital work. They incentivized longitudinal care \u2014 but the 24\/7 piece got hurt, particularly in rural areas. The manpower drain probably cost us 15 per cent of our rural doctors. The bonuses that had kept them rural no longer had the same differential.\u201d<\/p>\n
Schokking suggests the province find new incentives for communities so that new recruits receive bonuses for devoting part of their time to hospital work, urgent care, long-term care and obstetrics \u2014 wherever they are needed.<\/p>\n
Schokking says hospital work is not fun like it used to be because many healthcare positions are unfilled. The staff shortage extends to nurses \u2014 many of whom left the profession during the pandemic or were fired for not getting COVID-19 vaccines.<\/p>\n
\u201cBC is different than any other province \u2014 and during COVID it refused to let unvaccinated nurses work,” said Schokking. “In the\u00a0Peace Country we lost 40 per cent of our nurses \u2014 they either went to Alberta or changed careers, but most stopped nursing,\u201d said Schokking.<\/p>\n
\u201cThe province could have been creative and let them all work in virtual care short-term, but they didn\u2019t. They said you can\u2019t do any job \u2014 and the consequence, at a time of severe shortages, is we lost a bunch of doctors and nurses.\u201d<\/p>\n
Prince George clinics feeling pinch of doctor shortages<\/p>\n
Since Northern Health took over the UPCC in January, the clinic averaged 2,137 patients per month through the first three months of the year \u2014 and that number has increased each month. The clinic has 19 doctors who provide primary care to those not attached to a doctor or nurse practitioner. When capacity allows, those doctors also provide urgent or episodic care.<\/p>\n
The UPCC is open weekdays from 8 a.m. to 8 p.m., and weekends and holidays from 9 a.m. to 5 p.m. Doctors working weekdays after 4 p.m., or on weekends or statutory holidays, see only urgent-care patients.<\/p>\n
\u201cWhile the Prince George UPCC is making progress to increase the number of patients seen, Northern Health recognizes the needs in the community remain high,\u201d said a Northern Health spokesperson. \u201cEfforts to recruit primary-care providers to provide coverage at the clinic are ongoing.\u201d<\/p>\n
The privately owned Salveo Medical Clinic at Real Canadian Superstore is open weekdays from 8 a.m. to 4 p.m., Saturdays from 9 a.m. to 3 p.m. and closed Sundays. It currently has just two doctors who bill under fee-for-service: they receive full pay for the first 55 patients seen, half pay for the next 10, and no compensation beyond that.<\/p>\n","protected":false},"excerpt":{"rendered":"Ian Schokking says we’re already facing crisis with old doctors retiring and new ones unprepared to fill the…\n","protected":false},"author":2,"featured_media":7543,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[49,48,84,392,8151],"class_list":["post-7542","post","type-post","status-publish","format-standard","has-post-thumbnail","category-healthcare","tag-ca","tag-canada","tag-health","tag-healthcare","tag-ian-schokking"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/7542","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/comments?post=7542"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/posts\/7542\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media\/7543"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/media?parent=7542"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/categories?post=7542"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ca\/wp-json\/wp\/v2\/tags?post=7542"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}