Human resources

Doctors at medical clinics talk about lack of support, resources and the province’s failure to provide health services

One of the city’s walk-in medical clinics has chosen to cut hours after suffering from burnout, the crippling effect of limited resources and a chronic understaffing.

The Ancron walk-in clinic has been operating seven days a week for 10 years, but since March 31 it has reduced its weekday walk-in traffic, operating only on weekends (10 a.m. to 2 p.m. ) on a first-come basis. , First served.

Citing numerous reasons – including lack of support from the healthcare community, the BC Division and government – ​​the clinic felt it no longer had the capacity to meet the growing demand. of walk-in patients in addition to his own family practices.

The decision leaves a significant hole in the delivery of health services in the city. While the clinic operated full time, she helped patients who were alone and attached to Nelson, as well as those who were visiting or temporarily in town.

The service has reduced demand in emergency departments in the Kootenay-Boundary region, with the number of patients consistently assisted through the system resulting in up to three full-time practices.

The Nelson Daily asked the doctors at the clinic what their decision was and they got a very detailed answer.

The Nelson Daily: What do you mean that Ancron was affected “without the support of the healthcare community, BC divisions and government?”

Ancron: In 2021, the walk-in component of Ancron Medical was overwhelmed with phone calls from patients desperate for appointments and help.

We were receiving more than 300 calls to the office a day, which prevented both walk-in patients and attached patients from reaching our overwhelmed staff. The journey to this is complex, but is largely due to the exodus of family physicians from longitudinal care due to retirement and shifting scope of practice to other medical roles.

There has been a significant loss of patient attachment over the past five years. Although an adequate number of family physicians are trained each year, new family medicine graduates are not replacing retired physicians as they choose higher paying positions such as hospital work, addictions, or other underserved fields. specialists, both public and private.

This has led to less attached patients all over British Columbia and, in fact, across Canada.

In addition to the loss of family doctors, we also lost an internal medicine specialist and four psychiatrists in Nelson. Ancron Family Physicians all manage large populations of attached patients in addition to working in the hospital to see inpatients or assist with obstetric/maternity care coverage.

The walk-in clinic is run by these same physicians in addition to their full-time family practices to which patients are attached. We are committed to helping the community access medical care, but this burden has become unsustainable for our clinic to manage in isolation.

The Nelson and Area Family Physicians Collective are unable to assist us with sessions to staff walk-in clinics due to personal pressures to run their own clinics, cover their own overhead, see attached patients and inpatients, cover maternity care, cover Emergency Department and cover ancillary services such as sports medicine, addiction medicine, oncology and pain clinics.

We have not been able to secure long-term locum for the walk-in because the pay is low compared to salaried positions, or rural or out-of-province locum opportunities, and physicians who would have the time to walking -in sessions chose to work in more lucrative sessions and positions.

Our clinic was so overwhelmed with calls from single patients asking for help that our staff burned out and three quit and two went on sick leave. Staff morale was low, the workload (between our attached patients and our walk-in) became unsustainable for family doctors as well as our medical assistants (MOAs).

The volume of calls meant that our existing attached patients were unable to call or reach us and get help. We had to keep our existing memoranda of understanding, and the biggest contributor to low staff morale was the demand from walk-in patients as well as the significant (and growing) cases of verbal abuse from people who got treat in our clinic.

After contacting the Divisions of Family Practice BC in November 2021 with our concerns and asking for assistance in formulating a strategy to keep the walk-in clinic open, we were advised that no assistance would be available from the Ministry of Health. Episodic walk-in care is undervalued by the healthcare community, both locally and provincially.

Despite significant pressures on the system, family physicians in Nelson did their best to maintain attachment to a family care provider, but ultimately inadequate compensation and rising overhead worked. as a barrier to achieving optimal attachment to a primary care setting (which should be the good of every citizen of this province and country, and falls within our health care system).

If there was adequate attachment, there would be less need for a walk-in clinic, however, adequately attaching people to a family physician and primary care team has been nearly impossible due to the overall inadequacies of the system that Ancron has graciously compensated for, for more than 10 years. years.

TND: What support did you not have?

Ancron: We have not had any funded allied professional assistance made available to us. Our overhead costs are not subsidized.

As mentioned above, we are unable to attract physicians to work in private practice. Fewer and fewer family physicians are willing to work in the clinic, whether it’s longitudinal care or episodic walk-in care. They are attracted to alternative, better-paying positions that have little or no overhead, paperwork to carry, after-hours responsibilities to monitor incoming labs, or having to find a replacement if they are absent from work or are moving.

Ancron has been operating seven days a week since 2010. This has been made possible because the clinic’s organized staff and family physicians take turns covering walk-in shifts on weekdays and weekends to allow people with and without family to have access to health care the same day. physician, thereby reducing inappropriate use of emergency services.

We have recognized this need and this importance of offering people access to care. We continued to provide weekend access because it was morally difficult for us to give up this service altogether.

This is a voluntary service funded entirely and solely by the income of doctors who have subsidized the costs of our public health care system, namely office rent, medical supplies, salaries of medical assistants, maintenance and telephone system/EMR costs. At the same time, doctors’ income has not increased in line with inflation, with no significant increase in salaries since 2006, and it has become impossible to continue covering insurmountable overhead costs without significant personal sacrifice on the part of doctors. , while trying to maintain decent salaries for their staff and cover rising costs.

Under the current payment model and rate, we are being punished for spending time with patients with complex issues, which if we do, we do so at a high personal cost where we have to choose between patient care and time to spend with loved ones. , or face the rising costs of operating clinics.

Often, after clinic hours, we spend much of our free time doing paperwork related to patient visits with no pay or recognition for that extra time, missing family dinners, or doing paperwork after the children are in bed.

It is morally unjust and untenable. The healthcare system takes advantage of physicians and their professional duty to their patients.

TND: What support are you looking for?

Anchor :

• covering overhead costs such as renting office space, staff salaries, EMR/telephone costs, essential supplies needed to provide care;

• two MOAs;

• a full-time social worker;

• a full-time nurse or nurse practitioner;

• 1.0 to 2.0 full-time equivalent of another compensation contract for primary care providers (preferably at least 1.0); and

• family doctor and 1.0 full-time equivalent nurse practitioner to staff walk-in seven days a week.

TND: Will you change your decision if your conditions for assistance are met?

Ancron: We know how important the walk-in clinic is to many patients in the region, whether attached or not, and we want to discuss solutions to expand this service in a sustainable way.

If we have the support of the above, current Ancron physicians could each work some of the walk-in sessions while being able to offer an attractive per-session rate to other family physician providers in our area. for working sessions.

With the two additional MOAs, patients will be able to connect with the clinic to book appointments and our existing MOAs can be retained. A social worker will be a great asset in helping vulnerable patients access the resources needed to improve patient outcomes. A nurse practitioner will be able to help patients with longitudinal care.

Our immediate achievable goals would be:

• reduced emergency room visits;

• earlier diagnosis of a complex disease in the group of single patients;

• improving patient access to routine medical screening in a timely manner;

• access to care for people with mental health problems;

• vulnerable populations have access to comprehensive health care; and

• Improved patient outcomes will be a long term sustainable goal, patient lives will be saved.

TND: How many walk-in patients per day did your clinic see?

Ancron: About 40 per day on weekdays, and 20-30 on weekends.