Another medical clinic set to close due to doctor shortage
The province-wide shortage of physicians led to the closure of a medical clinic in Gordon Head at the end of August after half a century of operation.
Patient records and the four remaining physicians from the Gordon Head Treatment Center at 1595 Mckenzie Avenue will move to the Lansdowne Medical Clinic on Hillside Avenue in late August.
The Gordon Head Clinic lost five retired doctors in 2019, but the last straw this month was the departure this month of Dr Daniel Mendrek, 34, who moves to Prince George, where his partner will be residing. The household doctor, Mendrek, sees the most patients and covers 42 percent of the hours at the clinic.
His departure leaves Drs Layne Woodburn, Ellen Marie Skinnarland and Robert Shepherd, as well as Michael Greenwood, 72, who started at the clinic in the 1980s.
“We’re absolutely overwhelmed all the time and the phones keep ringing and people come in with multiple co-morbidities because they don’t have a family doctor,” Greenwood said.
About 920,000 people in British Columbia, or 17.7% of those 12 and older, do not have a regular health care provider, according to a 2019 Statistics Canada report. The national average is 14.5 percent. Only Quebec has more patients without a family doctor.
The Victoria Division of Family Practice advertises physicians to staff 11 clinics in Greater Victoria, while Health Match BC has 118 family physician positions posted for the island.
As of February 28, British Columbia had 6,943 active family physicians, up from 6,251 in 2017. During the same period, however, the population of British Columbia has grown from 4.89 million to 5.15 million. .
Woodburn, 66, said the Gordon Head Clinic had “advertised for anyone, anyone” to no avail.
“There is no one else apparently interested or they have had several better deals.”
Doctors fear uprooting their patients, some frail elderly and some with mobility problems.
“We all feel terrible, like we’re doing the community a blow by giving it up,” said Woodburn. “We have patients who call in tears every day and talk to our staff saying, ‘I can’t find anyone to replace my family doctor.’ “
Skinnarland, 64, has been working as a family physician at the clinic since 1998 and was a part-time palliative care physician for almost 20 years at the Victoria Hospice.
Prior to the loss of doctors over the past three years, the Gordon Head Clinic was open year-round, 12 hours a day, receiving approximately 100 patients per day.
Increasingly, the clinic has been overwhelmed with patients orphaned by other retired doctors, Skinnarland said.
In 2019, doctors would arrive to find 25 to 30 people at the door before opening, with as many pushbacks during the day. “It was absolutely horrible and demoralizing – we all started dreading going to work,” she said.
In recent years, Skinnarland said she has seen far too many cases of late diagnoses of cancer and other serious illnesses due to the shortage of doctors and the resulting lack of care.
If the Gordon Head Clinic had a nurse practitioner, part-time mental health worker and social worker, it would be able to provide primary care to “thousands of patients who see us as their family physicians,” said Skinnerland.
Mendrek, who studied in the Caribbean, worked 9 a.m. to 3 p.m. as a family doctor in Duncan to perform what is called a “return of duty”, which follows a residency for physicians trained in. abroad. He usually worked in the hospital during his lunch break and most nights he went to the Gordon Head Clinic to help cover a walk-in shift. He has since reduced his schedule.
“The exhaustion was real,” Mendrek said. “But the lack of coverage for these patients is what drives me to make these changes. I feel guilty, like I’m giving them up if I close for a Saturday.
He adopted a “hybrid” approach, providing emergency care while providing patients with appropriate follow-up. He said he sees evidence of gaps in patient care every day – tests not performed, diagnoses not followed and redundant tests performed, wasting time and money on diagnosis and treatment.
“A lot of family physicians are retiring and there aren’t enough arrivals to take the places,” Mendrek said.
Dr Benjamin How, 63, who, along with three other doctors, runs a full-service family practice with a walk-in clinic at the Oak Bay Medical Clinic on Oak Bay Avenue, said each time that ‘one clinic closes: “other clinics are under more pressure to see more patients and patients to wait even longer. He knows 20 local doctors who have closed practices without replacement in the past two years.
Primary care physicians provide care where a practitioner sees a patient and ideally their family during their lifetime, considered the best way to prevent and manage disease. Walk-in clinics provide episodic care, but a patient who regularly uses such a clinic becomes essentially a primary care patient.
According to Island Health, emergency and primary care centers offer similar services to private doctor’s offices, but offer weekend and evening hours, same-day mental health and addiction services. , and contracts for physicians rather than service charges.
In 2018, the province pledged funding for 200 additional general practitioners to work as a team and for 200 nurse practitioners.
He announced a three-pronged approach to address the physician shortage: primary care networks to coordinate health care providers; primary emergency care centers to provide necessary care within 24 hours and to provide ongoing care to patients without a family doctor; and community health centers adapted to broader social services and preventive care needs.
Most doctors seem to agree that a team approach is desperately needed, but doctors interviewed by The Times Colonist see no evidence that this is happening.
“I could see a lot more patients if I had a nurse working with me,” Skinnarland said. Most family medicine practices need at least one nurse and one mental health worker, she said, but that would cost an increasing $ 150,000 on top of other overheads, including rent.
“If I get $ 20 per patient, I can’t fund a nurse,” Skinnarland said. “If I had a nurse who could help my diabetic patient, it would be more profitable for the government than spending millions on these emergency primary care centers, which don’t provide longitudinal care. “
The additional expense is small compared to the additional cost of even a few patients ending up in the emergency room, Skinnarland said.
Woodburn said a colleague’s request for a registered nurse from Island Health came with a condition that the practice would take 500 more patients, so instead of relieving the pressure, he would add it.
Greenwood, who was trained at St. John’s College, Cambridge and St. Mary’s Hospital in London, England, had his own practice in the area from 1977 to 1992 and was Medical Director of the Victoria Pain Clinic, where he worked from 1993 to 2009. He still practices because he loves the job – he had wanted to follow in his father’s footsteps since he was two years old.
“I can’t imagine doing anything else,” Greenwood said. “It’s just the most rewarding job you can imagine. It is just too much at the moment.