Facing BC’s Medical Crisis: Doctor Shortages and Inadequate Care

[HunkyBill]

My GP is suddenly retiring after a serious medical event, and now my specialists are either retiring or moving to another province by the end of the year. No replacements have been found, and the doctors at walk-in clinics are mostly transient and unwilling to address complex issues or prescribe strong medications like sleeping pills or opioids such as codeine for chronic pain or a severe cough caused by a viral infection. I read how some are seeking MAID who have are facing similar "challenges".

One walk-in clinic's website looks more like an over-the-top advertisement than a healthcare provider's page. It’s filled with large fonts, huge glossy photos of physicians grinning inorganically, making it feel like they’re more focused on promoting themselves than providing genuine medical care. Meanwhile, the reviews on Ratemds.com aren’t encouraging.

It’s a frustrating, vicious cycle that younger people today don’t fully grasp—unless their parents are going through it. As if growing old isn’t difficult enough, we also have to deal with the added frustration of what appears to be ableism.

 

[80watts]

This doctor shortage started back in the 1990s where it was decided to limited the number of doctors being made each year. At this point in time these super smart people never heard of the demographics of aging out.
Another thing about the doctors, in bc there are about 200 positions to be filled, while there are about 500/600 candidates that want to become doctors. But there is no money to fund the rest of the candidates for medical training... Consider a 15-20% failure on medical school. And another 20-30% washout on practical training, and then consider that at the rate the province is losing doctors, there will be less and less doctors to train these candidates...

The problem is that most doctors don't get this joke. What do you call a doctor who got a C average in medical school?

Today people change their jobs, if you are only making 200 doctors a year in BC, 20 years down the line there might be 30 of them left in the medical system....
I do believe that Covid also has taken a role in the burnout of doctors and nurses....

In the last 4 years most of the clinics in Victoria are not taking walk ins as they used to take in walk in patients. This forces people that used to go to these places to the emergency room. (Something to do with the payment of people working in the clinic (not the doctors)). If so the emergency rooms have to be more efficient to deal (more effective triage), with the influx of people, waiting hours to see a doctor or you have to make an appointment to see a doctor in 2-3 weeks. Clinic used to provide a doctor and local space (where you live) for simple medical care. (prescriptions and advice).

I agree the whole system is a mess.

Also there is the change in society, where the doctors and nurses want a outside life from working 70-90 hours a week. High stress and long hours..... so doctors are just quitting.....

 

[westwoody]

The workloads on doctors are unrealistic.
Do you want to be in an ER with an intern making life and death decisions that has been working for 30 hours straight?
A lot of women are entering the field and strictly limiting their hours because they have a family. That reduces their availability compared to the old boys who worked 12 hours a day and were on call 24/7.

 

[GeeBeeP]

The workloads on doctors are unrealistic.
Do you want to be in an ER with an intern making life and death decisions that has been working for 30 hours straight?
A lot of women are entering the field and strictly limiting their hours because they have a family. That reduces their availability compared to the old boys who worked 12 hours a day and were on call 24/7.

I can’t blame them at all. Spend any time in an ER or hospital ward and you can see how easy it would be to burn out, and even a family doc can’t be expected to work those hours and have a life.

FYI lest you think the grass is any greener elsewhere, BC is actually in pretty good shape compared to some provinces. Hard to believe but true.

 

[marsvolta]

why do i think that the college of physicians some how has a hand in this mess? our system has been under attack for some time by them. "private" clinics are starting to pop up.

i may not understand the workings that well... but my understanding is that the province/universities/physicians control how many doctors get trained and that they have historically done so in a manner that all doctors get jobs.

why are we not opening up the flood gates? its not expensive to train doctors... and lots of people are willing to take that journey. we can easily make demands on what doctors can practice and where they practice if we are providing subsidized training. there should be more doctors than we need... the others can easily find work in other health related fields. and general practitioners don't have to be rocket scientists.

it just smells bad. like the profession is trying to screw us over.

 

[lukom]

Let's not also forget the number of spots they keep open for international students who up and leave when they get a chance. Those spots should be for locals. We end up losing those locals who then go out of country themselves for med school and then have little incentive to return.

 

[westwoody]

its not expensive to train doctors... general practitioners don't have to be rocket scientists.

Yikes
Try writing the MSAT

 

[Gerald778]

MSP pays a doctor $32 for a walk-in appointment. A paralegal charges $50 to notarize a college transcript.

Why would anyone want to see a patient for only $32?

 

[Gerald778]

why do i think that the college of physicians some how has a hand in this mess? our system has been under attack for some time by them. "private" clinics are starting to pop up.

i may not understand the workings that well... but my understanding is that the province/universities/physicians control how many doctors get trained and that they have historically done so in a manner that all doctors get jobs.

why are we not opening up the flood gates? its not expensive to train doctors... and lots of people are willing to take that journey. we can easily make demands on what doctors can practice and where they practice if we are providing subsidized training. there should be more doctors than we need... the others can easily find work in other health related fields. and general practitioners don't have to be rocket scientists.

it just smells bad. like the profession is trying to screw us over.

4 years of MD probably costs the government $60K a year while UBC only charges $20K for tuition. That's a $40K per year deficit.

Two years of family medicine residency costs the government $80K per year.

That's 4 x $40K + 2 x $80K = $320K

It's not cheap

Also don't forget that if your suggestions go in place then maybe people won't want to be doctors anymore

 

[PuntMeister]

We need more urgent care clinics to keep the non-critical patients out of emergency

We need to make family practice more attractive to physicians than the fast-food/fast pay walk in clinics.

We need doctors who want to live in rural communities, and a system that supports them.

We need a major upheaval of the entire medical system and the ministry to cut out the massive waste and crap in the system of healthcare delivery. Support front line workers and make the admins and the gov’t “In Service” to the front line. Bring in Elon! He’ll fix it, and put a rocket booster landing pad in the field for patient enjoyment.

If the public health care system cannot deliver your needed service or surgery within 3 months, you are free to apply the equivalent funds to private delivery of services or surgeries, BECAUSE WE HAVE FAILED YOU! Incentives snd KPI’s with teeth drastically needed. More execs that know how to meet client needs, and less beuracrats

 

[jgg]

why do i think that the college of physicians some how has a hand in this mess? our system has been under attack for some time by them. "private" clinics are starting to pop up.

i may not understand the workings that well... but my understanding is that the province/universities/physicians control how many doctors get trained and that they have historically done so in a manner that all doctors get jobs.

why are we not opening up the flood gates? its not expensive to train doctors... and lots of people are willing to take that journey. we can easily make demands on what doctors can practice and where they practice if we are providing subsidized training. there should be more doctors than we need... the others can easily find work in other health related fields. and general practitioners don't have to be rocket scientists.

it just smells bad. like the profession is trying to screw us over.

When my kid went through, she had an undergraduate degree in zoology (Honours, four years), a Master's in paediatric heart research (two years), an MD (four years), and a residency in paediatrics (four years). The acceptance rate into med school is around 10%. You have to be very dedicated to becoming a doctor, and not "lots of people are willing to take that journey."

This was 15 years ago, and it cost the provincial government ~$80K per year for the med school alone. Now toss in the student's tuition, likely $15K+ per year plus a living cost of $30K. Residency costs are likely to cost the province more than ~$100K per year. The limiting factor in how many doctors get trained is not "done so in a manner that all doctors get jobs" but the sheer cost of teaching them. Doctors "don't have to be rocket scientists," but some will literally hold your heart or brain in their hands, and @westwoody is correct in saying they may well be doing it at the end of a 30-36 hour shift.

I agree that if we subsidize medical students, there should be some form of a return of service and more of an emphasis on rural and northern students, providing they meet the prerequisites.

 

[jgg]

We need more urgent care clinics to keep the non-critical patients out of emergency

We need to make family practice more attractive to physicians than the fast-food/fast pay walk in clinics.

We need doctors who want to live in rural communities, and a system that supports them.

We need a major upheaval of the entire medical system and the ministry to cut out the massive waste and crap in the system of healthcare delivery. Support front line workers and make the admins and the gov’t “In Service” to the front line. Bring in Elon! He’ll fix it, and put a rocket booster landing pad in the field for patient enjoyment.

If the public health care system cannot deliver your needed service or surgery within 3 months, you are free to apply the equivalent funds to private delivery of services or surgeries, BECAUSE WE HAVE FAILED YOU! Incentives snd KPI’s with teeth drastically needed. More execs that know how to meet client needs, and less beuracrats

I am not sure about Elon, but you are pretty much dead on, especially the waste and top heavy bureaucracy.

 

[HunkyBill]

MSP pays a doctor $32 for a walk-in appointment. A paralegal charges $50 to notarize a college transcript.

Why would anyone want to see a patient for only $32?

What is your source? GPs in BC make at least $73.45 per patient (according to 2022 data): An overview of physician payments and cost per service | CIHI

The physician only wants one issue per appointment and spends less than 10 minutes with you.

 

[Gerald778]

What is your source? GPs in BC make at least $73.45 per patient (according to 2022 data): An overview of physician payments and cost per service | CIHI

The physician only wants one issue per appointment and spends less than 10 minutes with you.

MSP billing codes themselves

https://www.dr-bill.ca/msp_billing_codes/specialty/msp-billing-codes-by-specialty/family-medicine

00100

Visit in office (age 2 - 49)

0

$31.72

if you don't trust that link, then go find it yourself in here

https://www2.gov.bc.ca/gov/content/...icians/payment-schedules/msc-payment-schedule

 

[HunkyBill]

MSP billing codes themselves

https://www.dr-bill.ca/msp_billing_codes/specialty/msp-billing-codes-by-specialty/family-medicine

00100

Visit in office (age 2 - 49)

0

$31.72

if you don't trust that link, then go find it yourself in here

https://www2.gov.bc.ca/gov/content/...icians/payment-schedules/msc-payment-schedule

Thanks for the links.

The MSP link is accurate, the drbill is out-dated. But close and nowhere near the $73 I quoted.

From MSP's PDF:

 

[badbadboy]

I’ve been through four doctors in the past 8 years. Two immigrated from England and Scotland but didn’t last long due to high cost of living in Vancouver. They moved to BC rural communities. One was awol most of the time and a wait time for an appointment was 30+ days. I think he overbooked on purpose for the money grab. Fired him when I found out he hadn’t made an important referral to a specialist even though he swore he did.

Latest is a very capable doctor who is a new immigrant. Immigration informed him he had to get a full practice in 30 days. He did it in two weeks but saved a few spots for those really requiring a full time GP. He got me the referral in one week.

 

[Harmony-bc]

I had a family doctor for years since I was a kid. She retired a few years ago. She's irreplaceable. I was without a doctor for a while. Now I have a doctor who seems quite capable and nice but always in such a rush haha. My childhood doctor was never in a rush and went through quite a few teenage crisis's with me. I had her into my 30s. Times are really different now. But I'm happy to have all my medical things in one place.

 

[HunkyBill]

I missed this article from a few days ago: https://vancouversun.com/news/bc-doctors-sound-alarm-drop-in-medical-clinics-disappear:

"Very much in a free fall': B.C. doctors sound the alarm as drop-in medical clinics disappear"

The NDP’s efforts to improve health care through a new payment model for family physicians and the establishment of urgent and primary care centres has had the unintended consequence of cutting the ranks of walk-in clinics across the province.

According to the medical mapping service MediMap, the number of walk-in clinics across B.C. has dropped between 30 to 50 per cent in recent years as clinics move to an appointment-only model or close their doors.

This has led some doctors to warn that there are fewer and fewer options for immediate care in the province as urgent-care-clinic appointments remain hard to book in certain communities and emergency room waiting times continue to skyrocket.

Rita McCracken, a family physician and UBC assistant professor in the family practice department, said part of the problem is the new payment model introduced by then-health minister Adrian Dix in 2023 that aims to retain family physicians through better compensation. The model encourages doctors to work in family practice instead of putting in hours at a walk-in clinic, she said.

She likened health care to the education system and wants the province to increase the capacity of primary care, arguing that neither walk-in clinics nor urgent and primary care centres are an ideal model.

“If we want people to have better access to primary care when they need it, we need to have clinics that have the capacity to be able to provide care to the people that live close by, just like we do for elementary schools,” McCracken said.

“I’m not saying that there aren’t many, many problems with education right now, but if we just kind of take a look at that model of access to public education, we’ve completely thrown that out the window when it comes to primary care.”

 

[80watts]

We need more urgent care clinics to keep the non-critical patients out of emergency

We need to make family practice more attractive to physicians than the fast-food/fast pay walk in clinics.

We need doctors who want to live in rural communities, and a system that supports them.

We need a major upheaval of the entire medical system and the ministry to cut out the massive waste and crap in the system of healthcare delivery. Support front line workers and make the admins and the gov’t “In Service” to the front line. Bring in Elon! He’ll fix it, and put a rocket booster landing pad in the field for patient enjoyment.

If the public health care system cannot deliver your needed service or surgery within 3 months, you are free to apply the equivalent funds to private delivery of services or surgeries, BECAUSE WE HAVE FAILED YOU! Incentives snd KPI’s with teeth drastically needed. More execs that know how to meet client needs, and less beuracrats

I do believe that most clinics that have stopped taking extra people (no family doctors)(this started in Covid) is because they can't support their support staff on a lowly doctors visit. By law/order a doctor can only see a patient for only 1 thing during an appointment. People usually have 2-4 concerns when seeing a doctor.

Even today people that do have family doctors are finding it hard to see specialists, because the system only allows for certain number of specialist in an area.

As for bureaucrats, they are just email generators who expect other people to enact the dumb fucking orders they give out, causing more work for allready stressed out workers.....

 

[HunkyBill]

I do believe that most clinics that have stopped taking extra people (no family doctors)(this started in Covid) is because they can't support their support staff on a lowly doctors visit. By law/order a doctor can only see a patient for only 1 thing during an appointment. People usually have 2-4 concerns when seeing a doctor.

That's not true. There is no 'law.' Physicians are paid a fee regardless of how many issues are discussed. The 'one issue' rule was created by physicians, likely out of greed. They'll justify it (actually gaslight the patient why it's necessary).

Patients will come in with multiple issues because of long wait times for appointments, which lead offices to impose these limits. It has nothing to do with any 'law' or regulations."

Even today people that do have family doctors are finding it hard to see specialists, because the system only allows for certain number of specialist in an area.

I could be wrong, but I don't believe this is true either. The reason why I remain doubtful is one specialist which I seen before decided to restrict patients to only those who live in the area (I moved away). I asked my GP about that and he said it's becoming more common because the specialists have a long wailing list. He never made mention it was a law or rule either.

But that got me thinking, maybe we need to find ways to "navigate" the medical system (from South Park) in BC and create a local address for MSP so we are eligible to see those specialists who choose to see only those living in that city.