Doctors on the lower Sunshine Coast are asking the province for immediate help, as three family physicians prepare to leave the Sechelt Medical Clinic. With around 10,000 patients attached to that location, a third of the lower Sunshine Coast’s residents could be affected by those doctors’ departure.
The practice is losing three of its nine physicians, Dr. Jack Bryson of the Sechelt Medical Clinic told Coast Reporter. One retires at the end of October (a replacement is lined up to take over) and two more doctors are moving off-Coast within the next month.
He says the clinic is not closing – and current patients will not be without a doctor – but they are looking for local solutions and are considering teaming up with another clinic. They’re in the early stages of negotiating how to keep clinics open on the Coast.
“We are suffering from the lack of replacement doctors for doctors that are retiring [over] the past five to 10 years. The shrinking numbers of doctors and growing numbers of patients has made it very challenging,” said Bryson, who has practiced on the Coast for three decades. With fewer doctors to cover overhead fees, it is harder to stay open.
Call for help
On Aug. 13, a letter signed by 16 local physicians was sent to Premier John Horgan, the Minister of Health, Powell River-Sunshine Coast MLA Nicholas Simons, Vancouver Coastal Health, Doctors of BC, the Sunshine Coast Division of Family Practice and the District of Sechelt council.
“We are ready to help serve the community but cannot do so without financial support," the letter says. "We urgently request your attention to this matter as patients continue to suffer due to a lack of access to care.
"Primary Care Networks, contracts, and hybrid billing systems are not sufficient models to alleviate this crisis. We do not want non-family doctors, non-rural doctors, administrators, and quality improvement teams telling us what will result in maximized patient care. We want substantially increased income and/or overhead subsidies but our asks continue to fall on deaf ears.”
Their hope is to open one family medicine clinic based in Sechelt with 25-plus exam rooms to care for Sunshine Coast residents. Increasing the space will also allow for more medical trainees — crucial for recruitment and retention. But the group needs funds, as purchasing land and commercial space or renting a space is not financially feasible, with the operational costs required. Bryson said one clinic would be the ideal situation, but not one he anticipates the province is likely to grant.
Clinics won't abandon patients
There are six medical clinics on the lower Sunshine Coast: Sechelt Medical Clinic, Cowrie Medical Clinic, Arbutus Medical Clinic, Upstream Medical Clinic, Gibsons Medical Clinic and the Pender Harbour and District Health Centre.
When the Sechelt Medical Clinic approached the Cowrie Medical Clinic to consider merging the businesses into one space, the Cowrie Street location said they don’t have enough space with their nine full-time physicians and 11 examining rooms.
Dr. Kevin Koopman, one of the letter’s signatories and a physician at the Cowrie Medical Clinic, said for the foreseeable future, “Everybody who currently has a family doctor will be able to continue to have access to their family doctor. If and when that changes, they will be notified appropriately.”
He said the clinics will never abandon patients but urgently need a new space to provide proper healthcare to Sunshine Coast residents as they grapple with on-going financial restraints.
“This has been really building since the pandemic and people moving here. To date, we’ve had extensive collaboration amongst all of our clinics… leaning on each other to do the best we can,” Koopman said.
“The tipping point came a couple of months ago … We just need help at this point, because we can’t do it on our own.”
The cost of healthcare
While there are many factors at play, the doctors’ letter identified a core issue: “the cost to run a business has exponentially increased while our incomes have remained neutral for over a decade. Our fee structure ignores increased patient volumes and complexities amidst a steadily growing population on the Sunshine Coast. We are contributing a substantial percentage of personal income to cover overhead costs and the continued increases are simply not sustainable. Continuing without outside support is an impossible endeavor.”
Family doctors have been footing the bill, with overhead costs ranging from 20 to 40 per cent out of physicians’ personal income, Koopman says. But that amount increases every year as income stays the same, which and can dissuade graduating doctors who could work in other medical settings and specialities that have no overhead fees.
“At the end of the day, when someone graduates with $300,000 in debt, money unfortunately does persuade a lot of decisions. And so issue number one is there's just no incentive for people to want to do family practice,” Koopman says.
“The system is not making it easy to be a family doctor,” Bryson said, adding that there are no rewards or incentives for medical students, and not enough medical students are graduating in Canada.
Koopman estimates there are between 4,000 and 5,000 lower Coast residents who do not have a family doctor, and the wait lists for a family physician are growing as more people move to the Coast. The latest census shows the Coast’s population is older than both the provincial and national averages, and many are at the age when they will require more regular access to healthcare.
On the Sunshine Coast, family physicians also put in shifts at the hospital, do home visits, and often work outside business hours and on weekends. “There’s a lot more that comes with our position,” Koopman adds.
Lack of housing
Then there’s the housing and rental market (or lack of). Sechelt Hospital’s Foundation House is an example of subsidizing housing for visiting residents, and more is being sought. Since May, a ‘Wanted to Rent’ listing in Coast Reporter’s classifieds has been looking to rent a small-to-mid-sized suite for new doctors coming to the community. “There is a shortage of accommodation on the Sunshine Coast and as a result it is difficult to attract physicians,” the advertisements read.
The doctors’ letter comes just two weeks after the Sunshine Coast Division of Family Practice took out a full-page ad in the July 29 newspaper, sharing seven ways residents can help address the local health care crisis.
“It takes a village,” the title reads. The tips included inviting a doctor you know to the area, boosting morale by thanking a doctor, donating to the Foundation House or for medical equipment, advocating for physician compensation, renting housing to locums or doctors for below-market rates, and contacting councils to ask for subsidized long-term housing for healthcare professionals.
“With no end in sight to these challenges, we need to find some creative solutions. Perhaps by coming together as a community we can brainstorm ways that will help our physicians do what they’re trained to do and what we need them to do: provide the best possible care for their patients,” the Sunshine Coast Division of Family Practice’s ad states.
The response so far
MLA Simons told Coast Reporter he received the letter and has replied, saying he will make sure the doctors’ voices are heard by his colleagues at the Ministry of Health.
“The residents here know that our healthcare is facing a lot of challenges. And one of them is getting people access to family doctors. This is obviously serious and an issue that many communities are facing, but we have our own unique circumstances here,” Simons said on Aug. 15.
“We've seen other solutions [in other] communities. It seems to me that this letter indicates that the only solution is money for overhead. I'm not sure about that … I can certainly concur with their perspective that there is a challenge and our challenges are here as well as in other parts of the province, but the Ministry of Health will be the best people to respond to particular possible solutions to this issue,” Simons said, adding that he hopes there will be some imaginative solutions.
Koopman said the doctors who signed the letter appreciate Simons’s support and his acknowledgment of the situation’s urgency. The Coast needs both a short-term and long-term solution, the doctor said, and a meeting is being scheduled between the 16 doctors and some of the letter’s recipients later this month. Simons has told the doctors he will attend.
A spokesperson for the Ministry of Health said the ministry understands the level of frustration with the current system. While B.C. has increased the number of healthcare workers by more than 38,000 since 2018, the pandemic exacerbated challenges. The email statement says 362 entry-level medical residency positions are projected for 2022, an expansion from 134 in 2003, but “We will have to do even more of this to meet the growing healthcare needs in B.C.” and the province is proceeding with a second medical school in B.C.
In an email to Coast Reporter on Aug. 16, the executive assistant to Sechelt’s mayor and council confirmed each council member received the letter requesting advocacy, “which the Mayor is in support of” and the correspondence will be considered for the next public council meeting, scheduled for Sept. 7.