Are there enough family doctors in Squamish?

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The Department of Health must step in to address the critical shortage of family doctors in Squamish, doctors say.

“We all have a breaking point.”

It was one of the lines of a letter sent by doctors at the Diamond Head Medical Clinic to Minister of Health Adrian Dix.

The letter was a plea for help from doctors, who are struggling with significant difficulties in attracting and retaining new doctors at the clinic.

The end result was that, by their estimate, there are thousands of people in Squamish who don’t have a family doctor. As the city grows, thousands more will experience this problem.

“We’re close,” Dr. James Cranston said in an April 21 interview with Chief Squamish. He was referring to the breaking point that the doctors at the clinic had mentioned in their letter to the minister.

“There’s a slim chance that we could dissolve the clinic completely. I don’t think that will happen. But almost every other doctor in this clinic has another source of income that pays them well. And, you know, in my case, for me, emergency medicine really allows me to do family medicine. You know, I can accept that I don’t earn as much here. And I can support that with emergency medicine. For d’ others is obstetrics, anesthesia, hospital work [and] working out of town doing various things.”

The main problem is that the financial situation of family doctors makes it very difficult to attract new doctors, he said.

There have been several retirements from the clinic and finding replacements has been a daunting task.

Three years ago, there were 13 doctors, but the clinic has only eight today.

Attempts to attract new doctors have been very difficult.

The average new doctor will have about $200,000 in student loan debt, Cranston said. On top of that, they face high overhead and living expenses in Squamish, where real estate prices have put new property out of reach for newly graduated doctors.

“So the compensation got to a point where we weren’t able to recruit people to move to Squamish and join a firm,” Cranston said.

The Diamond Head doctors have purchased the space in which their practice is located. A new doctor would have to buy a share of the unit and then find a place to live in a town where a home valuation has reached around $1.4 million.

“We’ve had five people leave our clinic, which means the rest of us have to keep buying real estate from them,” Cranston said. “And we can’t do that anymore. But unfortunately we can’t get new people to buy it, which we’ve always done in the past when someone leaves. Someone [else will come] and buy it. But there’s no one left.”

Diamond Head doctors are considering selling the clinic and hope to strike a deal that would allow them to lease the majority of the clinic, he said.

It will help break down a barrier, Cranston said, but it won’t solve the underlying problem that many doctors are no longer practicing family medicine.

Diamond Head doctors work in other fields to supplement their incomes, and many new graduates prefer to leave the family practice and work in a field where they are better paid.

“80% to 90% comes down to money,” Cranston said. “You can look at what I earned in the blue book and it looks pretty good. But then subtract from that many, many tens of thousands of dollars in overhead… huge overhead for the most part [general practitioners]you know, 30% to 40% of their lost overhead.”

On top of that, the rising cost of living in Squamish takes another big chunk out of that money, and the end result is that there’s little incentive for a new grad to open a practice in town.

What the provincial government needs to do, Cranston said, is provide assistance to family physicians who provide longitudinal care — in other words, physicians who make a long-term commitment to taking on a patient load.

“So it’s not the family doctors who work for TELUS who do health who do telehealth, not the family doctors who work in walk-in clinics, but the family doctors who support a load of patients they take responsibility for,” Cranston said.

The best way for the province to help is to cover the overhead costs GPs face, he said. It could be a number based on the number of patients and the complexity of their cases.

“The number won’t be small if they want to turn things around. They’ve just let things go too long now,” Cranston said.

The best way for locals to help doctors is to write to their MP and the Department of Health, he said.

As of April 21, Health Minister Adrian Dix, to whom the clinic’s letter was addressed, had not responded, Cranston said.

Ministry to consult

However, Chief Squamish sought comments from the Department of Health and received a written statement.

The statement indicates that the province is aware of the significant challenges across British Columbia related to the sustainability of family practice clinics.

“The Ministry is committed to putting in place a [primary care network] in Sea to Sky – Whistler and Squamish – to support the community with greater team-based primary care resources,” the statement read.

The release also says the ministry will consult with the community on potential short-term solutions — including access to additional resources — until the primary care network is established.

The province defines a primary care network as a set of partnerships between the Divisions of Family Practice representing BC family physicians, regional health authorities, the First Nations Health Authority and local community partners, as well as other community providers such as nurse practitioners.

The intent of these networks is to streamline and coordinate patient services.

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