British Columbia’s health care crisis has reached Cortes Island. A number of complex factors led to the resignation of all three doctors working out of the Cortes Island Medical Clinic. Their contract ends on Sunday, March 31, 2024.
“The physicians that we’ve had in our physicians group are moving on to do things in their own lives. They’re starting practices elsewhere and it no longer fits for them to come here,” explained Bernice McGowan, on behalf of the Cortes Community Health Association (CCHA) board.
“We will not be shutting the doors of the clinic on April 1st. That’s not in the foreseeable future. If our physicians leave, the worst case scenario is that we have a whole bunch of locums coming and we’ve been in this position before, where the only people that we had covering the practice were locums.”
She was referring to the situation prior to the beginning of the current group practice in 2016.
“I was only involved with the Health Centre because I was the home care nurse, so I was aware that there were different doctors every week. I would phone up with a concern about a client and this doctor didn’t have a clue who I was. Even though I said, ‘I’m the home care nurse,’ they didn’t know how much to trust me and my judgment. It’s like going to a walk in clinic and that’s not the model we’ve had for several years. It’s not good patient care and Island Health is very aware of that.”
“I don’t know how long it lasted for, I think probably a year or so, then Dr. Mary Jo Woolgar got together with some of the locums who had been coming here regularly, to put together a group practice proposal, which is what we’ve had since then.”
On Friday October 13 the CCHA met with Island Health to discuss the situation.
CC: Who was at that meeting?
BM: “Three board members, including myself. Rose Fitcyk, who’s our admin person, was also there.”
“The people from Island Health were Michelle Crosby, Director of Primary Care for Courtney Comox and Campbell River area, Erin Harrison, head of the primary care network which we are part of, Dr Louis DeBruin, who is the Medical Director for Courtney Comox, Campbell River, I believe and Dr Janet Conrad, who’s the Primary Care Medical Director for Campbell River. These are not the people who necessarily negotiate the contracts, but they are the people who know what’s going on.”
“They are committed to making sure that there’s some kind of primary care on Cortes. They don’t all want us to suddenly need to go to Campbell River for health care. We’re being told that there’s a shortage of physicians and given the extra complexities of getting people here, they floated the idea of a nurse practitioner continuing the practice.”
McGowan explained that the health centre is much busier and there are more demands on the physicians, than when she started working there five years ago.
BM: “There’s a lot of factors, one of which is the complexity of the care that’s needed for an aging population. There’s more health needs and more complex health needs and, because we have a group practice, the physicians are very careful to document everything so that the next doctor coming along can read those notes and go, ‘okay, I see where we’re going with this.’”
“The physicians that we currently have are very good at that. If we have more locums, they’re not maybe quite so used to that, and they may not document as well.”
“We have funding for a full time nurse at the clinic and we don’t have a full time nurse. We have a nurse who never wanted to work full time when she moved here, and she got a part time position, but has needed to work more. That’s not what she wants to do. We did have another part time nurse, but she moved away. The nurse that was going to take over from me (as home care nurse) moved away. That adds to the workload of the physician, particularly around palliative care and around chronic care.”
“There has been no nurse at Klahoose for a year, and I believe they were without a medical director for a while. Our doctors go there to have a clinic every couple of weeks, but the nurse over there was always able to follow up on things and maybe check in on people. The nurse would always draw their lab work over there in the morning. So these folks now need to come to our clinic to have their lab work done. That’s an increased burden on our lab collection services.”
“We had a pool of locum nurses that would come, but now they’re doing other things. They’re not coming. So there’s often days where there is no nurse at the clinic and that is definitely an increased workload for the physician.”
“It’s the same thing with doctors. This group practice started out with four physicians covering the full time position, and they are entitled to a certain number of days off as if they were one person, they’re allowed to have X number of days that they don’t have to cover the practice and then a locum would come.”
“Our physicians have been finding it harder to find locums willing to come here to fill their gaps. So they’re having to spend a lot more time when they’re not here, trying to fill those spots. That’s extra workload for them as well, because they find their own locums. There’s provincial agencies that post this locum position, but the doctors still have to communicate with people and beg people to come here or figure out how to make it work.”
“I can’t even wrap my head around all the variables that are involved in the way everything is funded, but the physicians are telling us it’s not as lucrative to come here, and work here for two weeks or a week, as it used to be. People who are wanting to do locums could do that elsewhere with less effort.”
The doctor’s job did not necessarily end after they found a locum.
BM: “The physicians have to be available if there’s locums that come and have a question that needs answering. I don’t imagine that happens a lot, but it’s one more piece of it.”
CC: In the notice that the CCHA posted on the Tideline, it states, ‘We must find a way to make Cortes an attractive community for primary practitioners. This may need to include looking for community funding to fill gaps.’ What exactly does this mean?
BM: “That’s a very general statement that some board members felt was important to include. It was around making sure that there’s housing and if there’s a gap between housing costs on Cortes and what physicians are realistically able to pay. Or if there’s a week when there is no physician here, but those housing costs are still there. There has to be some remuneration for housing, but whether that’s adequate in terms of what rental costs are on Cortes, that might be something that we might have to do some fundraising around.
CC: The Community Association recently did a public survey. Did you have any updates from that?
BM: “We did a whole community engagement process, which 165 people answered. There was lots of really good feedback , and we had a facilitator then do a report. We’re just starting on the real work of it, which is to take what we have learned and start the work on that. It’s a good process to be going through and hopefully will make us a better organization. I can’t give you details because we’re just working through what the themes were.”
CC: Do you have any final words for the community?
BM: “We all have an absolute commitment, and Island Health does as well, to keeping primary care here in whatever format it looks like. It will be different for the community, it will be different for the staff, and change is hard. Hopefully it can be done with the least amount of change and pain for everybody.”
In their press release, the CCHA states “We strongly encourage community members to write to our MLA and the Health Minister directly, with your concerns about factors beyond the local ones that impact our situation. One of our Board members is drafting some example letters which will be available to the community, more on this in the future update.
If community members have comments or suggestions, please put them in writing either in a letter which can be dropped off at the clinic, addressed to the Board, or emailed to admin@corteshealth.com.”
Some other resources:
Top image credit: The Cortes Island Medical Clinic – screenshot from Google maps
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