Almost a million B.C. residents have no family doctor. Many blame the province's fee-for-service system

Camille Currie has less than a year of battery life on her pacemaker and no family doctor.

The Greater Victoria resident and mother of two says she also has bleeding and connective-tissue disorders that would make post-op care challenging when she does get the battery replaced. If she has trouble healing,she is afraid she will have to line up atan urgent and primary care centre (UPCC).

Currie also says both her children have a rare auto-inflammatorydisorder.

Yet she and her family are among almost a millionBritish Columbians without a family doctor. According to the B.C. College of Family Physicians, only 80 per cent of residents in the Capital Regional District have one, compared to 84 per cent of people provincewide.

According to Canadian tech companyMedimap, which publishesonline wait-times for walk-in clinics,B.C. residents wait an average of 58 minutes atwalk-in clinics more than double the national average.Victoria had the longest average wait time in the country at more than 2 hours.

CBC spoke to patients, doctorsand other people impacted by the shortage for a special series titled "A Crisis in Care: The Family Doctor Shortage in Greater Victoria" to examine the roots of the problem, and one issue that came up multiple times was B.C.'s fee-for-service system.

Current system leading to doctor burnout

Fee-for-service is a system of care that pays doctors for each office visit.

People familiar with how it works say the high volumeof administrative work needed for doctors to get payment combined with the low amount of take-home pay it generates is discouraging doctorsfrom practising family medicine, and that's created a dire need for family physicians and a reliance on emergency rooms and clinics.

"B.C. is not providing us with universal health care," saidCurrieon CBC's All Points Weston Tuesday.

Greater Victoriaphysician Jennifer Lush is trying, though.

Lush has been a family doctor for 20 years and understands why others would choose not to be. Most doctors are paid about $30 per patient visit and, from that, Lushpays for staff,medical equipment and office space.

Shesays she works 70-hour weeks and struggles with work-life balance.

Half the hours Lushputs in are unpaid, she says, because they arespent doing paperwork.

"The minute my kids are tucked in bed, I'm pulling out my computer and I start charting. Often I will chart until twoor three in the morning,"Lush told CBC'sOn The Islandon Tuesday.

Comparable to minimum wage

A report published in the Canadian Family Physician Journal in November 2021 found up-and-coming doctors are choosing more hospital-based work and specialized practice rather than family medicine in part because they're worried about the consequences of B.C.'s fee-for-service model on work-life balance.

Alicia Pawlukbecame a doctor in 2018 and does hospital-based work alongside treatingpatients at theCool Aid Community Health Centre in Victoria.

She says under the current system,the take-home income of a family doctor is comparable to minimum wage.

"The average physician graduates with about $200,000 of debt. Minimum wage is not going to be able to cover the sort of payments that we need to make," said Pawluk.

In May 2020, the College of Family Physicians of Canada called for alternative funding models to replace the fee-for-service method in order to recruit andretain morefamily doctors.

B.C. Health Minister Adrian Dix said connecting people with a family doctor has beenhis "highest priority" since entering the rolein 2017.

To reduce the administrative burden on doctors, and help people who don't have one,Dix's ministry invested inUPCCstoprovidesame-day, urgent, non-emergency support. He said the province is also increasingthe use of alternative payment methodsto attract more family physicians.

"The will of doctors and others to work with us toreform and make the system better is there, and we need to do so," Dix told CBC's On The Island onThursday.

'I did not receive that care until too late'

Change can't come soon enough for Joy Williamson, who has been without a doctorfor eight years. Diagnosed with breast cancer in 2020, shebelievesit would have been caught sooner if she had had one.

"I did not receive that care until too late," saidWilliamson, who explained thatthe cancer had travelled to her lymph nodes by the time it was detected and she needed to have her whole breast removed instead of a lumpectomy.

The day before her surgery,Williamson was worried she had a blood infection and says she drove around Greater Victoria with her husband and two kids for hours looking for a UPCCthat was not full.She ended up waiting five hours in emergency for a diagnosis.

Currie hears how frustrating that is firsthand. She created B.C. Health Care Matters, a website where patients can petition for change and share their stories.

Those stories include parents who waited eight hours in emergency with sick kids, and a senior couple with mobility issues who lined up for hours, several days in a row, at a UPCC that was constantly full.

Astime ticks closer to Currie's own pending surgery, her own fear grows.

"This pacemaker is going to run out and I can only pray that I will be able to trust the system," she said.