by Timothy Schafer Local Journalism Initiative Reporter on Monday June 20 2022
One of the city’s walk-in medical clinics has elected to reduce its hours after suffering from staff burn-out, the crippling effect of limited resources and chronic under staffing.
The Ancron Walk-In Clinic has been operating seven days a week for the last 10 years, but as of March 31 it has curtailed its weekday walk-in traffic, operating only on the weekend (10 a.m. to 2 p.m.) on a first come, first served basis.
Citing numerous reasons — including the lack of support from the healthcare community, division of B.C. and the government — the clinic deemed it no longer had the ability to service the growing demand of walk-in patients on top of its own family practices.
The decision leaves a significant hole in the delivery of healthcare services in the city. During the time the clinic operated full time it assisted unattached and attached patients in Nelson, as well as those who were visiting or temporarily in the city.
The service reduced demand on Emergency departments across the Kootenay-Boundary region, with the amount of patients consistently assisted through the system translating into up to three full time practices.
The Nelson Daily asked the clinic doctors about their decision and they had a very detailed response.
The Nelson Daily: What do you mean that Ancron was affected “without support from the healthcare community, divisions of B.C. and the government?”
Ancron: During 2021 the walk-in component of Ancron Medical became overwhelmed with phone calls from patients desperate for appointments and assistance.
We were receiving over 300 calls to the office a day which prevented both walk-in and attached patients from getting through to our understandably overwhelmed staff. The lead up to this is complex but is due largely to longitudinal care family practitioner exodus due to retirement and change of scope of practice to other medical roles.
There has been a significant loss of patient attachment over the past five years. Despite an adequate number of family physicians being trained every year, new family practice graduates are not replacing retired physicians as they are choosing better remunerated positions such as hospitalist work, addictions or other sub-specialized areas both public and private.
This has led to less attached patients across B.C., and indeed all over Canada.
In addition to the loss of family practitioners we have also lost an internal medicine specialist, and four psychiatrists in Nelson. The family physicians at Ancron all manage large attached patient populations in addition to working in the hospital seeing in-patients, or assisting in obstetrical/maternity care coverage.
The walk-in clinic is managed by these same physicians on top of their full-time family practices to which patients are attached. We have been committed to assisting the community with access to medical care, but this burden has become unsustainable for our clinic to manage in isolation.
The collective family practitioners in Nelson and area are not able to assist us with sessions to staff the walk-in clinics due to personal pressures to run their own clinics, cover their own overheads, see attached patients and hospital patients, cover maternity care, cover Emergency department and cover ancillary services like sports medicine, addiction medicine, oncology and pain clinics.
We have been unable to secure any long-term locum support for the walk-in as the remuneration is poor when compared to salaried positions, or rural or out-of-province locum opportunities, and those doctors who would have time availability to do walk-in sessions have chosen to work in more lucrative sessions and positions.
Our clinic became so overwhelmed with calls from unattached patients seeking assistance that our staff became burned out and three have quit and two went on medical leave. Staff morale has been low, the workload (between our attached patients and our walk-in) became unsustainable for the family practitioners as well as our medical office assistants (MOA).
The call volume meant that our existing attached patients were not able to call or reach us and get through to get assistance. We needed to retain our existing MOA’s, and the highest contributor to low staff morale was the demand from walk-in patients as well as significant (and escalating) instances of verbal abuse from individuals who sought care at our clinic.
After reaching out to Divisions of Family Practice B.C. in November 2021 with our concerns and request for assistance to formulate a strategy to keep the walk-in clinic open, we were informed there would be no assistance available from the Ministry of Health. Episodic walk-in care is undervalued by the health community both locally and provincially.
Despite significant system pressures the family physicians in Nelson have done their very best to maintain attachment to a family provider but, ultimately, inadequate remuneration and rising overhead have acted as a barrier to reaching optimal attachment to a primary care setting (which should be the right of every citizen of this province and country, and is the responsibility of our healthcare system).
If there was adequate attachment there would be less need for a walk-in clinic, however, adequately attaching people to a family physician and primary care team has been near impossible due to general system inadequacies which Ancron has been benevolently compensating for, for over 10 years.
TND: What support have you not had?
Ancron: We have not had any funded allied professional assistance made available to us. Our overhead is not subsidized.
As mentioned above, we are unable to attract physicians to work in private practice. Fewer and fewer family physicians are willing to work in a clinic setting, whether it be longitudinal patient care or episodic walk-in care. They are attracted to better remunerated alternate positions which have little to no overhead costs, take-home paperwork, after hours responsibilities to monitor incoming labs, or need to find a replacement if taking time off work or moving.
Ancron has been operating seven days a week since 2010. This has been made possible because the clinic's organized staff and family physicians take turns covering weekday and weekend walk-in shifts to make same-day access to healthcare available to those with and without a family physician, and thereby reducing inappropriate utilization of emergency services.
We recognized this need and importance of offering access to care for individuals. We have continued to provide access on weekends as it was morally difficult for us to completely relinquish this service.
This is a voluntary service completely and only funded from physician income who have been subsidizing the costs of our public healthcare system from office rent, medical supplies, medical office assistant salaries, to phone/EMR system maintenance and costs. At the same time, physician income has not grown in proportion to inflation, with no significant increase in pay since 2006, and it has become unviable to continue to cover unsurmountable overhead costs without significant personal sacrifice from physicians, while trying to maintain living wages for their staff and covering increasing costs.
Under the current payment model and rate we are punished for spending time with patients with complex problems, which, if we do, we do it at a high personal cost where we have to choose between patient care and having time to spend with our loved ones, or affording the rising costs of operating clinics.
Often after clinic hours we spend a significant amount of our free time doing paperwork relating to patient visits with no remuneration or recognition for this extra time, missing dinners with family or doing paperwork after children are put to bed.
This is morally unjust and unsustainable. The healthcare system is taking advantage of doctors and their professional duty to their patients.
TND: What are you looking for as support?
- support for overhead costs such as office space rent, staff salaries, EMR/phone costs, essential supplies needed to provide care;
- two MOA’s;
- a full time social worker;
- a full time nurse or nurse practitioner;
- 1.0 to 2.0 full-time-equivalent alternate pay contract for primary care providers (preferably at least 1.0); and
- family practitioner and a 1.0 full-time-equivalent nurse practitioners to staff the walk-in seven days a week.
TND: Will you change your decision if your terms of support are met?
Ancron: We know how important the walk-in clinic is to many patients across the region — both attached and unattached patients — and we are keen to discuss solutions to expand this service in a sustainable way.
If we have the support of the above then the current doctors at Ancron could each work some of the sessions of walk-in as well as being able to offer an attractive sessional rate for other family doctor providers in our region to work sessions.
With the additional two MOA’s patients will be able to connect with the clinic to make appointments and our existing MOA’s can be retained. A social worker will be an excellent asset to assist the vulnerable patients reach resources to improve patient outcomes. A nurse practitioner will be able to assist patients with longitudinal care.
Our immediate attainable goals would be:
- reduced ED visits;
- earlier diagnosis of complex disease in the unattached patient group;
- improved patient access to timely routine health screening;
- access to care for those struggling with mental health;
- vulnerable populations have access to comprehensive health care; and
- improved patient outcomes will be a long term sustainable goal, patient lives will be saved.
TND: How many walk-in patients per day did your clinic host?
Ancron: Approximately 40 per day on weekdays, and 20 to 30 on weekends.