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Diagnosis critical: A visit to a Kamloops family physician clinic

High demand for family doctors was on full display outside the Bee Well Medical Clinic last week as people were lined up down the block in the 1100-block of Battle Street downtown

Another doctor has been recruited to a recently renovated family practice in Kamloops, but the owners of the medical clinic need more to help keep the facility open.

High demand for family doctors was on full display outside the clinic last week as people were lined up down the block from the Bee Well Medical Clinic in the 1100-block of Battle Street downtown.

They were trying to get their names added to the patient list of the new family physician who is expected to begin working there in September.

The new doctor will be the practice’s third, joining Dr. Cristina Liciu and Dr. Steven Broadbent who, alongside wife and business manager Sarah, bought and renovated the location more than a year ago.

Having rented space on Columbia Street West for years, the Broadbents undertook the move to expand their practice and create a place to attract more family doctors to Kamloops.

They have been open at their new location since April 2021, with Broadbent wanting to establish a place to work collaboratively with doctors who could focus on their patients without having to worry about the myriad challenges of running their own family clinics.

According to a joint Venture Kamloops-Thompson Region Division of Family Practice committee, an estimated 900,000 British Columbians don’t have a family doctor. There are about 12 vacancies for family doctors in Kamloops, according to Dr. Hancke de Kock, who is closing his downtown practice in June and does recruitment evaluation in Kamloops for UBC’s family practice residency program.

Within two days last week, the new doctor’s patient list had already been exhausted, with hundreds of people lining up to submit application forms in the process. It all happened by word of mouth, with Broadbent noting it was sad to see, given the need.

“It’s embarrassing. I feel shame,” Broadbent said, adding he was shocked when he drove in to work and saw the lineup of people seeking a family doctor.

Searching for more physicians

The Bee Well clinic is trying to fill the void of family doctors, but to date has added just the one coming this fall.

The clinic found recruitment difficult this past year, having had three potential doctors fall through due to complications in the recruitment process. Broadbent noted one example in which a doctor from England with 17 years of experience hit a snag with the BC College of Physicians because she hadn’t completed a required exam not required under the college in that country, where she is qualified to work.

“The colleges block you or they put stipulations in that don’t make sense to me,” Broadbent said of the regulatory body. “Basically, when we’ve tried to recruit, it’s been very difficult or it’s been made more difficult or impossible.”

When it comes to the doctor shortage, footing the bills of a practice is also a problem, Broadbent said, which is part of what inspired him to open Bee Well.

“I’ve double mortgaged myself to put my money where my mouth is to try and develop stuff for doctors because there’s no investment [in the field]. It’s a self-run business,” Broadbent said, noting he doesn’t think doctors want to operate their own practices. “When you’re a qualified new doctor, are you going to want to do that? You’ve got to be working to earn some money, so how are you going to develop a business or get a new place?” Broadbent said. “These are all business problems, which is why you’re finding it difficult to recruit and retain doctors, I think.”

The Bee Well project involved a massive gut job of the building and cost about $800,000, an investment the Broadbents are shouldering on their own, less a $30,000 grant from the Thompson Region Division of Family Practice.

“It was a total shell,” Broadbent said of building’s original state, noting there is also a shortage of spaces for clinics in town.

Bee Well already has a physiotherapist renting space and time at the facility, as well as a doctor with training in botox work, and would like to add another four family doctors, be it part-time or full-time, working whatever hours and days that suit their lives.

“If we’ve got family doctors who’ve got kids or spilt families, maybe they want to do two days a week or in the evenings, but you cannot afford that as a [family] doctor because you’ve got your overhead, you’ve got to pay it 24/7, you’ve got your staff 24/7, so it doesn’t make sense,” Broadbent explained of the difficulties of family practices.

“You’ve got to work a set number of hours to break even.”

If they can recruit enough doctors, the Broadbents expect Bee Well to meet its overhead, breaking even on operating expenses of running the practice.

“If we don’t get anybody [doctors] to come, it doesn’t work as a business,” Broadbent said.

Generally speaking, family physicians split about 30 per cent of their clinic’s earnings with a facility like Bee Well to help cover expenses.

More than meets the eye being a family doctor

It’s the challenges of running a business and other pitfalls of a demanding job that Broadbent suspects are keeping medical school graduates from pursuing family practices.

“Essentially, it is very tough in general practice at the moment, I feel, because if it wasn’t, we’d be getting more family doctors and there wouldn’t be 900,000 patients without a family doc,” Broadbent said.

He explained it’s hard for new graduates coming out of medical school to try to learn the ins and outs of starting up a business, noting many probably can’t afford to given their student debt and they may be more inclined to seek less strenuous options.

Those include shifts in walk-in clinics or urgent primary care centres, where there are more defined hours and fewer tasks bogging them down. However, Broadbent added, work in urgent care doesn’t come with the same density of follow-up care as found in a family practice.

There is much involved with being a family doctor that the public may not realize, he told KTW.

Over the course of a day, Broadbent sees many patients, but various paperwork — such as checking and renewing medications, setting up tests and making referrals, known as “tasks” — are generated alongside those visits, which must get done, but often can’t within the work day and aren’t billable.

Broadbent accumulates hundreds of tasks each day, some taking more time to complete than others.

It’s work that Broadbent said has him at the office for hours on end, arriving home for just a few hours at the end of the work day to have dinner with his kids before returning to the office to complete tasks until nearly midnight.

“If you’re a new doctor coming through, screw it, why would you do that? If you go to [work at] an urgent care centre, you can clock in at nine, clock out at one or four and you have just a few tasks,” he said.

Dr. Cristina Liciu, the other family physician working out of Bee Well, told KTW she easily works 12 hours a day and is on call 24/7 for her clients in nursing homes.

Doctors can have as many patients as they want, but the current system doesn’t reward thoroughness, Broadbent said.

“You get penalized for doing good work,” he said, noting billing is the same for a visit that takes 10 minutes as it is for visits that are more complex and require more time for tasks.

“Essentially, if you do a good job, you lose money,” he said.

“[But] I’m not going to change my standards. You want to treat people how you want to be treated yourself, what you’d expect for your family, and I want the best for my patients.”

Broadbent feels billing is a big issue, especially for new doctors just starting out of school, noting running your own practice means no indemnity or extended health benefits or holiday pay, not to mention the third of earnings that goes to overhead and is taxed.

Broadbent said there is little an organization like Interior Health can do to help the situation, as changes to alleviate issues would have to come from provincial legislation.

“Where there’s a will, there’s a way,” Broadbent said. “Family physicians are in crisis.”