As his ear began to ache, Mathew Fournier considered his options.
He’d moved from Burnaby to Nelson last year and had no local family doctor. What he suspected was an ear infection, he decided, didn’t warrant a trip to the emergency room at Kootenay Lake Hospital. Instead, he called one of Nelson’s two walk-in clinics, which said it couldn’t book him in until Saturday.
“Five days is a bit of a wait for a walk-in, but OK I can survive to that day,” he thought.
Except it wasn’t for the following Saturday. The clinic meant Saturday, July 9 — nearly three weeks from when he first made the call.
Now Fournier is waiting to see if his pain will subside without medication. If it doesn’t, he’ll need to visit the ER after all.
“You do the mental math until you decide to go to the emergency room. Should you have or should you not have? I don’t know, I’m not a doctor. What constitutes an emergency? But we have no other health-care options.”
Doctor shortages have made walk-in clinics and emergency rooms the only options for the nearly one million British Columbians without a family doctor, according to the BC College of Family Physicians.
In the West Kootenay, those without a doctor of their own have just two walk-in clinics to visit, both of which are located in Nelson.
Kootenay Lake Medical Clinic no longer offers same-day appointments, and booking by phone means patients must wait a week or two to see a physician. ANCRON Medical Centre, which used to offer walk-in service seven days weekly, now only has availabilities Saturdays and Sundays on a first-come, first-serve basis.
The Castlegar Medical Clinic only accepts walk-ins from its own patients who must make a phone appointment for Saturdays.
Peggy Aitken and her husband Paul Lamoureux have owned and managed Kootenay Lake Medical Clinic since 2012 when it was exclusively a walk-in clinic. In 2014 they combined it with family practice to encourage foreign doctor recruitment. Working at a walk-in gave doctors the opportunity to build their own practice, assist people who may not require longitudinal care, and be guaranteed a certain number of patients each day.
Seeing more patients in a walk-in setting than they might in a family clinic also appealed to doctors interested in the public service aspect of their job.
“There was a huge misconception that walk-ins were just ramming patients through and not providing good care,” said Peggy Aitken. “And I will tell you, that’s not the case at our clinic, and never has been.”
The clinic maintained that system until the COVID-19 pandemic shut down in-person visits. Doctors pivoted to virtual appointments, but have since become overwhelmed by demand for care.
Aitken says the clinic currently employs one full-time physician, one part-timer and one more who works just one day per week. She estimates they see 250 patients weekly, 100 of whom aren’t attached to a family doctor. There are currently about 1,000 patients who regularly use the clinic but have no family doctor, and Aitken says they haven’t attached a patient to a physician in two years.
“The assumption is that there’s five doctors sitting back there just waiting for that walk-in patient to come in, and that they should be able to get in. Those days are gone. It’s never going to happen again.”
The need for care has also forced changes at ANCRON Medical Centre. In a statement to the Nelson Star, the clinic said it was forced to make changes after receiving 300 calls daily from patients in 2021. That led to three staff members quitting and two more going on medical leave.
The clinic used to see 40 walk-in patients on weekdays and 20-to-30 more on weekends. Now it is limited to a pair of four-hour windows on weekends where would-be patients compete to get an appointment. Otherwise, ANCRON said, its doctors can’t manage a workload that already includes their own family practices.
“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.”
Meanwhile, family doctors have become a privilege in Nelson.
There are just 23 family practitioners in the city, according to the Kootenay Boundary Division of Family Practice. Thirteen physicians work in the Kootenay Lake Hospital emergency room, although many of those also work at clinics.
At Kootenay Lake Medical Clinic, doctors bill the province $35 per patient through the B.C. Medical Services Plan. Doctors also pay a percentage to the clinic to cover its overhead expenses.
That payment per patient is too low to attract a family doctor to a walk-in clinic, Aitken says, when they could be making more in a specialized practice or at a publicly funded clinic where wages are guaranteed and doctors don’t pay for overhead.
On June 22, the provincial government said it would reconsider its plan to attract new family doctors after it was criticized for not offering benefits, pension plans or reimbursement for overhead. The BC College of Family Physicians estimates family doctors pay 35 per cent of their annual income to pay for overhead expenses, depending on location.
“The problem is people think that family physicians make way more money than what they make,” said Aitken. “So there’s a lot of education around that, that has to happen. People have to realize that when you take your needs up to the emergency room, it’s costing us all way more money.”
Interior Health said in a statement it couldn’t provide an estimate for how much more a patient’s visit to an ER costs taxpayers than a trip to a clinic.
“Emergency department visit costs are based on total visits, which will include patients with higher acuity of injury-illness than what someone would generally visit a clinic for, therefore it’s difficult to compare the costs of a visit to the emergency department versus a visit to a clinic.”
Both Nelson clinics say it wouldn’t require many more doctors to alleviate the walk-in crisis, at least locally.
Aitken said two more family practice providers, either doctors or nurse practitioners, at Kootenay Lake Medical Clinic could take on 1,000 attached patients.
ANCRON wants two office assistants, a full-time social worker, a full-time nurse or nurse practitioner, and a full-time equivalent doctor and nurse to staff the walk-in clinic seven days per week.
But Aitken conceded Nelson is competing with every other B.C. city for family doctors. The remaining walk-in clinics, she said, can only continue to operate as they are for so long without more resources.
“That’s my concern, that we close down completely. Where are all those patients going? Where are they going to go? I can’t subsidize the health care system as a private business owner. I just can’t.”