Several Castlegar doctors are hoping to help the community understand what the Castlegar Urgent and Primary Care Centre is — and what it isn’t.
Like most communities across the province, residents in Castlegar are struggling to access primary health care. Almost one million British Columbia residents do not have a family doctor due to a nationwide shortage, according to the BC College of Family Physicians.
When the Urgent and Primary Care Centre (UPCC) at the Castlegar Community Health Centre opened in spring of 2020, community expectations were that it would help provide access to needed primary care, ease congestion at the emergency room and help attach people to family doctors.
But two years later, finding a family doctor is no easier and Dr. David Larocque, the UPCC’s medical advisor and chief of staff, and the Kootenay Boundary Division of Family Practice (KBDFP) are trying to dispel some misunderstandings related to the unique, site-specific plan for the centre.
“The UPCC in Castlegar was a very unique model based on the fact that it was a smaller, rural community and that the Castlegar physicians and Interior Health were collaborating and went into depth to determine what would be the best make up and model to support the community,” explains KBDFP spokesperson Paul Edney.
Those consultations concluded that what was most needed at the site was more nursing and mental health supports as well as physiotherapy.
At the time Castlegar did not have any Interior Health funded social workers or physiotherapists, and emergency nursing was chronically understaffed, according to the KBDFP.
That localized approach is where some of the confusion begins. The province began announcing plans for Urgent and Primary Care Centres across the province in 2018. When the Castlegar centre was announced in early 2020, it was the 16th UPCC and the first in a small, rural city.
In most larger cities, UPCCs and emergency rooms run differently than they do in Castlegar. At the Castlegar Community Health Centre’s 12-hour-a-day ER, local physicians take turns staffing the facility. There are no staff doctors to work the ER full time — the local doctors step away from their clinics and spend a day seeing patients at the ER on a rotating basis.
The same goes for the UPCC. Whoever is staffing the ER takes care of the UPCC, which is located right next to it.
The Castlegar UPCC planning document includes a statement that doctors would be paid by continuing the fee-for-service model currently in place at the ER in order to “maintain current culture of physicians working together to provide primary and emergency care services.”
An anonymous letter sent to media outlets in June made accusations that the “current culture” meant local doctors had banded together to ensure a permanent UPCC doctor position remained out of the picture in order to further their own interests.
Edney, Larocque and Interior Health say that is untrue.
Rather, they say the current culture is one of co-operation where doctors work together to ensure that both local clinics and an emergency room stay viable for Castlegar.
“Castlegar has an amazingly well-running primary care team in the physicians and in the other supports that are there,” Edney told Castlegar News in an interview that included Larocque.
“Our culture is working hard,” added Larocque. “It’s not about money, it’s not about prestige, it’s about working hard at various levels to support this community.”
They also say maintaining local doctor shifts in the ER is essential to recruiting more doctors to the area. ER shifts help physicians maintain essential skills not often used in their clinics. The variety of work roles is also more attractive to prospective doctors over a clinic-only based practice.
Edney says that philosophy has paid off and seven physicians have been recruited for the community in the last two years.
The doctors say the accusations are also hurtful and discouraging.
“I am generally a relentless optimist, but this one does feel like a slap in the face after all the work that we have done as a community,” said Dr. Meghan Taylor in a email sent to colleagues and shared with Castlegar News.
“I am not thrilled to be painted as a money-hungry ogre. But I am honestly too tired to respond. I am going to focus my energy on doing my job and caring for my patients.”
Edney says dealing with this type of situation is disappointing, hurtful and takes up doctor’s mental and physical energy and time that could be better spent serving patients and working on health care solutions.
Dr. Ellen Smart says the problems with health care start at the top.
“The administrative leaders of our health care systems have had data from the last five to 20 years showing a growing dearth of physicians in almost every specialty; and especially in family medicine.
“Canada has not strategically planned for the worsening shortage of health care providers and family physicians are constantly asked to extend their skills so they can step in to help with the lack of psychiatry, oncology, pediatrics and OB-GYN to name a few.
“The UPCC was an attempt by our health administrators to mitigate the number of people who have no access to a family doctor, but it was a cookie-cutter approach which didn’t fit our community and certainly does not begin to address the scope of the problem we have after decades of inadequate planning.
“We need to demand Canada’s health care leaders plan strategically for the future, instead of desperately fixing issues decades in the making. It is going to be a terrible climb out of this place.”
Dedicated UPCC doctor
Across the province, the new UPCC model called for dedicated on-site physicians to be hired to staff the centres full time.
However, according to Larocque, hiring a full-time doctor for the Castlegar UPCC was never part of the plan.
Larocque and the KBDFP agree that the best placement for any newly recruited doctor for Castlegar would be in a clinic where they can permanently take on hundreds of patients.
The UPCC offers two types of visits — scheduled appointments based on physician referrals and walk-in appointments through the emergency room.
Services provided at the centre include cast and stitch removal, transfusions, bladder scans, mole removals and vasectomies as well as appointments with the full-time social worker and physiotherapist. Nurses staff the UPCC full time and provide many of the services that don’t require a physician. But there is always a physician available when needed.
Some of these referrals free up appointment space in local clinics and others free up space in the emergency room.
Prior to the UPCC, minor medical procedures were often performed in the emergency room, occupying one of the few beds available.
“I am proud of the decisions made by our physicians and local Interior Health administrators to expand the ability of emergency doctors to see more people and deliver better care with the addition of a social worker, nurse and physio,” says Smart.
“In the past an emergency doctor may have spent an hour with someone who had primarily psychiatric or social issues and now the emergency doctor can manage the medical issues and have the social worker take over the issues of follow up.”
The UPCC is not meant to be a walk-in clinic for patients who don’t want to wait until they can get an appointment with their primary care provider, it is intended for urgent needs.
Interior Health says they have no plans to reduce services or cut funding at the Castlegar UPCC. Instead, they are looking to build on the current services and make improvements wherever possible.
Larocque and Edney acknowledge that the UPCC’s communication surrounding its functions and operations could have been better.
“The UPCC is not a perfect model, it’s a new model and it’s something that is being tried out … it is in a state of constant improvement,” said Edney.
“The staff at the UPCC are an amazing group of people. The manager and staff are trying to make this the best possible place it can be. They are constantly coming up with ideas and they are being heard.”
It’s also important to note that Castlegar’s UPCC was opened during a very challenging time for health care — the beginning of the COVID-19 pandemic. In spite of that, the UPCC has seen 11,700 patients since it opened, creating the capacity for an extra 4,000 patient visits per year for the community.
“This is less about the UPCC and more about the issues in primary care as a whole,” said Larocque.
He adds the UPCC is helping, but it is just one piece in the big picture of the struggle to access primary health care.
The province has stated that an objective of UPCCs is to facilitate attaching patients to primary care providers. But when there are no available practitioners with open spaces, it is impossible to meet that goal.
“The physicians here are tired and we suffer from ethical fatigue,” said Larocque.
He describes that fatigue as the weariness that comes from trying to do the best for your patients but continually facing frustrating backlogs and under staffing in the medical system.
“The primary care crisis is one of the biggest conundrums of our time,” KBDFP’s acting executive director Jen Ellis said. “In the face of a growing population, an aging population and increasing complexity, which will increase demand, we have both supply side and demand side issues. We have to work together, we cannot get through this otherwise.”