As one of the founding members of the Nechako Medical Clinic group of doctors, family physician Liam Higgins has been seeing patients since the Prince George clinic opened in 1992.
On Saturday, he’s scheduled to work one last shift as part of the doctor group that is at the end of its contract with Northern Health to operate the Parkwood Mall clinic, now known as the Urgent & Primary Care Centre (UPCC).
The UPPC provides a vital lifeline for patients who do not have a primary care provider (either a doctor of nurse practitioner) but due to changes in the way doctors are paid and the fee-for-service model, collectively the clinic is not seeing enough patients to pay the overhead costs of operating the clinic.
A clinic that used to have 40 or 50 doctors in the Nechako group is now down to about 20 and that’s not enough to cover the costs of paying clerical/reception/cleaning staff as well as the cost of leasing the building.
“There’s less and less doctors working in it, so they couldn’t cover all the shifts and no matter how good you are you can only see so many per shift,” said Higgins. “So suddenly, instead of seeing 150 or 170 a day they might be seeing 60 or 70 a day.
“The group accumulated quite a bit of money for a rainy day, but that money, over the last two years, was being eroded and it was getting to the point that if they didn’t close it we wouldn’t be able to keep it going.”
Higgins said the seven staff members at the clinic will be paid severance but that had to be paid while there was still money in the group’s savings account.
On Sunday, Northern Health will take over as the operator of the clinic - known for its long lineups of patients - and will introduce a new service model.
Doctors at the UPPC will no longer be paid based on the number of patients they see and instead will receive salaries based on a fixed hourly rate. Higgins said the change might discourage some doctors from signing up for the clinic.
“Some of them would have made more on the old system, so they might not want to come, but on the other hand, some of them who might be newer (to the city) might have made less in the old system because it would take them longer to see them,” said Higgins.
“So far it hasn’t been taken up that well with signing up for it.”
The new clinic hours for urgent care walk-in appointments will be Monday-Friday 4-8 p.m., and for Saturdays, Sundays and holidays it will be 9 a.m.-5 p.m. The clinic will also operate in daytime hours for pre-scheduled appointments from 8 a.m-4 p.m.
Each doctor will be working two- or 2 ½-hour shifts.
The Nechako Group has been operating the clinic Monday-Wednesday 4-9 p.m. and Thursday and Friday 1-9 p.m., Saturday 9 a.m.-7 p.m. and Sunday 10 a.m.-7 p.m.
The new service model not only means reduced hours, but patients will no longer have immediate access to a doctor at the clinic. Instead, they will be triaged by a nurse upon arrival and will be seen in order of urgency, rather than the time they arrive.
Depending on the patient’s condition, that might mean they will be seen that day by a doctor, nurse practitioner, social worker, physiotherapist or other health professional or be sent to the emergency department at University Hospital of Northern BC.
Some patients will be booked for an appointment the following day or will be referred to their family doctor, pharmacist or other community resource. Others will receive appointments that will be handled remotely by teleconference and/or video.
In the case of an emergency, Northern Health recommends patients either go directly to the emergency department at UHNBC or call 911. The emergency room tends to patients experiencing sudden and/or unusual changes in their health, including but not limited to breathing difficulties, severe bleeding of pain, broken bones, chest pain, suspected overdoses or eye injuries.
Northern Health also operates a virtual clinic (open daily 10 a.m.-10 p.m.) that is staffed by doctors, nurse practitioners, nurses, mental health clinicians, a social worker and a physiotherapist. Patients can call the virtual clinic at 1-844-645-7811.
The province also has a nurse available by phoning 811 for patients to access medical advice before leaving home.
You can also book the services of a pharmacist online or visit a pharmacy to receive treatment for 21 minor ailments including: acne, allergies/hay fever, canker sores (oral ulcers), cold sores, fungal infections, headaches, heartburn, hemorrhoids, hives and itching (including from bug bites), impetigo, menstrual pain, nicotine dependence, pink eye, pinworms/threadworms, shingles, skin rash (dermatitis), sprains and strains, thrush, upset stomach, urinary tract infection and yeast infection.
A pharmacist will also provide contraceptives (for birth control), a renewal or change of some prescriptions, immunizations and drugs by injection, and will make recommendations to see another health care professional.
With nearly one-quarter of British Columbians unattached to a family physician, Higgins says it’s critical for each patient to be their own best advocate.
“Patients have to look out for themselves,” said Higgins. “Patients at the walk-in clinic get about a quarter of the level of care that patients of full-time (general practitioners) get.”
Where patients in a doctor’s office usually take more of that doctor’s time to assess multiple health concerns, usually a clinical visit is limited to a shorter timeframe in which only one ailment is addressed and that can lead to more complicated medical conditions.
“It’s a much better service (in a doctor’s office) and they have longitudinal care, so if you order something you’ll probably get called back about it, and you won’t fall through the cracks,” said Higgins.
“You could easily fall through he cracks in the walk-in clinic. I could order some tests there and not have seen the result of it and unless the patient follows up themselves, it might never surface until something serious happens.”
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