No closure as doctors end contract with Prince George Urgent and Primary Care Centre

After 33 years providing patient care to the Prince George region, the Nechako Medical Clinic group of doctors who operate the clinic at Parkwood Mall will terminate their contract with Northern Health as of Dec. 7.

However, that does not mean the imminent closure of the Urgent and Primary Care Centre, which provides a critical lifeline to the estimated one-third of area residents who do not have a family physician.

But it does mean Northern Health will have to find a different way to pay doctors who have been operating at a loss for the past two years while providing their services at the privately-owned clinic.

“The urgent care centre is not closing," said Barend Grobbelaar, chair of the Nechako Medical Clinic.

“In a nutshell, what’s happened is not enough doctors in Prince George are contributing to after-hours care - weekends, holidays, nights. We’ve got approximately 70 family physicians in Prince George and we’ve got 20 docs who are contributing to after-hours care. We spent two years trying to entice more docs to come in and we were not successful.

“We didn’t come to an arrangement that would give us a reasonable chance of sustainability, so our members decided to dissolve the corporation and put it in Northern Health’s hands, so now they’re responsible. They get contracts from the government and it remains to be seen whether they will get physicians there to work.”

In a statement sent to The Citizen Wednesday afternoon, Northern Health reassured patients who rely on the clinic for medical care they will still be able to access doctors at the facility beyond the December contract expiry date.

“The Prince George Urgent and Primary Care Centre will remain open,” according to the statement.

“Northern Health is aware that on Oct. 9, 2024, the members of the Nechako Medical Clinic voted to cease providing physician staffing to the Prince George Urgent and Primary Care Centre. Northern Health is currently reviewing alternate compensation models to ensure continuity of services and will provide more information at a future date.”

The Nechako Clinic doctors associated with the clinic formed a corporation and each paid to be part of the ownership group. Grobbelaar says the clinic lost close to $100,000 in 2023 and has lost about $60,000 this year and is on pace for another six-figure loss. Rather than wait for the reserve funds to dry up, they decided to fold the corporation while there’s still money to pay severance and accounting fees.

“We wanted to dissolve the corporation while we still had enough cash to do it,” he said.

“The only thing that’s going to change is that the way the doctors get paid to work.”

Doctors at the Nechako Clinic currently bill the Medical Services Plan through a fee-for-service payment plan. The more patients they see, the more money they receive.

But the complexity of patient conditions in an aging population has substantially increased in recent years and that’s increased the time it takes to treat a patient at the clinic. Where there used to be 100-120 patients seen each day (when Nechako had 40 physicians involved), that average has dropped to 60 or 70 per day, and revenues have dropped while fixed costs (salaries for clerical staff, wait room staff, building costs) continue to rise.

Grobbelaar said because there are so many patients coming to the clinic unattached to family doctors who haven’t seen a doctor in years, they often need primary care treatment for complex conditions that can’t be done in an after-hours clinic where lineups are persistently long.

That means doctors often can’t get to all the patients in need of acute care, for injuries or sudden sickness, and the clinic is forced to turn some away.

“You can’t do primary care on 50 people standing at the door,” said Grobbelaar. “You can do urgent care, so if someone gets bitten by a dog, we can sort out your dog bite. But we can’t necessarily, in the evening or on weekends, sort out all the primary care problems of everybody in town.

“Patients are definitely getting more complex. Ten or 15 years ago the majority of patients in town had a family doctor and was just the most complex that maybe didn’t. Now, I would estimate a third of the population has no family doctor, and more and more of them haven’t seen a doctor for some years, so their conditions are not very well managed.

“They’ve got lots of primary care problems. Some of the young doctors don’t want to work there because it’s too challenging trying to deal with a complex person while there’s 20 people in the waiting room and they have to make quick decisions.”

The Nechako Clinic moved from Spruceland Mall to its current Parkwood Mall location in June 2019. The pandemic led to a steep decline in patient numbers which affected profitability.

Northern Health started a daytime-use primary care clinic in the same building about a year ago and that’s helped relieve some of the burden, but there is not enough capacity to take the heat off the after-hours clinic.

Grobbelaar said 50 per cent of all the work in the clinic is being done by a handful of people who are approaching retirement age.

In February 2023 the BC government enacted the Longitudinal Family Physician (LFP) payment model which better compensates doctors for time spent on patients and recognizes the complexity of their conditions and the increased paperwork needed to support those patients. Doctors are tied to those patients whenever they enter the healthcare system either as office patients, in the hospital emergency ward, as hospital in-patients or in nursing homes.

Before LFP, doctors were paid only when they came face-to-face with their patients.

Since LFP was introduced, 800 new family physicians are now working in the province which has created a doctor-to-patient ratio that’s higher than ever. But because they are better paid for seeing patients in their offices or at hospitals, doctors have shied away from working in clinics which still utilize the MSP fee-for-payment plan.

“They’re paying them so well now it’s easier for them to sit in their office looking through their charts than to come to the clinic,” said Grobbelaar, who admits he advocated for the province to adopt the LFP system.

“Whenever you make one big change it’s going to take time to work things through and do all the corrections that need to happen.”