Another family practice in Coquitlam facing demoviction by next Christmas

More Tri-Cities residents are at risk of losing their family doctors by Christmas 2023 as another clinic faces demoviction.

Five doctors, each treating between 1,000 and 2,000 patients out of Austin Family Practice in Coquitlam, have less than a year to find another location.

“Our patients are very anxious, they ask us about it every time they come in,” said Dr. Trung Binh Hoang, noting some have been with them for decades. “They’ve all got their ears and eyes open for deals.”

The centrally located three-storey building on Austin Avenue is set to be demolished to build a new highrise in 2024. 

Home to the family clinic, a podiatrist, a dentist, an eye surgeon, and a medical imaging office, upwards of 8,000 patients could be displaced, according to Kristan Ash, executive director of the Fraser Northwest Division of Family Practice.

The physician exodus would be a significant blow to local primary care coverage, as nearly 14,500 people are already on waitlists for family doctors in the Tri-Cities and New Westminster.

At least 10 clinics have closed down in the last four years due to similar demovictions associated with new developments, Ash said, including North Road Medical, which housed 15 physicians in Coquitlam.

The team of Austin Avenue doctors all want to stay together, and even expand the practice to help share costs, but they have “nowhere to go” without displacing patients, Hoang said.

They have been searching for a replacement space since 2019 without success. In order to continue as a practice, they estimate they need to find a new office by July.

They’ve looked in Port Moody, Coquitlam, Burnaby and New Westminster but locations have been too expensive or lacking proper accessibility or infrastructure, Hoang said.

She said one space did not even have sinks, and they would have to use mobile handwashing stations.

“It’s a setup that somebody might have for camping … It’s not ideal,” Hoang said.  “There are a lot of substandard buildings that people are just making do with in order to see patients.”

Austin Family Physicians has operated as a clinic since the 1990s. Physicians pay an affordable monthly lease rate between $5,000 and $6,000, said Dr. Michelle Birch.

She said each location they’ve made inquiries into would double the rent, and she estimates their overhead costs are already close to 30 percent.

These costs don’t take into account increased startup costs, as a new location would likely require extensive renovations, according to Birch.

“When this clinic was started, it took $60,000 to kit it out. I dread to think how much a new building would cost,” she said. “We’d probably have to get a line of credit.”

Austin Family Practice just missed out on a grant opportunity that allocated $35,000 per doctor to be able to move into a new location. 

By the time they were able to apply, the grant program had run out of money. 

“We were really keen on that,” Hoang said. “If they could find the money again, for another round, we would definitely apply for it.”

It’s not the only Tri-Cities clinic struggling with real estate space. 

Burke Mountain Medical in Port Coquitlam currently has 12 family physicians crammed into a 3,000-square foot office.

Dr. Ali Sanei-Moghaddam bought the 1980s-era facility two years ago for $1.4 million, and said he’s doubled the number of doctors to keep up with demand and lower overall costs.

Three doctors practice out of the pharmacy located below the office, and he shares his private office.

While they want to expand the practice to address the spatial constraints, Sanei-Moghaddam said there is “no affordable space left.”

“Buying the real estate is just not financially feasible, ” he said, adding he was lucky to be able to purchase the clinic when he did.

From a business perspective, he said the more physicians that are working together, the lower the overhead costs.

The lease rates he charges physicians only covers his mortgage, and overhead still ranges upwards of 25 percent, according to Sanei-Moghaddam.

“I’m not a very good businessman in that way, because I’m not making any profit,” he said.

A facility of the same size at Burke Mountain Medical would cost $2.7 million today, according to Sanei-Moghaddam. 

Any move would push everyone’s overhead costs well above 35 percent, he estimated.

But Sanei-Moghaddam said, in his opinion, owning a clinic is the only way to maintain a sustainable practice, otherwise they would be “at the mercy of the landlord.”

“We want to be in charge of our fate,” he said. “I think that is one of the main reasons that a lot of family physicians choose not to be in community practice and shift to hospital work.”

The province announced a new pay model for family physicians at the end of October, which factors in administrative costs, time with a patient, patient complexity and patient load.

While all the physicians said they were encouraged by the news, they all said real estate costs need to be addressed.

Hoang said she was considering leaving family practice before the provincial announcement. She now says it’s “manageable.”

But Hoang and Birch, who both originally hail from England, said the province needs to subsidize space for family doctors like the U.K.’s National Health Service does.

Hoang added it would likely decrease pressure on hospitals.

“The government provides urgent care centers, provides hospitals, and pays for the buildings,” Hoang said. “They don’t look after the people that are providing the longitudinal care for chronic disease management, and these are the people we’re trying to prevent from going into hospital.”

Sanei-Moghaddam said the change is long overdue, but that many problems have not been addressed, particularly when it comes to affordability.

He said the province is pumping money into urgent care centres, but they are not as effective as family doctors when it comes to continuity of care.

Family physician lease rates could be subsidized for a fraction of the cost, according to Sanei-Moghaddam.

“If we are struggling with emergency departments, a huge part of it is because there is no good access to primary care,” Sanei-Moghaddam said. “The investments should be in primary care.”

Birch said that family doctors spend a significant portion of their days practising business management rather than medicine, which decreases their capacity to care for patients.

“It seems like a bit of a waste of our expertise,” she said. “We’re spreading ourselves over all these things that we don’t really have an idea of how to do, and then trying to do the job that we’re actually being paid to do.”