Real estate unaffordability plagues nearly every corner of the Lower Mainland, including doctor’s offices.
It’s the biggest obstacle preventing family doctors from setting up shop in the Tri-Cities, said Kristan Ash, executive director of the Fraser Northwest Division of Family Practice (FNWD).
“Port Moody is a beautiful, very desirable place to live – just not cost wise,” Ash said. “There really isn’t any affordable space left.”
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The city opened a new $3.9 million urgent and primary care centre on Nov. 6. It was fast tracked by the province due lack of affordable office space and doctor per capita ratio in Port Moody.
Since the FNWD launched its primary care network in April 2019, they have lost several family physicians. By June, they were down 19 doctors. While the numbers have rebounded slightly, they’re still down seven family physicians overall.
According to FNWD’s latest report to the Ministry of Health, there are nearly 14,500 people registered on the family doctor waitlists in their jurisdiction, which covers the Tri-Cities and New Westminster.
Ash said the true number of unattached patients is much higher, as people registered typically have an underlying health condition.
“That’s essentially 14 more doctors that we need to come join our community, and we need 14 spaces for them to practice,” she said
- Coquitlam: 5,813 patients in line, waiting an average of 512 days over the last six months (8 percent increase)
- Port Coquitlam: 1,404 patients in line, waiting an average of 241 days over the last six months (18 percent increase)
- Port Moody: 2,946 patients in line, waiting an average of 512 days over the last six months (5 percent increase)
Municipalities are in competition with one another to attract family doctors, and the number one factor for physicians is affordability, according to Ash.
“Beautiful buildings are going up, but the cost to operate a small business is going up with every one of those towers,” she said. “We’ve lost doctors in the last number of years to rural and remote communities, even to places like Pitt Meadows and Langley. It’s just that much cheaper to practise.”
In the last eight years, Ash said the lease rate for office space has jumped from $15 per square foot, to between $58 and $63 per-square foot.
The local development boom has even led to a large number of clinics being “renovicted” by landlords, she added.
Physicians typically sign five-year leases, and they get priced out of the space every time an old building gets sold or demolished, Ash said. “A lot of landlords, they see ‘Dr.’ at the beginning of the tenant’s name, and they will drive up the rate.”
At least 10 clinics have closed in the last four years due to renovictions, according to Ash, including North Road Medical in Coquitlam, which had 15 physicians.
Young doctors with less money to spend account for an increasing percentage of the workforce as long-established physicians hang up the stethoscope.
Approximately 40 percent of FNWD’s members are in the first seven years of their practice. Three years ago, it was less than 10 percent.
New doctors interested in becoming family physicians are weighed down by student debt, little startup cash, and are expected to know how to run a business, manage staff and set up computer systems, according to Ash.
“This is probably the only occupation in a publicly funded system, where the individuals are also expected to build the infrastructure,” she said.
Ash said that most just want to practise medicine, but finding a family practice is a daunting task when faced with soaring overhead costs and huge patient lists.
A Tri-Cities clinic’s overhead cost is at least 30 percent at the low end, according to Ash. In Port Moody, it’s closer to 50 percent due to real estate costs.
Between 20 and 24 students complete their postgraduate training in the FNWD annually, however, on average, only five return to service in Fraser Health communities, according to the FNWD.
A Canadian Family Physician journal report from November, 2021, found new doctors are frequently choosing more specialized fields and hospital list work rather than family medicine.
And the old guard of family doctors will inevitably leave the field, something Ash said the FNWD has seen coming for five to six years.
Thirty-seven percent of their current members have been practising medicine for over 23 years, and 21 percent have been practising for over 33 years.
When one retires, thousands of attached patients can be jettisoned.
The Wilson Centre Family Practice in Port Coquitlam had to email 2,000 patients earlier this month to inform them they no longer had a family doctor.
The clinic, which has 17,000 attached patients, had recently lost four physicians, and was only able to replace two of them.
Two of the doctors they interviewed turned down the position because of the heavy patient load, according to reporting from the Vancouver Sun.
Ash said adopting a retiring doctor’s panel of patients comes with pressures that many new physicians don’t feel they are ready for.
She said when a well-established doctor retires, they can have more than 3,000 patients, but a busy physician in their first five years may treat half that number on average.
“It’s not a one-to-one replacement,” Ash said.
This has led to veteran doctors putting off retirement, and their own health, to avoid displacing their long-term patients.
Two Tri-Cities doctors, Dr. Ian Woods and Dr. Matthew Choi, continued to treat patients while they fought cancer over the last year of their lives.
It wasn’t until the last week of Choi’s life that he decided to close his practice down, Ash said.
“Through everything, he was still trying to see his patients … which is devastating,” she said. “They feel like they owe it to their patients, their patients become like family.”
The province announced a new pay model for family physicians at the end of October, aiming to retain and attract doctors to the field.
As early as next February, it will allow them to escape the fee-for-service system and factor in administrative costs, time with a patient, patient complexity and patient load.
The model’s targets bump family physicians’ pay up to $385,000 annually, an increase of nearly 35 percent from the previous average.
Ash said she was “cautiously hopeful” after the announcement.
“It sort of lifted the dark cloud that has been over doctors for the last couple of years,” she said. “This last year has been really hard, predominantly because of the amount of retirements we’ve seen.”