As his ear began to ache, Mathew Fournier considered his options.

Hesa国际传媒檇 moved from Burnaby to Nelson last year and had no local family doctor. What he suspected was an ear infection, he decided, didnsa国际传媒檛 warrant a trip to the emergency room at Kootenay Lake Hospital. Instead, he called one of Nelsonsa国际传媒檚 two walk-in clinics, which said it couldnsa国际传媒檛 book him in until Saturday.

sa国际传媒淔ive days is a bit of a wait for a walk-in, but OK I can survive to that day,sa国际传媒� he thought.

Except it wasnsa国际传媒檛 for the following Saturday. The clinic meant Saturday, July 9 sa国际传媒� nearly three weeks from when he first made the call.

Now Fournier is waiting to see if his pain will subside without medication. If it doesnsa国际传媒檛, hesa国际传媒檒l need to visit the ER after all.

sa国际传媒淵ou do the mental math until you decide to go to the emergency room. Should you have or should you not have? I donsa国际传媒檛 know, Isa国际传媒檓 not a doctor. What constitutes an emergency? But we have no other health-care options.sa国际传媒�

Doctor shortages have made walk-in clinics and emergency rooms the only options for the nearly one million British Columbians without a family doctor, according to the BC College of Family Physicians.

In the West Kootenay, those without a doctor of their own have just two walk-in clinics to visit, both of which are located in Nelson.

Kootenay Lake Medical Clinic no longer offers same-day appointments, and booking by phone means patients must wait a week or two to see a physician. ANCRON Medical Centre, which used to offer walk-in service seven days weekly, now only has availabilities Saturdays and Sundays on a first-come, first-serve basis.

The Castlegar Medical Clinic only accepts walk-ins from its own patients who must make a phone appointment for Saturdays.

Peggy Aitken and her husband Paul Lamoureux have owned and managed Kootenay Lake Medical Clinic since 2012 when it was exclusively a walk-in clinic. In 2014 they combined it with family practice to encourage foreign doctor recruitment. Working at a walk-in gave doctors the opportunity to build their own practice, assist people who may not require longitudinal care, and be guaranteed a certain number of patients each day.

Seeing more patients in a walk-in setting than they might in a family clinic also appealed to doctors interested in the public service aspect of their job.

sa国际传媒淭here was a huge misconception that walk-ins were just ramming patients through and not providing good care,sa国际传媒� said Peggy Aitken. sa国际传媒淎nd I will tell you, thatsa国际传媒檚 not the case at our clinic, and never has been.sa国际传媒�

The clinic maintained that system until the COVID-19 pandemic shut down in-person visits. Doctors pivoted to virtual appointments, but have since become overwhelmed by demand for care.

Aitken says the clinic currently employs one full-time physician, one part-timer and one more who works just one day per week. She estimates they see 250 patients weekly, 100 of whom arensa国际传媒檛 attached to a family doctor. There are currently about 1,000 patients who regularly use the clinic but have no family doctor, and Aitken says they havensa国际传媒檛 attached a patient to a physician in two years.

sa国际传媒淭he assumption is that theresa国际传媒檚 five doctors sitting back there just waiting for that walk-in patient to come in, and that they should be able to get in. Those days are gone. Itsa国际传媒檚 never going to happen again.sa国际传媒�

The need for care has also forced changes at ANCRON Medical Centre. In a statement to the Nelson Star, the clinic said it was forced to make changes after receiving 300 calls daily from patients in 2021. That led to three staff members quitting and two more going on medical leave.

The clinic used to see 40 walk-in patients on weekdays and 20-to-30 more on weekends. Now it is limited to a pair of four-hour windows on weekends where would-be patients compete to get an appointment. Otherwise, ANCRON said, its doctors cansa国际传媒檛 manage a workload that already includes their own family practices.

sa国际传媒淲e have been committed to assisting the community with access to medical care but this burden has become unsustainable for our clinic to manage in isolation.sa国际传媒�

Meanwhile, family doctors have become a privilege in Nelson.

There are just 23 family practitioners in the city, according to the Kootenay Boundary Division of Family Practice. Thirteen physicians work in the Kootenay Lake Hospital emergency room, although many of those also work at clinics.

At Kootenay Lake Medical Clinic, doctors bill the province $35 per patient through the B.C. Medical Services Plan. Doctors also pay a percentage to the clinic to cover its overhead expenses.

That payment per patient is too low to attract a family doctor to a walk-in clinic, Aitken says, when they could be making more in a specialized practice or at a publicly funded clinic where wages are guaranteed and doctors donsa国际传媒檛 pay for overhead.

On June 22, the provincial government said it would after it was criticized for not offering benefits, pension plans or reimbursement for overhead. The BC College of Family Physicians estimates family doctors pay 35 per cent of their annual income to pay for overhead expenses, depending on location.

sa国际传媒淭he problem is people think that family physicians make way more money than what they make,sa国际传媒� said Aitken. sa国际传媒淪o theresa国际传媒檚 a lot of education around that, that has to happen. People have to realize that when you take your needs up to the emergency room, itsa国际传媒檚 costing us all way more money.sa国际传媒�

Interior Health said in a statement it couldnsa国际传媒檛 provide an estimate for how much more a patientsa国际传媒檚 visit to an ER costs taxpayers than a trip to a clinic.

sa国际传媒淓mergency department visit costs are based on total visits, which will include patients with higher acuity of injury-illness than what someone would generally visit a clinic for, therefore itsa国际传媒檚 difficult to compare the costs of a visit to the emergency department versus a visit to a clinic.sa国际传媒�

Both Nelson clinics say it wouldnsa国际传媒檛 require many more doctors to alleviate the walk-in crisis, at least locally.

Aitken said two more family practice providers, either doctors or nurse practitioners, at Kootenay Lake Medical Clinic could take on 1,000 attached patients.

ANCRON wants two office assistants, a full-time social worker, a full-time nurse or nurse practitioner, and a full-time equivalent doctor and nurse to staff the walk-in clinic seven days per week.

But Aitken conceded Nelson is competing with every other B.C. city for family doctors. The remaining walk-in clinics, she said, can only continue to operate as they are for so long without more resources.

sa国际传媒淭hatsa国际传媒檚 my concern, that we close down completely. Where are all those patients going? Where are they going to go? I cansa国际传媒檛 subsidize the health care system as a private business owner. I just cansa国际传媒檛.sa国际传媒�

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| tyler.harper@nelsonstar.com
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