North Shore doctor shortage slowly improving, stats show

The bad news: thousands of people are still without a family doctor on the North Shore, putting strain on both the hospital’s emergency department and local specialists, who find themselves standing in for primarily care.

The good news: very slowly, those numbers are beginning to shift, with a net gain of family doctors practicing on the North Shore in the past 18 months and fewer patients on official waiting lists.

“Overall, the trend is changing,” said Dr. Dean Brown, co-lead of the North Shore’s Division of Family Practice. “But we’re just starting to see the shifts. We still have a long path ahead of us.”

For the most part, doctors in family practice are still working in a “100-year-old model,” said Brown, which doesn’t work for either doctors or patients in many cases, especially if they have complicated health issues.

The health care system is starting to address that, said Brown, through the introduction of primary care networks, which includes family doctors working in teams with both nurses and mental health clinicians whose role it is to follow up with patients and connect them with community resources.

Those changes are new, and the impact won’t be felt immediately, said Brown. But he said it’s a step in the right direction.

Provincially, the North Shore is still officially considered an “underserved area” in terms of the number of family doctors serving its population – a designation that historically was more likely to be attached to rural and remote areas of the province.

Officially, the numbers are getting slowly better.

From the period April 2022 to Jan. 2024, for instance, there were 43 new physicians who started practising on the North Shore, 10 of whom took over practices from retiring doctors, according to Claudia Frowein, executive director of the North Shore Division of Family Practice.

In the same 22-month time frame, 18 doctors left family practice on the North Shore, including eight doctors who retired, leaving a total of 275 doctors, including locums.

Officially, the number of patients waiting for a family doctor on North Shore is 3,266, down from 7,600 just a year and a half ago.

In 21 months, between April 1, 2022, and Jan. 31, 2024, GP Link – the official waitlist system for finding a family doctor – managed to hook up 13,739 patients with doctors on the North Shore.

It takes on average between eight and 10 months to connect a patient with a doctor in North Vancouver and up to a year in West Van, says Frowein.

Patients can sign on to be linked to an available doctor at healthlink.bc.ca

Some patients deemed more urgent cases get fast-tracked. Among those are patients with a recent cancer diagnosis, those who’ve recently been admitted to hospital and elderly patients with complex needs that might include dementia.

Both Brown and Frowein acknowledge those on the official waiting list are likely just a fraction of those who don’t have doctors on the North Shore.

A lot of people still don’t know about the waiting list.

Some – like young men between 15 and 40 – don’t tend to use the health care system as much as other demographics and may not be concerned that they don’t have a doctor.

Others have likely given up.

“They don’t even try anymore. They think it’s hopeless,” said Brown.

For many of those without a family doctor, the ER at Lions Gate Hospital has become the de facto doctor of choice when urgent health needs strike.

“They’re using the emergency department, regrettably, as a family doctor because they feel they have nowhere else to turn,” said Brown.

The ER at Lions Gate has always been busy, but “the volume has gone up substantially in the last year or two,” said Brown.

At any given time, the hospital is often over capacity.

The North Shore’s Urgent and Primary Care Centre was meant to help ease the pressures on both the ER and on family doctors, by treating people who needed to be seen within 12 to 24 hours but in reality, “it sees quite a range outside of that,” said Brown.

The urgent care clinic is a “wonderful resource,” Brown said, but is also limited by its ability to find staff – still a difficult task where affordability is worse compared to other areas.

And while the number of doctors is up on the North Shore, so is the population. Statistics put the latest numbers at 205,478, up 7.6 per cent over the past five years. And of those new residents, 5,704 were either born or moved here in 2022 or 2023, the data shows.

Not everyone is convinced that the doctor shortage is improving.

Dr. Kevin McLeod, a specialist in internal medicine who has been working on the North Shore for the past 19 years, says as far as he can see, “access has dramatically worsened.”

The hospital is “completely overrun most of the time,” said McLeod, and the number of referrals he sees for patients without a family doctor is up.

“It does make things worse,” he said.

In some cases, serious health conditions are caught at a later stage, which makes them more difficult to treat and “that care is way more expensive,” he adds.

McLeod said he’s still seeing referrals for far more patients than he can take on.

It would help if someone like a physician assistant or nurse practitioner could do some of the follow-up, he said. But physician assistants – who work under the direction of a doctor – aren’t even licensed in B.C. and there’s no mechanism for specialists to pay nurse practitioners to help specialists in their practices, said McLeod.

Dr. Ahmer Karimuddin, president of the Doctors of B.C., spoke about those challenges at a press conference Feb. 9 where health officials discussed the state of care in the province.

“Too many specialists across the province have had to take on the role of providing primary care and that’s something that just is not sustainable,” he said, adding that’s also creating pressures on emergency departments.

The issues underlying those problems are complicated and “solutions to most of these things unfortunately just take time,” he said. “There’s still a lot of work to be done.”