Emergency physician worries primary care needs could strain ER resources, as patients search for new doctors

This story is part of Situation Critical, a series from CBC British Columbia reporting on the barriers people in this province face in accessing timely and appropriate health care.

Dr. Anna Chodyra has crossed land and sea to practise medicine.

Originally from Poland, the 47-year-old first immigrated to Canada as an international medical graduate in 2001.

She did her residency in Calgary before crossing the Rockies in 2006, when she relocated to the small city of Port Moody in the Tri-Cities area of B.C.’s Lower Mainland, just east of Vancouver. She worked there for 13 years before following the Barnet Highway east to Coquitlam, where she joined Meadowbrook Family Practice.

The family doctor said she currently has a patient panel of 2,100 people — and she isn’t sure where any of them will go when she, and her family, relocate to New Zealand this fall.

“It’s a very difficult decision, knowing that I’m leaving my patients without finding someone to replace me, leaving them on their own,” said Chodyra, adding that she never planned on leaving B.C.

“We tried to find a replacement physician, but we couldn’t. Nobody is taking over practices anymore.”

Chodyra closed her B.C. practice at the end of June, as she prepares to join a new family physician group in the small town of Waihi, about two hours southeast of Auckland.

She said the decision stems from a need to be closer to her husband’s family in Australia, and because of “the state of primary care in B.C.,” including the province’s current fee-for-service system and staffing shortages which she says will be less of a problem in New Zealand, where she will have five nurses and three doctors helping assist patients.

“Family doctors, we don’t feel supported and we really feel undervalued,” she said.

Her imminent departure, however, has sent shock waves throughout the Tri-Cities, as her patients scramble to find new family doctors amid a shortage, where an estimated one million British Columbians are already without a primary care physician.

The Fraser Northwest Division of Family Practice (FNDFP) — a non-profit organization that works with and supports family physicians in Anmore, Belcarra, Coquitlam, New Westminster, Port Coquitlam and Port Moody — said its membership has decreased seven per cent over the past year. It estimates that, across the six communities, there are 170 primary providers, roughly 49 of whom live in Coquitlam.

The non-profit’s program director, Jessie Mather-Lingley, said that since 2014, Coquitlam has lost nearly 50 family practitioners. She said 15 of those have been since 2021, either due to retirement, relocation or changing roles within health care.

B.C.’s Ministry of Health said in a statement that it “is committed to ensuring all British Columbians have access to health care when they need it.”

“The number of family physicians has increased by nearly nine per cent since 2016-17 to 6,760 FPs (family physicians) in the province in 2020-21. That’s an average annual increase of 2.1 per cent.”

Still, Chodyra and other doctors worry that patients unable to find new physicians will turn to acute care providers like hospital emergency departments for non-urgent care, because they have no other option, further straining British Columbia’s health-care system with delays and increased costs.

Doctors without doctors

For family doctor Mahsa Mackie, Chodyra’s departure hits especially close to home. Along with working in Coquitlam, she is also one of the patients Chodyra is leaving behind.

“If someone who we think has a lot of years ahead is closing their practice or leaving the community, it’s never a good sign,” said Mackie.

Mackie, who finished her residency in 2014, said the hardest part of her doctor’s decision to close shop is knowing she and her colleagues at Manhas Health Co. Health Clinic will not be able to take in all of Chodyra’s “orphans.”

“I have a couple thousand patients and my waiting time is already a couple of weeks. Taking more patients means my current patients would not have access to care in time.”

Mackie said she has taken some of Chodyra’s patients, but that many more are stuck on the clinic’s wait list, which has been growing ever since she joined in 2021.

‘Orphaned’ patients may strain ER resources

Emergency physician Dr. Ali Abdalvand, who is also part of Chodyra’s current roster, tells CBC that orphaned patients will turn to temporary stop gaps like urgent primary care, or acute emergency care if they cannot find a family doctor in their community.

“The purpose of having emergency medicine as a specialty, and of having the emergency department as part of the health-care system, is delivery of acute unscheduled care,” said Dr. Abdalvand.

“If you end up sharing the resources of an emergency department to deliver primary care, that will leave less and less of those resources for delivery of acute unscheduled care.”

Data from the Canadian Institute of Health Information, meanwhile, shows that emergency department expenses across Canada have climbed in recent years.

The cost of an emergency department visit climbed from $96 in 2005-2006, to $158 in 2018-2019, an annual growth rate of four per cent.

The same data set also shows that, in 2018-2019, emergency department staff in B.C. worked more overtime than anywhere else in Canada, except the Northwest Territories, at 9.14 per cent of all hours worked.

As he looks for a new family physician, Abdalvad tells CBC the province is losing “one of the best doctors” he has ever met.

“I know patients who told me [Chodyra] went and got [their] prescription filled … and dropped it off,” he said. “This is above and beyond [care]. And that makes me sad.”