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Good morning. Wendy Cox in Vancouver today.

B.C. Premier John Horgan has had comfortable approval ratings for years, bolstered by general satisfaction over his government’s handling of the pandemic. As recently as March, pollster Angus Reid had Mr. Horgan and his government with the second highest approval ratings in the country.

But as pandemic restrictions have lifted and the daily news focus hasn’t been about COVID-19, the hard questions governments have always faced are starting to bite. The family doctor shortage in this province, brewing for years, has bit hard, forcing Mr. Horgan to acknowledge last week it’s a “real problem.”

Almost a million people in British Columbia are without a family doctor. In 2003, 437,000 people did not have one. By 2017, that number had doubled to 897,000. But the situation, especially on Vancouver Island, has become acute as the provincial government tries to shift to a different kind of care model, one based on teams, which allow a group of health care professionals – doctors, nurse practitioners and pharmacists, among others – to look after patients together.

The vision of primary care networks is supposed to provide more efficient care while taking strain off emergency rooms, which is where too many patients go when they don’t have a family doctor and the walk-in clinic is full.

“Our primary care strategy and the networks are providing a real solution to people so they can get the care they need, closer to home,” Health Minister Adrian Dix said in a 2020 news release announcing the government was “transforming primary care.”

The transformation isn’t going smoothly.

As Xiao Xu reports today family physicians aren’t happy. The province’s efforts to solve the doctor shortage with urgent and primary care centres – UPCCs – has rankled some, such as Dr. Anna Wolak, who did some of her own math and concluded that each patient who visits a Richmond UPCC costs the province about 10 times more than a visit to her clinic.

Doctors of B.C. said last week that family physicians such as Dr. Wolak earn between $114 and $130 per hour, whereas a doctor working at a UPCC earns $164 per hour and a general practitioner working in a hospital earns $174. That gap is further widened after family doctors pay out their overhead costs, such as staff and office space. To cover these expenses, which are rising, many family physicians try to see as many patients as possible in an hour. Dr. Wolak, who has 1,500 patients, attends to four to six people an hour.

Meantime, the UPCCs are dramatically understaffed. Documents released to the B.C. Liberals show the Fraser and Interior authorities are only staffed to 62 per cent of the promised commitment. In the health authority covering Vancouver, that rate is 55 per cent; in the province’s north, the rate is 49 per cent; and on Vancouver Island, it is only 39 per cent.

Family doctors say they are burned out and feeling undervalued. Many of them are leaving – in Victoria alone, at least four medical clinics have closed since the beginning of the year and thousands of patients have been displaced.

When asked if she considers leaving family medicine, Dr. Wolak responds: “Every day.”

Goldis Mitra, a family physician and a clinical assistant professor at the University of British Columbia, said the fee-for-service system needs to be modernized, and alternative payment models, such as capitation funding – where doctors in clinics are paid per patient per year, rather than per visit – should be expanded.

Dr. Wolak said family physicians in the province have not received any significant pay raise since 2006. Under the predominant funding model in B.C. – fee-for-service – family doctors are paid $30-$40 per visit, regardless of whether they are renewing a patient’s prescription for just a few minutes, or treating a complex health problem that takes much longer time.

The doctors’ contract with the provincial government expired March 31, but will remain in place until a new contract has been ratified sometime later this year. Separate to those talks are efforts by the doctors and the province to develop a new compensation model.

“It all does come back to compensation, and it’s not because we’re greedy. It’s because we need to be recognized that we provide so many facets of care,” Dr. Wolak said.

This is the weekly Western Canada newsletter written by B.C. Editor Wendy Cox and Alberta Bureau Chief James Keller. If you’re reading this on the web, or it was forwarded to you from someone else, you can sign up for it and all Globe newsletters here.