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Every day at the Prince George Urgent and Primary Care Centre, patients who need a prescription, treatment for a wound or relief from a minor ailment are first assessed by a nurse who determines the urgency of their case.
The triage system works well — when there are enough doctors to provide care. But at the Prince George clinic, there are not nearly enough physicians signing up for shifts.
Barend Grobbelaar, former chair of the Nechako Medical Group, which operated the clinic for 33 years, no longer represents the group. Speaking as an individual, he says he is deeply concerned that so few of the city's 70 family doctors are volunteering to cover urgent care shifts at the clinic, located in Parkwood Mall.
“The ability to get through the triage system depends on how many physician hours are available, and the Achilles heel right now is that there just aren’t many doctors,” Grobbelaar said. “Right now, there are fewer than a handful participating on a regular basis.”
Years ago, when the Nechako Medical Clinic was thriving, each doctor could see six to 10 urgent care patients per hour. Today, that number is closer to four. Physicians used to earn a premium for working evenings and weekends — more than they could make anywhere else. That incentive disappeared under the current provincial contract, where doctors now earn less than they would in other settings.
Two years ago, BC replaced the fee-for-service model with the Longitudinal Family Physician (LFP) payment model, aimed at better compensating family doctors for time spent with patients. The new system factors in the added time needed to manage complex conditions and the administrative burden that comes with them.
Under the LFP model, physicians are responsible for patients across the continuum of care, whether in their office, the emergency department, hospital or palliative care. It replaced a system where doctors were paid only for face-to-face visits.
The LFP model has persuaded many doctors to convert their walk-in clinics to longitudinal practices, where they provide ongoing care and coordinate services. But that shift has had consequences. Doctors are now better compensated for office and hospital work, and fewer are willing to take on urgent care shifts.
“We’re getting paid better now to look after panels of patients, and a lot of doctors are realizing they don’t need to work long extra hours to cover their overhead and make a living,” said Grobbelaar.
“There’s also been a generational shift in priorities. Family life is more important now than it was in the past. Urgent care means working after hours, on weekends and holidays, and many doctors just aren’t willing to do that anymore.”
The urgent care clinic offers services to patients with minor injuries, non-life-threatening conditions or who need a prescription refill. It also helps relieve pressure on emergency staff at the University Hospital of Northern BC. However, the triage process adopted by Northern Health, while improving care quality for individual patients, has also led to fewer being seen overall.
“This would be a net positive if we had enough doctors,” Grobbelaar said. “The real problem is that we don’t have enough showing up to sign on for shifts, and that’s a serious vulnerability for the ongoing function of the urgent care centre.”
“It’s much less efficient now. The quality of care is better per patient, but we’re not seeing the same volume, and the cost per patient is three to four times higher.”
According to Grobbelaar, about half of patients are now seen virtually by Teladoc Health, an international company offering remote services. Each Teladoc consultation involves both a remote doctor and a nurse, supported in person by another nurse who facilitates the visit on-site.
“For one patient, you’re paying three people, and you’re paying Teladoc,” he said. “They won’t see really sick people or anyone needing a quick, hands-on exam. We’re paying two to four times more just to get a prescription filled, and that’s happening because there aren’t any doctors signing up. The money is leaving the community, and the care isn’t as good.”
Grobbelaar said Teladoc is useful in remote parts of northern B.C. where doctors are scarce, but a city the size of Prince George shouldn’t have to rely on it.
For 33 years, until their contract ended in December, the Nechako Medical Clinic operated the urgent care centre, offering a critical service for the one-third of local residents without a family doctor.
But the group withdrew because they couldn’t recruit enough of the city’s 70 family physicians to work there. At the time of closure, only 19 doctors were involved, down from 40 or 50 in earlier decades. Mounting costs, including rent and staffing, meant the clinic was operating at a loss for two years before the group dissolved the corporation.
Northern Health took over on Dec. 9, 2024. Patients are now seen the same day by a physician, nurse practitioner or other health-care professional, depending on the urgency of their case. Triage prioritizes care based on severity rather than order of arrival, aiming to improve flow and reduce the frustration of patients being turned away once the daily schedule is full—but the system is far from perfect.
A decade ago, the shortage of primary care wasn’t an issue. Most Prince George residents had a family doctor. The Nechako Medical Clinic, which operated at Spruceland Mall from 1991 to 2019, focused on urgent patients and used the Medical Services Plan fee-for-service model, which rewarded speed and volume.
When the current clinic opened at Parkwood Mall in June 2019, Northern Health combined urgent and primary care services. But an aging population and physician shortage means more patients showing up at the clinic haven’t seen a doctor in years and often have complex conditions that require primary care.
At opening, 35 doctors were involved. Most have since left, and the situation is likely to worsen. Grobbelaar, now 70, says many of his colleagues are nearing retirement.
“There are only five or six of us doing regular urgent care shifts. Realistically, two of us are covering 80 per cent of the work,” said Grobbelaar, who averages 20 shifts a month.
“It just takes forever to be seen. You show up four or five hours before a doctor arrives,” he said.
“I believe that if more local doctors tried a few shifts, they’d find it a good working environment and would return. We’ve got to overcome their reluctance to participate.”
