If you think it’s difficult trying to find a family doctor in Prince George, get in line.
You’re not alone.
It’s estimated that one out of every three people in the city is unattached to a family physician. That leads to long lines at the two drop-in medical clinics in Prince George — and a crush of people regularly clogging the emergency ward at University Hospital of Northern BC.
And the problem is expected to worsen with an aging population of both patients and care providers.
Patients have more complex needs as they age — but if they aren’t visiting a doctor regularly, that reduces the likelihood those conditions will be managed before they turn into serious health risks.
It’s estimated one in six doctors in the country are approaching retirement age. Those pending retirements — and a generational reluctance by new doctors unwilling to work the long hours of their older peers — could leave millions more Canadians without a primary-care provider.
“We have a system that’s in crisis,” said Ian Schokking, a 64-year-old Prince George family physician and one of 15 doctors currently working at Northern Health’s Urgent and Primary Care Centre (UPCC) at Parkwood Place.
“The issue is that the system is built on people of my generation who work 24/7 and are always available — and that’s what the BC College of Physicians and Surgeons' rules say we need to do. When I trained (40 years ago), we did 100- or 120-hour-a-week training, and that was the volume you got used to working. That’s what you do and you don’t doubt it.”
Since then, Schokking says physician unions have gotten stronger and have limited medical-student training and two-year residencies to 40 hours per week. They graduate with half or less the training doctors in his era had, when medical students regularly turned in 80- or 100-hour work weeks.
“The first consequence is people are used to working that volume and don’t want to work more — and the second is they’re scared, they don’t have enough experience and they don’t have enough context,” said Schokking.
“Virtually all the grads are limiting their clinical environments because they don’t have the clinical experience in their training. They’ve limited the amount they can train at the suggestion of their union — and the notion that if you don’t sleep enough, you don’t learn.”
That generational shift means doctors are less independent and aren’t put in positions where they might be the only physician working a night shift — something Schokking looks back on as one of his most valuable learning experiences. He agrees a societal reset was needed so doctors could devote more time to their families, but says the pendulum has swung too far and doctor shortages are the result.
Longitudinal care a requirement for BC doctors
The BC College of Physicians and Surgeons policy is clear: all its registrants must provide longitudinal care for their patients. Family physicians and specialists are ethically and legally responsible to ensure patients have access to after-hours care for urgent medical issues, either in person or virtually.
Longitudinal care means a family doctor who takes on a patient is expected to develop a primary-care relationship that offers continuous healthcare support over an extended period — basically until death. Familiarity with the patient generally leads to better management of chronic conditions, reduced hospitalizations and improved overall health.
Schokking, who received the College of Family Physicians of Canada award as a family physician-of-the-year finalist, says the new pay structure introduced by the province in 2023 to increase the number of family physicians has removed the incentive for doctors to work in local walk-in clinics and cover hospital shifts.
“It used to be everybody worked in the hospital — and gradually that has eroded, and now we have a big problem with only seven of us working in long-term care, when we used to have 15 taking on new patients,” said Schokking.
“We’re about to get 200 new beds with the new facility at O'Grady — but who’s going to look after those patients when they build it? We’ve got fewer and fewer doctors looking after their own patients, and we’ve had four more bail in the last three months, and their work falls on the same few of us who do long-term care, urgent care and hospital work.
“There’s more and more work being dumped on fewer and fewer of us as the old docs age — and it’s mostly the young docs who have been bailing. They’re doing office practice only — they’re not doing hospital or nursing-home work anymore and they’re not working at the urgent-care clinic.”
The UPCC now has just 15 doctors — a staggering drop from the 69 physicians who used to fight for shifts when it was run by the Nechako Medical Clinic group at Spruceland Mall starting in 1991. Half of those doctors left when the clinic moved to Parkwood Place in 2019.
The new service model means doctors at the UPCC who used to be paid per patient (fee-for-service) now receive a fixed hourly salary. So instead of seeing six to eight patients an hour, they’re paid to see only four per hour. As a result, only 12 to 15 of the city’s 100 family doctors work at the urgent-care clinic — meaning patients no longer have immediate access to a doctor. On arrival, people are triaged by a nurse and referred based on their urgency — not on when they arrived.
Schokking has a solution that would restore quick access — though it would require a shift in thinking across the family-doctor community.
“If we asked for four hours per month from all our docs in town, our urgent-care clinic would be open, our hospital work would be managed,” he said. “If all the doctors who have stopped doing what they used to do gave me an hour a week, my urgent problem would be solved.
“I think if we could somehow encourage docs to look at their social responsibility and provide a little bit of time, then we could weave new grads into the system we have and we'd have less of a problem.
“We have to figure out how to provide 24/7 care in a way that works for Gen Z. The answer we're using now doesn’t work.”
The lack of access to urgent-care doctors at the UPCC and Salveo Medical Clinic at Real Canadian Superstore puts more pressure on the emergency ward at UHNBC — and patients are forced to go to hospital for minor ailments or to get a prescription filled.
The province has tried to ease hospital pressure by allowing pharmacists to renew an existing prescription for up to three months and setting up virtual-video links to connect patients to doctors. But Schokking says that doesn’t compare to a longitudinal doctor who knows you and your healthcare needs — and who won’t bill the system for unnecessary scans or duplicate tests.
“People do not value longitudinal care, and data suggest having somebody in that relationship with you saves 40 per cent of health dollars,” Schokking said.
Province introduced new doctor-payment model in 2023
The potential cost savings drove the province to introduce the Longitudinal Family Physician (LFP) blended-payment model in February 2023 to increase the pool of GPs and improve access to primary care.
The LFP model streamlines administrative tasks and removes some of the burden so doctors have more time with patients. Doctors receive payments based on their panel size and the complexity of each patient’s needs. Billing is simplified: visits are coded according to complexity and duration.
Since it became a voluntary alternative to fee-for-service, more than 4,300 family physicians have signed on, but that didn’t create more doctors. It meant many shifted from hospital and urgent-care work to office-based longitudinal care because of the financial incentive.
Years ago, GPs working in hospitals treated less acute patients and referred complex cases to specialists. But when GPs left hospitals for office practice, they were replaced by hospitalists — who now make up about one-third of all family-medicine graduates — and these physicians do not provide longitudinal care.
In June 2024, the province expanded the LFP model to include doctors working in hospitals providing inpatient, pregnancy/newborn, long-term and palliative care.
“If you get urgent care organized, then you’d get all these people having somebody provide some care for them — there wouldn’t be so many people who walk in with six problems and cancer that somebody has missed,” said Schokking.
“We’re working in an under-resourced environment with no good model to pivot from a system run by doctors who worked everywhere always, to one where everybody is much more compartmentalized. Everyone’s fighting each other for resources.”
LFP introduction prompted rural-doctor exodus
Under the LFP model, doctors are paid more for office-based work than for clinics or hospitals — and that change has carried a heavy price for rural Northern Health.
“The consequence was you now get paid quite a bit more to work in the city seeing patients, so places like Prince Rupert lost 10 doctors and rural medicine got killed by the LFP model,” said Schokking.
“Many who moved to longitudinal care came from urgent care and hospital work. They incentivized longitudinal care — but the 24/7 piece got hurt, particularly in rural areas. The manpower drain probably cost us 15 per cent of our rural doctors. The bonuses that had kept them rural no longer had the same differential.”
Schokking suggests the province find new incentives for communities so that new recruits receive bonuses for devoting part of their time to hospital work, urgent care, long-term care and obstetrics — wherever they are needed.
Schokking says hospital work is not fun like it used to be because many healthcare positions are unfilled. The staff shortage extends to nurses — many of whom left the profession during the pandemic or were fired for not getting COVID-19 vaccines.
“BC is different than any other province — and during COVID it refused to let unvaccinated nurses work," said Schokking. "In the Peace Country we lost 40 per cent of our nurses — they either went to Alberta or changed careers, but most stopped nursing,” said Schokking.
“The province could have been creative and let them all work in virtual care short-term, but they didn’t. They said you can’t do any job — and the consequence, at a time of severe shortages, is we lost a bunch of doctors and nurses.”
Prince George clinics feeling pinch of doctor shortages
Since Northern Health took over the UPCC in January, the clinic averaged 2,137 patients per month through the first three months of the year — and that number has increased each month. The clinic has 19 doctors who provide primary care to those not attached to a doctor or nurse practitioner. When capacity allows, those doctors also provide urgent or episodic care.
The UPCC is open weekdays from 8 a.m. to 8 p.m., and weekends and holidays from 9 a.m. to 5 p.m. Doctors working weekdays after 4 p.m., or on weekends or statutory holidays, see only urgent-care patients.
“While the Prince George UPCC is making progress to increase the number of patients seen, Northern Health recognizes the needs in the community remain high,” said a Northern Health spokesperson. “Efforts to recruit primary-care providers to provide coverage at the clinic are ongoing.”
The privately owned Salveo Medical Clinic at Real Canadian Superstore is open weekdays from 8 a.m. to 4 p.m., Saturdays from 9 a.m. to 3 p.m. and closed Sundays. It currently has just two doctors who bill under fee-for-service: they receive full pay for the first 55 patients seen, half pay for the next 10, and no compensation beyond that.
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