Correspondence: Letter from Dr. T. Walls, Re: Lack of Family Physicians in View Royal/Esquimalt

Dear Mayors David Screech and Barbara Desjardins as well as the Elected Councils,

My name is Dr Tania Wall, and I am the family physician who recently opened a practice in View Royal. As you are well aware, as soon as the news broke that my practice was open our office was flooded with patients in need. Within 2.5 days my practice was full and we had to begin turning people away. We have received stacks of intake forms completed by people in their 90’s who have been more than a decade without a family doctor. There are young families, mothers, babies. There are people with multiple specialists for their chronic disease, yet no family doctor to walk with them on their health journey. Though all of us are aware that our Western communities are in need, I think the events surrounding my practice announcement have highlighted the deep severity of the primary care crisis in the Westshore.

It is not hard to understand why we are in this crisis. Family physicians are not choosing to open or manage community practices. Soaring overhead costs, dismal compensation compared to other avenues and provinces, and a nearly unattainable cost of living make practicing community family medicine a labour of both love and massive sacrifice which deters many from joining us in the arena of primary care.

I chose to open a practice in View Royal because I love community family practice and I believe in its importance for the health of our populations. I also wanted to raise my family in the Westshore, and found an office of amazing people that I wanted to work with. Despite all of this, I almost did not open my doors. Starting a practice has come with financial risk and strain, as well as personal sacrifice and stress as I return from a very short and underfunded parental leave after the birth of my second child.

When I moved back to the Island after completing my training in Ontario, I was appalled by the family physician shortage in the area. I was quickly driven to write a letter of advocacy to the local municipalities, urging them into action. Unfortunately, I never received a response to my call to arms. Perhaps now, however, our eyes have all been opened.

I was encouraged to hear Mayor Desjardins on CBC radio speaking about how the Western communities and Esquimalt in particular are working hard to understand how they can help in this extreme primary care crisis. I heard mention that Esquimalt has discovered ways that they can be involved in drawing family physicians into our communities to open practices. This is wonderful news that, quite honestly, is in opposition to much of the rhetoric I’ve heard in response to my inquiries. Often, I’ve been told that communities ‘can’t do much’ to support family physicians, their ‘hands are tied’ and that the responsibility lies with the province, and I am pleased and heartened to hear this may not be true.

I also read through the Esquimalt Community Heath Needs Assessment report written by Dr Eileen Pepler last year. I am impressed that this report was commissioned, and I am also pleased that the South Island Division of Family Practice was consulted and involved. There are obvious health care gaps and needs in your Esquimalt community that are mirrored in most of the western communities. I read the report’s finding that Esquimalt needs more walk in clinic services and I have read the recent announcement about Esquimalt’s plans to create an Urgent Care Clinic.

I respectfully and strongly disagree that this is the solution for your communities. The longitudinal care of a person by a family physician is not only what your communities want (demonstrated by the line up at my doors), but also what improves the health of your populations. Longitudinal care by family doctors improves health outcomes, decreases emergency visits and negates the need for more walk in clinics. Urgent care and walk in care are not in crisis in your communities – family practice is in crisis. To increase walk in and urgent care facilities is a bandaid solution only and should be treated as such. There is a possibility that they are necessary evils in the short term (though again, I would argue against this), but we should never let go of the ultimate goal that will improve your population health – the successful recruitment of community based family physicians to the Westshore.

I would love the opportunity to sit down with you and discuss what options are available to improve the current lack of support that is being offered to new and existing family physicians in your communities. Certainly, any help would be greatly appreciated – both by your overburdened force of family physicians and by your communities who are clearly desperate for attachment to a family doctor.

Sincerely

Tania Wall MD CCFP