Open letter: Family doctors burned out, demoralized and calling for change

Family doctors demoralized

Open letter to: Premier John Horgan and Health Minister Dix,

We the undersigned physicians at Rutland Medical Associates have decided we need to speak out on what is happening within longitudinal primary care (traditional family practice medicine) in our province. Never before have we stood at such a precipice. The coming crisis will have lasting consequences for many years to come.

Primary care is the bedrock foundation for our healthcare system and the collapse of this will have after shocks felt at all levels of health care delivery. Having a family physician means promoting preventative medicine, doing outpatient work ups re directing care away from overwhelmed ER departments when appropriate, providing earlier more manageable disease diagnosis, collaborating with specialist and ensuring you get the best care possible. We are instrumental in decreasing the number of in patients and over capacity at the hospital. We help transition patients to short stay units, long term care or follow up on our discharged patients, and some of us even do house calls for the infirm. Good care means taking initiative and ensuring our patients don't fall through the ever enlarging cracks in the system.

Unfortunately, Minister Dix and this government have created a false equivalence between urgent and primary care centres and nurse practitioners to family physicians and continue to divert limited money without proper accounting to this model. They believe it will provide the same, if not better, delivery of care and we just need to wait to see it. We believe this to be blatantly false and not a cost effective use of funds. Simply put, family physicians are the work horses that are able to quickly assess manage and treat patients with a clinical acumen that can not be matched.

Family medicine means dealing with mental health, cancer, heart failure, liver failure, multiple sclerosis, neuropathic disorders etc. The breadth of knowledge we must be aware of is extensive and ever growing. Our education is rooted in four years of medical school, and two plus years of residency rotating through a multitude of services including cardiology, surgery, ICU and more.

The sad fact is family physicians are undervalued and the government has failed to address this. Remuneration falls short when compared to other provinces when our living expense in B.C. are quite high. Additionally, while we don't begrudge our specialist colleagues their superior pay, the wide discrepancy between GP and specialty medicine becomes disheartening and compounds the problem. Becoming an ever less desirable field to go into means there are less medical students willing to go into family medicine as a career path.

Practising in longitudinal care, it becomes quickly apparent the unreasonable expectations built into the current fee for service model. Physicians are pressured into a rushed limited issues per appointment care and penalized financially for taking additional time when needed. Fortunately, the majority of family physicians are inherently caring and genuinely want the best for our patients, so we take on the on the extra issues seeing the "oh just one more thing doctor," and spending extra time with our complex and frail elderly. However, this results in punishing after clinic and weekend hours completing paperwork. Family physicians shouldn't have to enforce a rushed limited problem based appointment model with patients just to be able to have a semblance of work life balance.

The government makes us go through hoops to try to get our higher billing patient payments such as the complex care plans or chronic disease management plans. This forces us to play a game that "proves" we are taking care of patients as if the expectation is we are not. Age payment modifiers to the fee for service model still don't accurately reflect our time. While people may comment on salary values they don't see or appreciate our extensive work hours of 60-plus hours a week and overhead clinic splits. Physicians, doing a full work week practice are burning themselves out with the unseen after hours. The government looks for creative ways to increase access to care and minimize the time burden required, but it is inherently part of the job that can't be "shifted." Time is needed these days due to the especially high burden of quality of charting expected given our medico legal responsibilities.

The government expects a 24-hour-on-call evening/weekend service which we must provide services for emergency results such as labs, investigations, long term care facilities, hospice patients and more. When we deal with these issues, we bill a nominal fee. Our clinic rotates through this service. It affects what we do and plan with our families as we need to be available. We all would rather not be "on call" given the disruption.

Given the expectation the government places on us, should we not be provided an hourly on call availability fee for this service. Something as nominal as 6-8$/hr would make family physicians happy to receive something for providing 24-hour availability. Fundamentally, something is wrong in medicine when providing a below minimum baseline hourly wage premium for an add on service mandated by the regulatory colleges to enhance patient care would be a step towards making us feel valued.

Family physicians are burned out and demoralized. That is why so many of us look for any subspecialities with better pay to go into such as hospitalist work, rural ER, GP oncology, addictions medicine, skin clinics, etc. It is why so many licensed family physicians are on the sideline NOT practising full practice longitudinal care. If the public wants access to family physicians for the future now is the time a substantial investment needs to be made to incentivize it. Not tomorrow or next week, but now.

That means dramatically increasing fee for service or providing a dramatic change within the system itself, perhaps a new hourly payment model for administrative charting, referral or other time that directly comes out of the patients appointment. This will attract those that left traditional family medicine care to come back when we are paid appropriately and work life balance is obtainable. The unattached patients in the province nearing a million will decrease.

The government always has money to spend on whatever it values including museums, but never money when it comes to GP recruitment and remuneration. Currently we are on track for more physicians looking for their way out of longitudinal care and a never ending stream of more clinics shuttering. The domino effect will multiply through the system and patients will suffer.

Dr. Joshua Nordine, Dr. Jason Cassidy, Dr. Joel Strautman, Dr. Louise Graham, Dr. Jennifer Verhelst, Dr. Anthony Morham, Dr. Lawrence Wiebe — Rutland Medical Associates.

Developers must address needs of high-density downtowns now

Downtown density

The current narrative around urban living is that cities are shrinking as pandemic-related influences such as remote work and the desire for additional space led many Canadians to flee major cities in favour of suburban or rural communities.

However, recent census data has shown that the story of urban exodus is somewhat exaggerated and major urban centres are actually growing.

Census data showed that downtown centres are growing faster and more rapidly as the downtown populations of large urban centres increased by 10.9 per cent from 2016 to 2021, compared with large urban centres as a whole, which grew by 6.1 per cent.

Statistics Canada defines downtown centres as the core of an urban centre with 100,000 people or more. Canada also welcomed the most immigrants in a single year in history in 2021, reaching its target of 401,000 new permanent residents.

As pandemic restrictions start to lift and borders begin to reopen, Canada is expected to receive an additional influx of immigration and will continue to fulfil its goal of adding 2,000,000 new permanent residents to the country’s population in the coming four years, further fuelling the growth of major urban centres.

Increasing urban population growth means cities will need to grapple with greater density. For example, census data found that Vancouver was the country’s most densely populated downtown, and Metro Vancouver planners project the region will welcome more than one million additional residents by 2050.

This presents both challenges and opportunities that developers will need to address when it comes to future housing needs, making now the time for developers to start planning innovative housing projects that will lean towards future urban population growth.

Denser downtown cores mean we will need to fit more people into the same amount of space.

It also means increased pollution and hotter cities as buildings and infrastructure in densely populated areas absorb and re-emit the sun’s energy, creating heat islands.

We saw the devastating effects of climate change in B.C. over the last year with unprecedented heat waves and floods, making it more important than ever for developers and city planners to start designing and developing more energy efficient and sustainable homes. This means investing in projects that both maximize square footage and help fight climate change, including taller towers that are net zero, and follow energy step code or Passivhaus design principles.

It is also important for developers to consider the effects increasing density and pollution will have on urban residents and when designing towers to address population growth. Looking at cities such as Hong Kong and New York that already have high urban density, developers are incorporating features such as enhanced air filtration into buildings to help mitigate these effects and improve the quality of life for residents.

The wants and needs of homebuyers have evolved as the pandemic reinforces the importance of health, community and wellness.

The perception of luxury is changing: in addition to marble countertops and stylish finishings, homebuyers are looking for community-based amenities that enhance their well being and foster connection with their neighbours.

While homebuyers long for fresh air and outdoor space, satellite images have shown that green space is decreasing across major cities in Canada as a result of urbanization. Developers can address this by incorporating amenity spaces within buildings that mimic being in nature.

We are already starting to see this in Toronto, with 123 Portland’s rooftop outdoor fitness space and communal cooking zone and in B.C., with One Park, a new project in downtown Richmond that will include a 31,000-square-foot private park for residents. One Park is half the size of a soccer field, filled with walking paths, a playground and a large outdoor fountain, providing residents with access to green space within their residence.

We are also starting to see bigger and bolder energy-efficient towers that follow Passivhaus design principles in the works. Once completed, they are poised to usher in a new era of healthier, more sustainable living.

As cities become denser, outdoor-inspired community-based amenity spaces and buildings that positively contribute to both our health and the Earth are expected to be high drivers of demand.

As Canada’s population continues to grow, now is the time for developers to start planning buildings that will address the demands of increasing urbanization and ensure a high quality of life for residents of high-density neighbourhoods.

Jacky Chan is the president of BakerWest Real Estate Inc. in Vancouver.

Relevance of resurrecting abortion debate in Canada questioned

Support for abortion

For the past few days, federal and provincial politicians in Canada have been paying a lot of attention to the United States. A draft opinion by the U.S. Supreme Court that was inexplicably leaked to the press suggests that the landmark Roe vs. Wade decision that legalized abortion in the country in 1973 may be overturned.

Canadians are no longer being subjected to American news as much as they were during the Donald Trump presidency, when the confirmation hearings of Supreme Court justices were the opening story in domestic newscasts. Still, social media has been riddled with varying opinions on what a leaked draft opinion in another country might mean, and elected representatives have been quick to defend Canada’s status quo on abortion.

Research Co. and Glacier Media were in field last month before the leak. We revisited two simple questions that we asked in 2019 and 2020, seeking the views of Canadians on pregnancy termination and their appetite towards a broader debate on an issue that has not been prominently featured in domestic politics.

Right now, 44 per cent of Canadians believe abortion should be legal under any circumstances, down four points since 2020. More than a third (37 per cent, up one point) say abortion should be legal only under certain circumstances, while 10 per cent (down two points) think abortion should be illegal in all circumstances.

The numbers have not shifted dramatically since the first time I asked this question in 2013. The group that endorses the possibility of pregnancy termination without an explanation has always been larger than the one that calls for a review of the circumstances behind the decision.

Support for legal abortion under any circumstance drops with age, from a high of 48 per cent among Canadians aged 18 to 34, to 42 per cent among those aged 35 to 54 and to 43 per cent among those aged 55 and over.

There is also a gender gap.

Practically half of women (49 per cent) think pregnancy termination should always be legal, but only 39 per cent of men concur with this point of view.

This year marks the first time that we register one in 10 Canadians suggesting that no person should be allowed to go through an abortion under any situation – a proportion that rises to 14 per cent in Ontario and Atlantic Canada. A vocal group, perhaps, but not one that would be eagerly courted by elected politicians.

The overtures of some centre-right parties to organize events and rallies seeking to outlaw abortion appears to be misguided. A majority of Conservative Party of Canada voters in the 2021 federal election (54 per cent) would like to allow the practice under certain circumstances – not ban it. This is a significant departure from the 57 per cent of New Democratic Party (NDP) voters and 48 per cent of Liberal Party of Canada voters who think no restrictions should be placed.

The proportion of voters who would be willing to make pregnancy termination illegal is minimal across the board (six per cent among New Democrats, nine per cent among Conservatives and 10 per cent among Liberals). Simply put, there is not a lot to gain from an unmitigated anti-abortion stance.

In four different surveys conducted in 2013, 2019, 2020 and 2022, we have seen consistent majorities of Canadians preferring not to discuss this matter. This year, 53 per cent of Canadians say there is no point in reopening the debate about abortion right now.

Just over one in four Canadians (26 per cent) think a debate on abortion is long overdue in Canada and the discussion should be reopened. This represents a one-point increase since 2020, but well below the level observed in 2019 (37 per cent).

Prior to the U.S. Supreme Court leak, Canadians did not seem eager to revise the country’s state of affairs on pregnancy termination. Conservative voters are not particularly adamant either, with 30 per cent calling for a new debate on abortion – higher than the sentiments of those who cast ballots for the New Democrats (26 per cent) and the Liberals (24 per cent).

There have been suggestions that the Conservative Party is seeking to place restrictions on abortion. The outcry has not been accompanied by facts. While one of the candidates for the leadership – Leslyn Lewis – has discussed the issue primarily from the standpoint of sex selection, her key rivals have not. Jean Charest and Patrick Brown went on the record to say they do not plan to challenge existing regulations. In February, the Campaign Life Coalition announced it would not endorse Pierre Poilievre because of his stance on abortion.

As was the case during the Trump years, Canadian politicians glance at the United States for posturing. Most Canadians do not think this debate is warranted now, and they have felt that way consistently for almost a decade. Speeches in legislatures, press releases and tweets warning of impending problems here, or expressing concern with what could happen in a foreign country, help little.

The problems of Canadians now – housing, inflation, health care and COVID-19 – are significant. Our elected representatives should stop pretending that Roe vs. Wade applies north of the 49th parallel.

Mario Canseco is president of Research Co.

Results are based on an online study conducted from April 25 to April 27, 2022, among 1,000 adults in Canada. The data has been statistically weighted according to Canadian census figures for age, gender and region. The margin of error, which measures sample variability, is plus or minus 3.1 percentage points, 19 times out of 20.

Opinion: Some reasons why gas prices in B.C. are so much higher than in Alberta

Big disparity in gas prices

Premier John Horgan’s excuse for not trying to curb gas price jumps is that the industry will just jack prices higher to take up the room left by any tax cut.

But Alberta cut gas taxes five weeks ago, and there’s no evidence yet that oil companies seized the chance to charge even more. Alberta gas prices are generally rising, but the rate is smaller than B.C.’s. And it looks to be for the same global economic reasons everyone is citing.

Alberta “paused” the 13 cent-a-litre provincial tax on gas and diesel last month and tied the pause to the benchmark price for oil. So the tax holiday will last a long as the benchmark price stays high, and at least until July. Premier Jason Kenney said the provincial government would be watching “like a hawk” to see that the cut is reflected in pump prices.

“We sent a clear message to gas retailers that we won’t accept any games being played with this,” he said. Kenney said Alberta was ready to use legal tools if companies “tried to pocket a portion” of the cut.

The tax break would cost the Alberta treasury about $1 billion if it lasted a full year.

The retail gas market is hyper-competitive on pricing and the government is relying on that to bar individual companies from taking advantage.

A similar measure for natural gas could take effect next fall if natural gas prices are high. Ontario Premier Doug Ford, in the midst of a re-election campaign, promised something similar.

The Alberta cut took effect April 1 and the average per litre pump price went down to $1.57 from $1.67, according to media surveys. The full 13 cents wasn’t reflected because the federal carbon tax increased the same day.

The Canadian Automobile Association’s price tracker shows the average Alberta price Tuesday was $161.6.

By contrast, the CAA’s average price in Victoria is now $2.10 a litre, but $2.20 was common across the city Tuesday. It’s up at 30 cents in a month. The record high prices are holding all over the coast, although the Interior prices are lower.

B.C.’s response to the crisis is the $110 ICBC rebate that is now being distributed.

The steady hikes dominated the legislature Tuesday, as opposition B.C. Liberals demanded a similar tax holiday in B.C.

But Public Safety Minister Mike Farnworth insisted the gas companies would take advantage.

“Economists who understand the gas market have made it really clear that cutting gas taxes for the sake of cutting gas taxes does not guarantee that money goes back into people’s pockets. More often than not it is taken up by the gas companies that jack the price up.”

Provincial taxes on gas in Victoria amount to about 31 cents a litre.

He blamed the price hikes on the war in Ukraine, but critics said B.C. prices were much higher than elsewhere before the war started. Liberal MLA Peter Milobar said the B.C. pump price has gone up by 90 cents a litre since the NDP took power five years ago.

All of which make Horgan’s earlier promises about gas prices ill-considered.

After a hike just months into his first term as premier, he talked monitoring prices, “considering a range of options” and “taking steps if necessary.”

Five years later, there’s an ongoing review of gas prices by the B.C. Utilities Commission (which is forbidden from looking at the tax component) and a fuel-price transparency law that makes price data public every month. Guess what? They’re going up.

The most recent report tracked hikes that are obvious to everyone who drives by a gas station.

It also found that, as of March, retail margins in B.C. were 2.5 cents to 3.9 cents higher than in Alberta. The wholesale price for gas in B.C. was 17.7 cents a litre higher in B.C. than Alberta.

After years of intermittent huffing and puffing about gas prices, the only positive development is the creation of a useful website (gaspricesbc.ca) run by the BCUC. It allows you to see on your phone in real time how badly off you are compared with other places.

The premier can use it too, while he’s “considering his range of options.”

Les Leyne is a columnist with the Victoria Times Colonist

Buckle up for a wild real estate ride in the Okanagan

OK real estate market shift

It’s going to be a wild ride — in a good way.

Kelowna has been showing increasing promise as one of Canada's emerging economic hubs and one of the strongest real estate markets in the country. A recent report from Fundscraper showed Kelowna is among the top emerging real estate markets in the country.

The study analyzed population growth, location, GDP per capita, employment, income, and housing prices. Kelowna ranked just ahead of Saskatoon, Saskatchewan and Barrie, Ontario.

Additionally, Canada's latest census data released in February of this year reveals Kelowna is the fastest growing census metropolitan area in Canada, with 14% growth (among cities with 100,000 residents or more).

It's a promising recipe that has Kelowna’s buyers, sellers, developers, builders, and marketers set for growth mode. For instance, the Epic team has gone from three people to 26 in just over a year, and we are eying tremendous growth potential in Kelowna's multifamily, recreational, and luxury markets.

Expect an active summer market as buyers prioritize lifestyle

Thanks to its vineyards, wineries, beaches, and lakes, the Okanagan Valley has attracted interest from buyers across the country, and with more visitors expected this summer after two years mostly mired in pandemic restrictions, Kelowna's best marketing tool is ready to attract additional pent-up demand from people looking at getting a piece of the idyllic Okanagan lifestyle.

Remote work has allowed increased flexibility when it comes to where we live, empowering Canadians to prioritize their lifestyle needs. As a result, we are seeing shifting buyer demographics in the Okanagan Valley to a much wider range, including baby boomers seeking to relocate, investors, young professionals eager to set down roots, and mature families looking to upgrade their space.

In the new home market, there has also been a significant increase in interest from Lower Mainland buyers.

Our internal data showed that 45% of our buyers are from the Lower Mainland, 31% from the Okanagan, 12% from Alberta, and 5% from Ontario – a shift in location demographics compared to previous years where the majority of buyers were from Alberta.

However, as the Alberta real estate market starts to gain momentum, Epic expects the number of buyers from this region to ramp up again starting this year. Buyers from Ontario have also doubled year-over-year as the Okanagan is now on the map for Ontarians as a destination to visit and live.

Unlike previous markets where a large percentage of buyers were investors and speculators, the buyers we are seeing have close ties to the Okanagan and are looking to set down roots, move their business to the area, or spend a portion of the year enjoying the unparalleled lifestyle the region offers.

Buyer decision-making sees a notable shift

For those who experienced the Kelowna real estate boom and subsequent crash in the early 2000s, this real estate wave may feel familiar; however, there is a key difference with today’s market. There has been a significant shift when it comes to buyers’ decision-making. As market information is now widely available and easily accessible online, today’s buyers are making more informed decisions when it comes to purchasing homes in the region.

Lifestyle and the ability to retire early or work remotely are also significant factors that are driving buyer decision making today. The pandemic has led people to realize that time is precious, and they are taking the opportunity to live the lifestyle they want, whether it be moving their business to the region or working remotely. Buyers are also seeing the future growth potential of the Okanagan Valley for a savvy investment choice.

With strategic decisions being made and significantly more inventory available today compared to that of the early 2000s, we expect the market to continue experiencing growth in the coming years – even as it starts to become more balanced.

Economic growth fuels demand in the downtown core

Between 2020 and 2021, job postings in the Central Okanagan increased by 42.5% and the unemployment rate saw a steady recovery, according to the Central Okanagan Economic Development Commission (COEDC). That said, it comes as no surprise that Kelowna’s downtown core has experienced significant growth over the past few years.

In addition, new high-rise towers are currently in development to accommodate Kelowna’s increasing population and revitalize the downtown core, including ONE Water Street, Kelowna’s tallest residential tower which will be finishing construction this summer.

The expansion of the city center is expected to accelerate even further with the arrival of UBC Okanagan’s new downtown campus. We are already seeing significant interest from developers looking to build near the campus and expect this neighbourhood to be one to watch for further growth.

West Kelowna is also a growing region to watch as it’s becoming a great alternative to the city center with the addition of communities such as Lakeview Village that offers walking access to a retail village, outdoor activities, and the wine trail.

As Kelowna’s economy continues to diversify and buyers flock to the Okanagan Valley for its unmatched lifestyle, there will be immense future growth potential for Kelowna’s multifamily, recreational, and luxury markets, signaling a wild real estate ride we can collectively start preparing for.

Shane Styles is president and Curt Woodhall is the senior vice-president at Epic Real Estate Solutions in Kelowna.

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