Code Grey: Rural health shortages a historic issue

The critical shortage of health care staff affecting the province doesn’t just include nurses and hospital staff and began in rural communities long before the pandemic.

While many believe that staffing shortages in Northern B.C. are primarily due to the COVID-19 pandemic, this doesn’t appear to be the case. There is evidence to suggest that this issue is not a new one in rural communities.

Previous newspaper articles and studies dating back to the 1970s have shown that staffing challenges have pervaded rural communities for decades.

This is part two of Energeticcity’s series Code Grey, where we examine the history of health care in our community to determine if these shortages are a new issue, what caused them and what health officials are doing to combat the current crisis we find ourselves in.

History of health care in Fort St. John

The first hospital in the Fort St. John area was the Grandhaven Red Cross Outpost Hospital. The hospital was a two-bedroom building and was used from 1930 to 1931.

The second was opened in 1931 by the Sisters of Providence after receiving a request to visit the area from Father L. Beuglet. According to the South Peace Historical Society, the original hospital was 30 by 50 feet, two stories high and contained ten beds. A third story was added during the construction of the Alaska Highway. 

The facility, known as the Providence Hospital, initially began operating with just one doctor, Dr. Brown and two registered nurses — Sister Alfred of the Cross and Miss Laura Murphy.

Before the hospital had even officially opened its doors, it had already begun admitting patients due to the community’s immense need for medical care.

In 1962 the Sisters, along with the Peace Liard Regional Hospital District, built a new 44-bed facility, which became a public hospital in 1973 and was renamed the Fort St. John General Hospital.

Shortly after the hospital became a public facility, the first official records of staff shortages were reported.

“Policies designed to force urban doctors to “do their time” in rural communities have not yet worked.”

Dr. Harvey Thommasen

Historical health care shortages in Fort St. John

After Energeticcity.ca reviewed the public archives at the Fort St. John North Peace Museum, it became clear that health care shortages have been —at the very least—an intermittent issue within the community.

In August 1974, Alaska Highway News reported that the Fort St. John Hospital was in the midst of a nursing shortage, with over a quarter of the 32 nurses in the hospital’s employ away on holidays, resulting in a loss of services at the hospital and a drop in personal attention paid to an average of 65 patients daily.

A hospital administrator at the time, Rick Wilson, said the issue was one the hospital regularly experienced at that time of year, claiming it would likely be solved in the fall.

At that time, the hospital was reportedly having difficulty finding specialty nurses, particularly those to work in the ICU, which at that time was being staffed by two “regular” nurses — one full-time nurse who planned to leave in the fall and one part-time. In the major surgery ward, there were 35 patients —nine of which needed special care — being looked after by four nurses each shift.

In a 1975 article discussing a then-new policy requiring doctors immigrating to B.C. to practice in the north of the province for five years, Garth Wortman, an administrator of Fort St. John’s medical clinic, told Alaska Highway News that there wasn’t a shortage of doctors in the city, adding that there were no problems in recruiting doctors to the region.

However, Wortman did admit to a high turnover rate of physicians, adding that there had been brief periods when “there had been problems,” but he did not elaborate further.

But, recruiting and retaining doctors in rural communities like Fort St. John has been a long-standing issue for decades.

In May of 1995, the city of Fort St. John found itself in the midst of a dire doctor shortage, with Dr. Mike Wright telling AHN that doctors in the region working with a patient-to-physician ratio of 3,500 to one — about fives times the provincial standard at the time.

Dr. Wright said that Fort St. John doctors had been “burdened for years with an overwhelming work schedule,” one that is typically temporarily reserved for training physicians.

Earlier that same month, Fort St. John mayor Steve Thorlakson told AHN that despite paying doctors a substantially higher rate than their counterparts in the lower mainland, the province had been unable to encourage an adequate amount of physicians to practice in the city.

The population in Fort St. John has since grown from 14,156 in 1991 to 21,465 in 2021. About $7.7 million has been invested in the Fort St. John Hospital in the past decade, yet the B.C. Nurses Union says nurses in Fort St. John have reported increased negative patient outcomes due to a lack of nursing staff.

“[The province] is in a healthcare crisis, but rural B.C. has been in a healthcare crisis for decades,”

Paul Adams, British Columbia Rural Health Network

Rural areas contending with health care crisis “for decades.”

Fort St. John is not the only rural area to have problems with high turnover rates when it comes to physicians. Studies dating back to at least 1971 have illustrated the issues when it comes to the recruitment and retention of rural physicians.

A 2000 study completed by Dr. Harvey Thommasen compared recruitment and retention in rural B.C. communities based on population. 

This data showed that after two years, the number of rural physicians remaining after 2 years range between 64% and 74%. By three years, differences in physician retention are significant between communities with less than 7000 people and those with more than 7000 people.

In his report, Dr. Thommasen said that training more doctors likely won’t correct the issue of poor staffing in rural areas.

“The problem is primarily one of poor distribution—doctors recruited from urban centres, trained in urban centres, not surprisingly, want to work in urban centres. Policies designed to force urban doctors to “do their time” in rural communities have not yet worked.”

While this study is now about 22 years old, its findings still ring true for Paul Adams, an administrator of the B.C. Rural Health Network says there needs to be a focus on training rural medical students to serve rural communities.

“[The province] is in a health care crisis, but rural B.C. has been in a health care crisis for decades. You could probably take that back a hundred years if you want to look at it from that perspective,” Adams said.

“We need to have more equity in who’s going to come back to rural communities. So we need to train more rural people if we wanna see that intended result.”

Adams says that while a lot of things have changed over the past hundred years in regard to health care, it has always been challenging to recruit and retain physicians to work in rural communities.

The birth of Northern Health

In December 2001, the provincial government announced a new structure of delivery for health care services. The new system included 15 health service delivery areas governed by five health authorities —Interior, Vancouver Island, Vancouver Coastal, Interior, and Northern.

These health authorities replaced the previous health care delivery system in the province, which was comprised of 52 separate health authorities and approximately 600 appointees to health boards, health councils and societies.

The ministry of health says the new system has reduced jurisdictional overlap and duplication of costs.

“Under the previous system, huge budgetary discrepancies between small rural community councils and large urban boards led to disparities between urban and rural communities while impeding the efficient delivery and planning of health care services,” the ministry stated.

Northern Health was the largest of the announced five health authorities and is comprised mostly of rural and remote communities. According to data from the Resource Municipalities Coalition, within the N.H. jurisdiction, there is only 6.7 per cent of B.C.’s population covering approximately 70 per cent of the land area.

The ministry says that the establishment of Northern Health has resulted in a “critical” partnership that has brought improvements in care closer to residents of the north.

“Collaboration has resulted in the replacement of Fort St. John Hospital in 2012, the upcoming replacement of Dawson Creek and District Hospital and many other investments and improvements,” the ministry told Energeticcity.ca

Some of these improvements include the addition of MRI and C.T. capacity, additional long-term care beds and renal services in Fort St. John, assisted living capacity in Fort St. John and the South Peace, as well as Fort St. John and Dawson Creek-based community oncology clinics.

The ministry acknowledged that health care in the north faces “unique challenges” due to the remote nature of the communities it covers, adding it will continue to work closely with Northern Health to solve issues, such as staffing and retention.

Where are we now?

According to a 2022 survey completed on behalf of the B.C. College of Physicians, nearly one million British Columbians don’t have access to a family doctor, with forty per cent of residents that do have a family doctor citing concerns that they’ll lose theirs either due to the physician retiring or closing their practice. 

While 94 per cent of residents surveyed in Northern Health report having access to a family doctor —the highest of any health authority in B.C. — that doesn’t mean the shortage doesn’t affect those who live in the Peace region.

There has been movement in Fort St. John’s number of physicians, with just one local clinic welcoming 3 new doctors but seeing five leave the practice.

Earlier this month, Taylor’s only medical clinic closed its doors after it switched to a fee-for-service payment model, leaving residents —11 per cent of whom are 65 and older— without access to a doctor in their community. 

Ministry aims to ease the pressure off health system

On September 29th, health minister Adrian Dix, alongside the minister of advanced education and skills training, Anne Kang, unveiled B.C.’s five-year health human resources strategy, which looks to address the current challenges facing the province’s health care system.

The plan, consisting of 70 actions under four main pillars — retain, redesign, recruit, and train—includes up to 128 more seats in UBC’s faculty of medicine and plans for a medical school at Simon Fraser University.

Another portion of the announcement involved expanding the scope of practice for pharmacists in the province. Pharmacists gained an expanded ability to refill prescriptions on October 14th. By Spring 2023, Dix said, pharmacists should be able to issue prescriptions for less acute ailments, as well as contraception.

The plan also included new regulations seeking to allow paramedics the ability to provide an extended range of services to their patients, such as expansions in training.

Another portion of the plan includes developing a new provincial travel resource pool, which is based on a model developed by Northern Health.

Northern Health’s HR efforts

Chief Operating Officer for Northern Health’s Northeast region, Angela De Smit, says that the health authority’s Travel Resource Pool program has grown significantly over the past six months, going from 30 nurses to 80.

“It used to be called the travel nurse program, and now it’s called the travel resource pool because we’re also getting Sonographers and X-ray techs and lab techs, so it’s expanded quite a bit,” De Smit said.

She says the program was born out of listening to what staff enjoyed about being agency nurses and has been an effective tool in retaining staff in Northern Health.

“There’s a couple of reasons for that. One is, is that when they’re a Northern Health Authority employee, then they accrue seniority, which impacts their benefits in terms of paid vacation time, sick time and the job security of being part of a health authority.”

As for private practice, De Smit says staffing is largely the responsibility of private practitioners. However, the health authority has a physician and nurse practitioner recruitment team that works closely with local physicians and divisions of family practice to identify upcoming and new physician needs.

Since the 2018 audit by the Auditor General of B.C. found that Northern Health was not doing enough to recruit and retain nurses effectively, De Smit says they have implemented most of the office’s recommendations.

“We’ve had conversations with nurses and health care providers in terms of what brought them here and what they are looking for. We’ve done creative things in terms of changing positions from part-time to full-time in order to have an increased ability to recruit.”

“We’ve contacted over 144 internationally educated health care professionals that live here in the Northeast. Lots come here because they have taken or are enrolled in the Northern Lights College Health Services Management Administration program,” De Smit said.

She adds that being flexible and meeting applicants halfway has been a success for the health authority.

“We had a community kinesiologist position that we hadn’t filled for a year. And then we had a couple of applicants for an occupational therapist position, and we said, why don’t we change these positions?” De Smit began.

“That’s what has been successful is our ability to respond in a reasonable manner, especially when we have qualified staff who come to us or applicants who are seeking employment. We can bring them here, and we’re able to retain them,” she continued.

Other recruitment and retention supports the health authority has implemented include partnerships with post-secondary institutions such as Northern Lights College, attending specialty conferences throughout Canada and the U.S., and engaging with youth in schools to raise awareness of the variety of health care careers available.

In our series Code Grey, we look to decipher the current state of the health care system in Northeast B.C. In part one, Energeticcity.ca spoke with health officials, local leaders, and health care staff advocacy groups in part one.

During the course of Energeticcity’s investigation, it has become clear that there are many moving parts to the health care crisis now being felt across the province. While there have been and continue to be efforts made to alleviate the issues being felt in rural communities, these are long-standing historic challenges that require creative and innovative solutions.

Those who wish to share their stories about being a patient in Northeast B.C. can do so by emailing Spencer Hall at [email protected].