Like any other city employee: Meet one of the doctor’s drawn in by the offer to work in a city-run clinic in B.C.

Dr. Cassandra Stiller-Moldovan expected to be settling into a new house in London, Ont., around about now. Her family has grown with the addition of a little daughter. Last autumn, they found a property they liked and made an offer.But instead of landing in that particular new house in that particular place, Dr. Stiller-Moldovan saw a unique job posting that excited her so much, she applied. Three months later, in the middle of January, she packed up her life and moved west with her family to Colwood, B.C., a municipality of 22,000, on the outskirts of Victoria, on Vancouver Island.“I’m absolutely loving these cherry blossoms,” she said in an interview with the Medical Post. “A light jacket, and you’re good to go.” Like so many of the interesting course adjustments that emerge in life, Dr. Stiller-Moldovan's happened by chance, as she was scrolling routinely through her emails. A family physician five years out of training, she was happily settled into her focus on sports medicine and student medicine in London. But there it was in black print: a call to a special and unique-sounding job that checked all the ideal boxes.“I thought, 'oh look, it’s offering all the things I’ve always said family doctors deserve,'” she said. “Doctors are basically government employees, but we don’t get any of the perks that government employees normally get, like benefits and a pension and health coverage—annual paid holidays, parental leave, paid sick leave.“ The job she had spotted was offering all those things—six weeks paid vacation, great medical and dental benefits—plus a free office, at an annual salary of $280,000 for full-time (and up to four patients an hour). The employer, curiously, was not a group of doctors or a health authority, but the municipality of Colwood itself, with the prospective doctor receiving the perks of any other municipal worker. The job also comes with a medical office manager and medical office assistants provided, as well as workers in accounting and payroll services, information technology, equipment and supplies, communications and marketing, and all other non-medical administration. The Colwood Clinic—as it is called—submitted these details as part of a written statement that said the design of the practice “allows doctors to focus on patient care without the stress of running a business. And as part of a team of doctors who are passionate about health, well-being, work-life balance and quality of life, there is a strong professional network to consult with and to cover each other’s absences.” The mayor’s ideaColwood was in a jam in 2022, it had lost its last walk-in clinic. Its physician resources hit zero. Mayor Doug Kobayashi, a former engineer, was recently elected on the promise to solve the problem. “I don’t think there’s any place that’s done it in Canada,” he said an interview, referring to the city’s leap into its new clinic-management role. He went about developing the strategy very methodically, making sure his bold idea did not conflict with any existing systems or laws.“There’s nothing I’ve read in the Municipal Act that says that we can’t do this,” the mayor said.Kobayashi says he navigated a lot of resistance to his idea. But his consultations with doctors made him confident that he’d found the right combination of features to build a model doctors would find irresistible. “All these doctors have been involved in this, right from the start, not one of them took one penny of payment. Everybody worked together because they wanted to see this happen.”Building on a new ideaThe new Colwood Clinic is now fully up and running, but it’s still evolving. For example, there are no nurses or allied health workers employed—so no team approach yet—but that’s on the cards. The plan is to move to a larger space as the clinic reaches its target capacity of eight doctors and shifts to broader team-building, the mayor said.“I think that’s part of the appeal for me—working to make this a successful model,” said Dr. Stiller-Moldovan. “I’ve always had some interest at the level of policy when it comes to healthcare and healthcare administration. So the idea that there could be some potential influence on that and helping shape the future models is something that really inspires me to kind of be curious and open minded with this experience,” she said.”And I think when you come from that curiosity lens, it oftentimes allows you to see things, maybe that you wouldn’t see otherwise,”Dr. Stiller-Mandovan bills B.C.’s Medical Services. Plan (MSP) the way just about every other FP practising longitudinal care does today—using the province’s new Longitudinal Family Physician (LFP) payment model. (It’s an optional alternative to fee for service that pays doctors $130 an hour for time worked, including hours spent delivering indirect care). The MSP payments she generates go directly to the city to pay the clinic running costs. The doctors receive the same salary regardless of numbers of patients seen or hours worked.“My goal was never to see so many patients in a day to make so much money,” Dr. Stiller-Mandovan said. “It really is trying to find that balance of providing good care and a livable kind of wage to pay off my debt.”On the day we spoke to her, she had just finished a full office with nineteen patients.What’s next? Research has shown that, for a lot of younger FPs, the community clinic model (which Colwood most closely resembles) is a popular concept. The bottom line being to be able to do your doctoring, on salary, without having to secure space and pay overheads.The University of British Columbia’s Dr. Rita McCracken co-authored a study titled Family physician perspectives on primary care reform priorities: a cross-sectional survey, published in 2021. This research surveyed family physicians in B.C. and found that 46.4% of respondents preferred to be clinic employees rather than small business owners. Additionally, 76% indicated a need for fundamental changes in primary care delivery. The study also highlighted that 69.6% of participants valued practicing in a team-based setting, and 81.1% emphasized the importance of the ability to take planned vacations and parental leave.It’s not for everyone, Dr. Stiller-Mandova acknowledges, pointing out that for many doctors it is important to own and manage your own practice.“Obviously, the medical decisions are mine, but the way certain things are done is definitely more of a collaborative approach to creating policies that are equitable, and can be defended by the city as well,” she said. Dr. Stiller-Moldovan has already been joined by a second doctor, Dr. Charles Lamb, who came from Calgary. Kobayashi is working hard to make sure more will be on the way soon. He has a third doctor—also from Calgary—about to sign on. “I could tell you right now, every, almost every community in B.C. has contacted my office or contact me,” Kobayashi said. “In fact, a military base commander called me because he wants to do something similar up where he is. You know, he doesn’t need as many doctors as us, but he likes the idea of what we’re doing here. And he wants to learn a little more.“I’ve had another mayor from another town that called me that said, ‘I’ve been warned by the (local) doctors. If we don’t do something the same, similar to you, they’re going to pick up and leave.’”

Like any other city employee: Meet one of the doctor’s drawn in by the offer to work in a city-run clinic in B.C.

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