The B.C. mayor who launched a city-run primary care clinic says people come up and hug him in the grocery store

Launching a city-run primary care clinicA British Columbia mayor who went rogue and started recruiting doctors directly for a new city-run primary care clinic remains somewhat of a maverick in Canada. Health authorities? Sure. But cities don’t normally physically set up their own medical clinics and bring in doctors paid on city salaries.Colwood, B.C. Mayor Doug Kobayashi decided last year that his municipality needed to address the critical shortage of doctors negatively affecting its citizens: around 22,600 and growing, on the close outskirts of Victoria. The clinic seems to have hit a nerve with family physicians on the job hunt—offering a salaried position ($280,000) with a pension, paid vacation, medical benefits and maternity leave. Office space and medical office assistant provided at no cost, with the expectation that the physician will build a panel of 1,200 patients. You can find the job listing here. Kobayashi told the Medical Post in an interview he’s had no shortage of applicants, with one doctor on coming on staff since January and two more set up to start this autumn: a Canadian FP who trained and has been working in the U.S., and a doctor coming from Ireland.How other cities are reactingAlthough the details of the Colwood model are similar to those of community clinics across the country, curious municipalities are still doing a lot of waiting and seeing. Mayors from across the country have quizzed Kobayashi for information, but haven't been as quick to implement similar schemes. Orillia, Ont. (for example) was seriously considering adopting the model—then decided this past spring to earmark $500,000 for physician recruitment instead. Kamloops, B.C. developed an official business case which is actively exploring the option, but motivation might wane if eight new doctors (including a family doctor, neurologist, neurosurgeon, hospitalists and an emergency room physician) move to town soon as is expected off the back of long-term recruitment efforts. Kobayashi is unfazed. He prepared a four-year business plan, passed by his council. His successes already put him way ahead of expectations.A self-sufficient clinic?“Basically, to cover everything, we have to have a minimum of six doctors (with a full panel of 1,200 patients),” Kobayashi said. “You know, that's break-even. Eight doctors (the clinic’s target) and we’re well in the black. And we're actually ahead of our business plan—we’ll have three (FT) doctors by the end of year one.” The Colwood Primary Care Clinic doctors bill the province using B.C.’s new longitudinal family physician (LFP) payment model—that has doubled to tripled FP income since it went active in early 2023. For context, B.C. family physician income had trailed down to being amongst the lowest in Canada prior to that boost, so it is not as huge a salary as that tripling might suggest. But it is a competitive blended model that pays doctors for capitation, complexity, patient encounter—plus a $130 hourly rate for both direct and indirect care. The municipality collects those fees on the doctor’s behalf and pays their salary directly. Which is beneficial to physicians in this early phase, while they are building up patients (and, later on, similar to the 25% or higher in overheads they’d pay in a regular group practice, but with the added municipalities perks).Challenges with patient attachmentMeanwhile, while recruiting doctors has been going well, getting the patients attached has remained a challenge. As mayor, Kobayashi knows there are many who don’t have a family doctor who have registered on the province’s registry, Health Connect. He does not know exactly how many and has not been able to get that information from the province. But to access the names of those unattached patients and match them with his clinic’s doctors, there’s a three-step process—and this is true for all B.C. family doctors accepting new patients, not just for Colwood.Patients have to register and wait their turn. The BC Health Connect staff does some sorting, giving people with the most serious health issues priority. Then it passes the names to one of the 36 community based Divisions of Family Practice that exist across BC as a partnership between the BC ministry of health and Doctors of BC’s Family Practice Services Committee (FPSC). As a Doctors of BC spokesperson explained in an email to the Medical Post, attachment coordinators—who are employed by Divisions of Family Practice—facilitate the process of sending lists of patients (who are on the Health Connect registry) to family doctors and NPs who have indicated they are accepting patients. Individual family doctors and NPs are not able to directly access the Health Connect registry to find patients. Kobayashi said the city clinic has been receiving the names of 80 patients per week through that process. A doctor reading this, building their practice, might feel that’s more than enough new patients to process properly. But the Colwood clinic’s current physician who opened her practice in January only has a panel of 600 so far, the mayor said. He has been calculating how long it will take for his clinic’s doctors to be working with full panel sizes, tilting operating costs towards self-sustainment.. “They (the South Island Division of Family Practice) just trickle down names too slowly . . . they control everything. And I think that's the wrong approach. You know, my approach was—and I almost did this, and it probably would have got me into big trouble—but my idea was, when we were sending out our property tax notices, I was going to tell them, just register here, and then we'll put you with the (clinic) database.” He’s not saying whether he would actually dare to set up that direct patient attachment method of his own, to speed up connection with his unattached citizens, but he does have some ideas up his sleeve.“The only thing that I can tell you is that with the next two doctors (who are arriving soon), I'm already going to have their patient list lined up. I'm going to have 1,300 to 1,400 people that they can select from right away, soon as they arrive,” the mayor said.Community responseKobayashi might be stirring things up but his citizens are happy. People come up and hug him in the supermarket. He says he has not had to raise taxes to pay for the clinic. “One of our citizens is a well known business person here in the community. He hasn't had a doctor in seven or nine years, and he finally got one at our clinic,” the mayor said. “He was so elated. He's decided to make a major donation, and is buying a very expensive ultrasound machine for us.”

The B.C. mayor who launched a city-run primary care clinic says people come up and hug him in the grocery store

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