Family medicine is in a state of crisis, exacerbated by the pandemic which, eight months in, has totally disrupted primary care physicians’ ability to provide face-to-face, quality care.

Things are so bad that while governments are urging everyone to get a flu shot to avoid a “twindemic” many doctors and their patients are confused about where to get vaccinated, just days away from the time when people typically start getting them.

At a visit to my own doctor’s office last month (for a shingles vaccination by the clinic nurse) I was told that I would have to make alternate arrangements if I wanted a flu shot. Then I heard rumblings about drive-through flu clinics, maybe even in the same parking lots where COVID-tests are offered by health regions. But I heard today from the ministry of health that drive-through vaccination centres are not being contemplated in B.C. even though they are happening in other parts of the country.

Instead, flu shot appointments, according to the B.C. government, can be made at “clinics, schools, large municipal spaces, and pharmacies where physical distancing and other public health measures can be maintained, and where individuals can be observed after their shot for the standard 15 minute monitoring period.”

The government spokeswoman also directed me to this information about where flu shots are available in Vancouver –

Indeed, it would seem that flu shots this year will be largely offered outside the offices of family doctors. Check health region websites for more information.

Dr. Maryam Zeineddin, a family physician in West Vancouver where she shares office space with six other colleagues, said her office won’t be offering any flu vaccination clinics because of pandemic limitations.

“In my clinic, we provide care to over 10,000 patients but we have no physical ability to bring so many of the patients in, given all the restrictions, cleaning protocols and requirements for personal protective equipment (PPE).

“We want to see our community vaccinated but this would require help from the Vancouver Coastal Health Authority. We need a proper space to do it and some administrative or nursing support plus help obtaining and funding the PPE.”

Doctors in private practices are obligated to source and buy their own PPE. But they don’t have supply chains that can, at a snap of the fingers, deliver high volumes of masks, gloves, gowns, and face shields.

“It’s been seven months and we still can’t access Canadian suppliers. We got some help from Vancouver Coastal Health –  two boxes of masks,” said Zeineddin, who often uses bike goggles when doing riskier procedures to protect her eyes from COVID and other contagions. She said the costs of ordering massive quantities of PPE are prohibitive for family doctors, many of whom are struggling to hold on to their leases and medical office assistants.

“We are seen as business owners, but it’s not a business where we can set or raise our fees to offset the extra costs since our fees are regulated. So when our overhead goes up exponentially, I can’t make up the difference.”

Overhead costs have risen up to 30% during the pandemic and it’s easy to see how. Face masks each cost between 50 cents and a dollar; N95 masks are at least $2.00 each; face shields are $3.00 apiece; disposable gowns $2.00 apiece and then there are gloves, cleaning supplies, and costs associated with cleaners (now $2,000 per month, up from $1,200) because deep cleans must be done daily in offices where patients are visiting. Many offices have installed plexiglass barriers as well.

Doctors of BC has negotiated a one-time grant up to $1,000 for doctors’ offices to help offset costs of PPE. Each eligible physician can apply for the grant. Zeineddin said every bit helps but that’s a drop in the bucket.

“Even if they gave us $1000 per month, these costs are prohibitive and you will see many more doctors’ offices closing,” she said.

“In our practice, we are doing 50-50- inpatient and virtual care. I see four patients per hour but can’t keep up because of so many complex concerns that have piled up over the course of the pandemic. Patients have not had proper care for seven months. They’ve been getting prescriptions over the phone.”

An organization that represents family doctors in B.C. has released a report describing the many problems in the primary care system – problems exacerbated by the pandemic. Zeineddin said the report makes it clear that doctors are running on fumes. As independent business owners, they don’t have the same resources given to hospitals and the urgent/primary care clinics that the NDP government has opened across B.C. where doctors are mostly salaried and. Indeed, many doctors are choosing to work in such clinics because they don’t have to worry about office overhead costs.

“Family doctors are (also) choosing paths such as hospital or emergency care where infrastructure is covered by the government-funded system,” said Dr. Jennifer Tranmer, president of BC Family Doctors’

The report concludes with these recommendations and pledges for advocacy:

Dr. Kathleen Ross, President, Doctors of BC

Dr. Kathleen Ross, president of Doctors of BC, which advocates for primary care physicians as well as specialists, said the report highlights “the critical role family doctors have played in the pandemic response to date as well as the pressures and challenges that remain for frontline primary care providers.

“Where we diverge slightly … is in highlighting the many key supports Doctors of BC has worked on for family doctors both before and after the pandemic began,” she said mentioning. supports for office expenses through business cost premiums on fee codes – based on where in the province doctors practice and their practice type, incentive fees for family practices that provide longitudinal care, and consulting with the government on Alternative Payment Contracts for community-based family doctors.”

Doctors of BC has also worked to get technical supports and fee changes so that medical offices could rapidly shift from 90% of office visits being in-person to 90% being virtual care.

The Divisions of Family Practice lobbied hard for COVID testing and assessment centres “to divert patients with respiratory symptoms away from community offices, both to limit exposures to other patients, office staff, and physicians and to preserve and centralize our limited supply of PPE.”

It has also consulted with health authorities to share their PPE supply chains with offices that have had trouble accessing their usual supply chains due to the global shortage of PPE. As Zeineddin said, however, her medical office has only been able to access two boxes of masks.

Ross said she knows there’s plenty more work to be done to support primary care and that “is proceeding more slowly than some may want.  However, meaningful change in our primary care system can only occur if all partners continue to work collaboratively. Doctors of BC remains committed to working with all our healthcare partners to address the remaining issues highlighted by the report.”