Advocating for family doctors: The Cranbrook In-Patient Care Crisis

The EK Division is committed to elevating the concerns and priorities of family doctors. Our team rolls up our sleeves and gets to work on it daily, making sure physician priorities are heard and addressed at the decision-making tables at both the provincial and regional levels.

An example of this work is the in-patient care crisis in Cranbrook.

“For years, Cranbrook was doing a fantastic job at having community family physicians look after all the in-patients at the East Kootenay Regional Hospital, even as other communities across the province were struggling,” said Dr. Todd Loewen, Rural family doctor, MDCCFD, and Senior Medical Director for the East Kootenay, Interior Health. “But, as the region’s population steadily grew, the number of unattached patients being admitted to the hospital significantly increased, and this began to put the hospitalist system under immense pressure. Add to that, longitudinal family doctors had no financial equity, support, or incentive to do in-patient care – so those who did began to feel the incredible strain of trying to do both in-patient care while maintaining their private practice.

“In-patient care at the East Kootenay Regional hospital (EKRH) was in crisis.”

By the summer of 2019, the family physician hospitalists at the EKRH started to experience sustained ‘unsafe’ numbers of in-patients to care for, and according to a 2019 EK Division Physician Survey, 1/3 of Cranbrook physicians indicated they planned to stop caring for attached in-patients. 

“The EK Division, given their connection to regional family doctors, understood this issue, identified what was happening early, and began work with physician leaders to address the difficulties that were happening in Cranbrook as a regional centre providing in-patient care,” said Dr. Loewen.

Backed by their physician membership, the EK Division, in partnership with Interior Health, the Ministry of Health, and Family Practice Services Committee (FPSC) began to brainstorm creative solutions and sustainable funding options that would maintain in-patient service at the EKRH.  

“We brought together four physician leaders, one from each of the primary care practices in Cranbrook, to learn from other areas and design a model that would work for Cranbrook,” said Megan Purcell, Executive Director at the EK Division.  “Drs. Wilhelm Pieterse, Kari Nishi, Mike Dawson and Ken Brown were instrumental in developing and moving this work forward. We also had support and leadership from Dr. Elena Schroeder, who advocated and led the new hospitalist contract development process.”

After close to three years of effort, conversation, advocacy, and negotiation, the EK Division’s proposal to develop a unique regional in-patient care hospitalist system was accepted by the Ministry of Health. This proposal focused on dedicated funding for hospitalists for unattached patients, as well as funding support for family doctors who want to do in-patient care and be part of a hospitalists program, without having it negatively impact their clinic family practice.

By April 2022, FPSC Bridge Funds were approved and started to flow to all communities in the EK with hospitals (Fernie, Creston, Cranbrook, Invermere, Golden). The more rural East Kootenay communities were not at risk of collapse, but the funds still help to compensate for the work more fairly. Cranbrook received $450,000, which was divided amongst the clinics ($300/day) to be shared among the FPs still offering care to attached in-patients. EKRH serves the entire East Kootenay population of 85,000 people.

“Our system is unique in that it includes our current family physicians in the hospitalist system by offering support and funding without destabilizing the very important work they are already doing to support primary care and patients in their clinic,” said Dr. Loewen.

“But we haven’t solved this problem yet; we know that, and there is a team of committed people still working on it. We recognize there are a number of vacancies that need to be filled within our hospitalist system. However, it’s slowly happening, and we are making progress.

“The good thing is, this in-patient care hospitalist system, unique to the East Kootenay, does create a diversity of opportunities for physicians in the Cranbrook area, which is attractive to a large group of potential candidates. Our funding model can support flexibility and diversity and can be customized to a family doctor’s passion and expertise, so there are a real variety of ways this can work that are available to family doctors.”

Recognizing there is still much to do, the EK Division is leading ongoing work supported by all partners to continue to:

• Recruit people into hospitalist positions, and;
• Secure permanent funding and support for community family physicians with longitudinal practices to continue to do in-patient care for their clinic practice.

“Those supports are the long-term solution, and we are hoping and waiting to see if it will be integrated with the new family physician payment model or an outcome of the physician master agreement,” said Loewen. “Our priority is to have high-quality in-patient care that delivers a good work experience for the providers (nurses, doctors, etc.), but also creates a good experience supporting the best possible outcomes for patients in their journey through the system.”

This past October, the FPSC announced it is extending current levels of funding available to support in-patient care past March 2023, into the next fiscal year (March 2024) until a new payment mechanism is in place to support this work.

“The EK Division, along with its partners and backed by its members, remains committed and invested in the work that delivers a long term solution,” said Purcell. “We appreciate the commitment of the physicians leaders who have worked hard to sustain in-patient care services in Cranbrook.”