If you're feeling sick and you don't get to a Richmond walk-in clinic four hours before closing time, you're unlikely to see a doctor that day.
That's the stark reality facing most Richmondites during flu season, when, not surprisingly, clinics are jam-packed with people suffering from all kinds of moderate to minor ailments.
Short of chancing an even longer wait at Richmond Hospital's emergency room, no agency, as the News found out, seems to have the answer and local residents are bang out of luck this winter.
It's a situation that's unlikely to change, according to a UBC health services associate professor, with doctors hamstrung by the amount of patients they get paid to examine and no local health authority control over the number of clinics or their opening times.
"It's important to understand the relationship between the health service and physicians," said Kim McGrail, associate director at UBC's Centre for Health Services and Policy Research and associate professor at UBC's School of Population and Public Health.
"There are some situations where health authorities operate a small number of clinics; but that number is quite small. Other than that, primary care doctors are independent.
"There's no mechanism for the style of clinic or its opening hours to be controlled. It's just left to the free market."
There are schools of thought, added McGrail, that the health service shouldn't be left to the free market and more physicians are the key. "Simply having more doctors working in clinics is not just the answer; there's no magic wand for this kind of issue."
Vancouver Coastal Health (VCH)'s spokesperson Anna Marie D'Angelo explained how the health authority has nothing to do with the running of walk-in clinics.
D'Angelo added that it's usually only a minority of patients in an ER who would ordinarily be treated in a walk-in clinic or doctor's office.
"These patients do not require a lot of emergency department resources for treatment," said D'Angelo.
"They may have to wait for hours before receiving treatment for their non-urgent care as those that are most ill are treated first."
D'Angelo suggested contacting the British Columbia Medical Association, now called Doctors of BC, to get a handle on how walk-in clinics are run.
Without being able to offer a solution, Doctors of BC spokesperson Sharon Shore did explain that physicians are restricted in how many patients they get paid to see in a day.
Up to 50 patients, the doctor is paid the full rate; from 51 to 65, 50 per cent of the rate and zero thereafter.
"It's basically down to the free market and that's the same for the opening and closing times," said Shore.
"There are daily volume limits for patients in terms of what doctors are paid, so there's no incentive for a doctor to see too many patients.
"The indirect result we're looking for is the standard of patient care being protected. This system has been around for at least a decade, maybe longer."
Shore suggested calling the College of Physicians and Surgeons of BC to get closer to how walk-in clinics operate and a potential solution to the problem. "The College has no authority over daily limits," said its communications director, Susan Prins.
"These are set by the Ministry of Health and Doctors of BC. We don't take a position on the number of clinics or their hours of operation.
"We only regulate the physicians who work in the clinics."
UBC's McGrail, while agreeing that the limits are in place for a good reason and should not change, did offer a potential solution, of sorts: Bring in more types of practitioners to deal with the more minor cases.
"More nurse practitioners, for example, might work. But there seems to be a shortage of places where they can work, rather than a shortage of them," said McGrail.
"In Ontario, there are more groups of physicians working together in teams in joint practices. The idea is to be more efficient in delivering the services, but they also have more nurse practitioners working there." In B.C., said McGrail, there has been "some reticence in allowing nurse practitioners a greater role."
"Are the physicians in B.C. protecting their turf or the quality of care? "But nurse practitioners have been a worthy addition to the health care system for many years."
