BURST
Richmond gastroenterologist Dr. Nancy Fu was aghast as she saw her patient wait list grow from a few months to 10 months, and then to more than a year.
Knowing that so many people were suffering gnawed at her conscience. She tried to work longer hours to see more patients but burnout was imminent.
“I was so stressed out,” she said. “I would think, ‘Will I miss a colon cancer because I can’t see someone soon enough?’ ”
Gastroenterologists and other specialists face the challenge of a growing population, particularly among seniors, and patients with more complex disorders. Fu, for instance, says she’s not just seeing patients with inflammatory bowel disease but also an increasing number of younger people with colon cancer and people with liver disease because of obesity. And such patients typically require multiple visits with a specialist.
“In my practice I don’t say, ‘OK, I’ve assessed you. You’re fine, go back to your family doctor, and I don’t need to see you again.’ No, these patients have complex diseases, and I need to continue to see them long-term.”
When it became clear to Fu that doing all this on her own wasn’t working, she joined a pilot initiative called the consultant specialist team care program run by Doctors of B.C. and the province to figure out a plan. The program is designed to help specialists implement a team-care model in their practices, improve access and outcomes for patients, and prevent physician burnout. Doctors and team members who are part of the program work with a physician mentor to analyze how their practice works and find efficiencies.
Now, Fu has support in the same office from two registered nurses and a contracted dietitian, both highly specialized in the gastroenterology field, which prevents her from having to send patients to multiple health professionals across the region. One of her nurses, Sarah Bains, helps by speaking with patients and co-ordinating their care. Often, this can involve educating patients about their disorder and how to manage it day-to-day.
Fu has reduced her wait list to about two months.
But there’s a catch. Program funding only covers the initial integration of team members, such as physiotherapists, specialized nurses or dietitians. Fu has to pay out-of-pocket after that.
“You can negotiate the hours, but you still have to pay your nurses yourself,” she said.
Every specialist will have a different situation and will have to weigh the cost of more staff, but she said it was worth it to reduce her stress.
The pilot program has gone through three cohorts of physicians over three years. The annual budget for the program is about $1.5 million and comes from the specialist services committee, a collaboration between Doctors of B.C. and the B.C. government.
Physicians who have taken part in it say a long-term funding model must be established because this team approach needs to be the future of specialist care in B.C.
More than 1.2 million B.C. residents are waiting to see a specialist, according to the Doctors of B.C. and Consultant Specialists of B.C. And that doesn’t include those waiting for diagnostic testing, such as MRIs, or surgery. Between 2024 and 2025, more than 4,620 died while on a wait list, according to secondstreet.org.
Dr. Jennifer Kouwenberg, a pediatrician on Vancouver Island who took the program, estimates the amount of time people have to wait to see her clinic has been reduced by half since she brought on a nurse skilled in pediatric care.
“Every patient interaction she has, I am a part of that clinical encounter, but where I might have seen them for 30 minutes, I now might see them for 10 to 15 minutes because she already knows their history. So she’s seeing a lot of my followups,” said Kouwenberg. “Her wage is covered by my income. I pay her out-of-pocket. But with her I can see double the number of patients.”
While the program is touted as a success there are drawbacks.
It doesn’t address overhead costs that specialists pay or how it could be a barrier for some clinics that can’t afford to pay the salaries of these team members.
Still, the results so far have been “impressive” with significantly more patients going through specialist offices that have employed the team-care model, said Dr. Chris Hoag, chief medical officer for the Consultant Specialists of B.C.
However, he said one of the barriers to expansion is financial sustainability.
Costs include salary of the team member — about $100,000 a year for a full-time nurse, for example — plus benefits and costs associated with more office space and liability insurance, noted Hoag.
Continuing financial support of specialist teams will be required to offset the startup and ongoing financial costs, he said.
“We are excited to continue working with government in developing these supports and a robust model that is ready for expansion,” said Hoag.
Dr. Jane Lea, a head and neck surgeon and one of the program’s physician leads, said team care frees up the physician to do more of what they’ve been trained to do.
“So you can imagine, for example, doing diabetes education with every patient. It’s the same thing over and over again for every patient, something that could be done by a nurse or other allied professional.”
The key question is how to bring more physicians onboard and how to pay for it when government funding runs out.
“Physicians are really excited about this because they’re overworked, they’re overloaded,” she said. “The stress really weighs on them. To have someone come into their practice that’s going to help them with administrative tests or direct or indirect patient care is such a relief.”