In 2004, Karen Morgan and Ambrose Marsh saw clear signs of trouble to come: while their community was growing, their doctors were aging. At the time, both were high-ranking members of the local medical field—Marsh as chief of staff at Saanich Peninsula Hospital, and Morgan as president of the Saanich Peninsula Hospital and Healthcare Foundation—and were greatly concerned with the future of primary care medicine on the Island.

“The two of us started looking at the roster of doctors and realized that they were all about the same age, and they were all going to retire within about a 15 year period,” Morgan said.

They weren’t wrong. Across Canada, communities are feeling the crush of the doctor shortage. In Greater Victoria, three walk-in clinics have closed within the last month—a resource that many rely on due to the scarcity of family doctors.

But on the Saanich Peninsula, Marsh and Morgan have hope.

“After we got over our panic, we said, ‘We’ve got to do something,’” Morgan said.

It took over a decade, but the pair helped to found Shoreline Medical Society in 2015, a charitable non-profit primary care network on the Saanich Peninsula. The team opened their doors in 2016, and has now grown from five doctors to 25 between their Sidney and Brentwood Bay-based clinics.

Originally, Shoreline Medical set out to match 10,000 patients, the number of people on the peninsula reported to not have primary care doctors, to the original five physicians within their first five years. 

“Our goal has always been to ensure that everybody on the peninsula has a family doctor, and at the same time as we're doing that, protect the Saanich Peninsula hospital and ensure its survival,” said Morgan, who is now interim executive director of Shoreline Medical.

This, she found, was no easy feat.

“It's a bit like playing whack-a-mole, because other doctors kept retiring,” she said. 

But within five years, Shoreline managed to match 11,000 patients with a new family doctor, and have 17,000 total patients in their care. For six doctors who retired—including Marsh, who stepped back from his practice in June—Shoreline went to work quickly matching up their patients with new doctors to ensure nobody was left untreated.

Marsh says he still runs into former patients on the street, who are grateful to still have stable primary care despite his having retired. “

“And I go, ‘It was Shoreline that did it.’”

But there is still work to be done. The peninsula has thousands of patients without family doctors—a need Shoreline Medical has made it their mission to address.

Building rural community care

Finding a way to attract new doctors wasn’t easy, particularly in a moment when doctors sometimes have 10 job offers awaiting them at graduation. 

First, they turned to Island Health, and asked if a primary care centre could be built alongside Saanich Peninsula Hospital.

“But they didn't necessarily pick up on the urgency of the issue,” Marsh said. “So we pivoted and thought about how we can do the same concept, but in the community.”

The model of community health care centres in Ontario and Saskatchewan caught Morgan’s attention. In Kincardine, Ontario, the municipality partnered with a corporation to build a primary health care centre bolstered by an aggressive recruiter offering incentive payments.

Shoreline Medical is a more grassroots, non-profit initiative than the Kincardine health centre, and Morgan feels it appeals to young doctors in a different way: through combining community and hospital-based care. It was slow going at first to introduce this new model, due to initial resistance from older doctors, but by now the practice is well established.

Shoreline’s doctors cycle between about five weeks of working in family medicine and one week at the Saanich Peninsula Hospital. This allows family doctors to support emergency room physicians by handling lower-severity cases so the emergency room staff can focus on administering complex care, Marsh said. The week that the doctor is working in the hospital, a locum doctor on a temporary contract will step in to care for their patients.

For the family care physicians, he said engaging in these different types of medicine once in a while can be “very appealing.”

According to Morgan, 60% of doctors providing care at the Saanich Peninsula Hospital are part of Shoreline Medical.

“It really is a particular kind of person that wants to have a practice like this where they're working both in the community in the hospital,” she said. “The physicians that have been recruited to Shoreline are really quite like-minded. Some of them have described it as feeling like a family, which is a wonderful side benefit.”

Balancing doctor and patient needs

Even before the pandemic, Morgan says Island doctors grappled with burnout and trouble navigating work-life balance. She remembers one young doctor who, in advance of starting his job there, came to Shoreline Medical and spoke to the board about his concerns with the toll this job can have.

“He said to the board, my mentors are on their third marriage and their second heart attack, and I don't want to live like that,” Morgan said.

Since then, although Shoreline is still a work in progress, Morgan and the Shoreline team have worked hard to balance the workload their doctors face. So far, they’ve heard that the hybrid model of working between the hospital and the office has helped—as has the number of new doctors they’ve recruited to help distribute the patient case load.

Morgan is also currently appealing to local municipalities to pursue options to make housing more accessible for new doctors looking to move to the peninsula. Ideally, she would love to see some secondary suites that the community could offer to incoming doctors for a certain period of time to help hasten their transition into communities like Sidney, which have notoriously low vacancy rates.

The high number of locals still without doctors is what keeps Marsh awake at night. To continue working towards their goal of matching every Saanich Peninsula resident with a doctor, he says, they’re going to need more doctors. 

“There are still many challenges and hurdles that take time. We're not going to get 10 doctors knocking on our door tomorrow, and we need 10 or 20 more doctors,” he said.

“But we’ll keep the model positive, look for incentives, design it by the doctors, and continue to teach as well.”

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