Two Greater Victoria health clinics have started charging monthly fees for doctor access this week, just as the province announced big changes to family doctor payment models.

Perpetual Health Clinic in Victoria and Beta Therapeutics in Saanich are now charging monthly fees equivalent to $125 and $110 respectively.

In August, The Westshore reporter Zoë Ducklow covered the story of a Victoria clinic that was planning to introduce enrollment fees for patient access to family doctors, raising questions of whether two-tier healthcare was advancing in the province.

While Dr. Perpetua Nwosu temporarily put her monthly fee “under review” during the media attention, but she ultimately proceeded with a non-refundable $1500 annual medical fee beginning on Nov. 1.

Dr. Nwosu wrote on Twitter how happy she was with the change.

“Nov 1st 2022, a day that my work and life balance changed to be more meaningful and impactful,” Dr. Nwosu stated. “I can finally find time to update my knowledge to improve the care I give to my patients,” she added in another tweet.

Beta Therapeutics is another healthcare clinic that began charging a monthly fee for access to a physician.

Interested patients can now pay $110 per month to see the clinic’s family doctor, Dr. Dan Cutfeet, a former senior physician with the Namgis’ First Nation. The clinic’s director told Macleans on Oct. 25 that Cutfeet’s patient panel is 80% full after opening applications in July.

Access to healthcare services is sparse and often inequitable across Vancouver Island. Hospitals in Port Hardy and Port McNeill have had multiple overnight closures of emergency rooms in the past six months. An on-call locum physician arrived this week to Port Hardy for work only to find the hospital closed overnight during his expected shifts, as previously reported by Capital Daily.

It’s not much better in Victoria: multiple clinics have shut down in Greater Victoria over the past year, leaving an estimated 100,000 people without care in the region. Family doctors are quitting the system, and national nursing shortages are also putting pressure on healthcare providers.

To combat this, BC has announced a new payment model for family doctors that will take into account overhead costs and other factors. It’s expected to bump a full-time family doctor’s salary by $135,000 before operating costs and taxes. The move—named “transformational” by Health Minister Adrian Dix—was also positively received by the president of BC’s doctor association. The agreement, if ratified by Doctors of BC  on Nov. 14, will take effect in February 2023.

However, the two South Island clinics have decided to go their own way.

Perpetual Health Clinic and Beta Therapeutics have previously said in coverage by Capital Daily and Macleans that overhead costs were the reason they opted out of the province’s Medical Services Plan and began charging subscription fees.

A patient at one of the clinics, which Capital Daily has been interviewing since early August, was told by the Medical Services Commision that medical referrals from a non-MSP doctor wouldn’t be covered.

“Seems to me it’s going to be a very expensive proposition if you have to pay for every blood test that is ordered,” said Hayley, whose name was changed upon request for fear of being viewed as a difficult patient by family doctors.

She and her husband, who will not be paying Dr. Nwosu’s fee, are now part of the estimated one million people in BC who don’t have access to a family doctor.

“There are many, many people like us, in Victoria and elsewhere,”she said. “Do we try and get into a clinic? Do we go to [emergency]? Do we try something online?”

“I haven’t got that worked out yet.”

With files from Zoë Ducklow