The overall health and wellness of Victoria residents is an issue that needs addressing, according to this year’s Vital Signs report in which residents gave the subject a C+ grade.

It’s the lowest grade given to the report’s health and wellness section since their grading system was first introduced in 2013, and is one of the lowest out of 12 categories—housing alone received a failing grade.

The report comes from a survey of 2,542 people conducted between May and July this year. Healthcare was one of the five most important issues facing Greater Victoria that survey respondents identified, along with housing, cost of living, homelessness, and addiction. They cited better access to healthcare and more doctors as things that would improve the city, and only a third of respondents gave ‘health and wellness’ a B grade or higher.

While only 12% of Victoria residents rated their overall health and wellness as below average or poor in the 2020 Vital Signs report, that number jumped to 39% in 2022. The survey also noted that men are twice as likely as women to give their health an A grade, as are those who make $80,000 or more compared to people who make less.

At a glance, it could be surprising to see Victorians’ health rated lower now than it was during the first two years of the pandemic. But according to Dr. Astrid Brousselle, director of UVic’s School of Public Administration and a public health system analyst, the longer-term impacts of the pandemic—and viruses like COVID-19, RSV, and influenza currently spreading unchecked amid a dearth of infection prevention measures—mean things are worse now than ever before.

“More people are vaccinated, but COVID is still around, we know that it’s circulating [and] the healthcare system is overwhelmed,” Dr. Brousselle said. “We’ve been in the pandemic for three years, so healthcare workers are exhausted. We see nurses willing to change jobs, we’ve seen clinics closing, doctors going to online consultations.”

A number of walk-in clinics have shut down in Greater Victoria alone in the past year, leaving around 100,000 people without care. Across the province, one million people do not have a family doctor.

In August, a doctor who worked at nine walk-in clinics in Victoria before switching to telemedicine spoke to Capital Daily and described years of underfunding that led to poor working conditions, a lack of support staff and insufficient conditions to properly consult patients’ health concerns.

Dramatic drop in access to care since 2020

Access to healthcare has been on a steady decline in Victoria over the past two years, according to the annual Vital Signs reports.

In 2020, 27% of survey respondents rated their ability to access physical healthcare in a timely manner as below average or poor, and 34% said the same of mental healthcare access. This year, 58% said physical healthcare access is below average or poor, and 54% said the same of mental health care.

“This kind of data is very concerning for me,” Dr. Brousselle said. “Access to care is fundamental to maintain the population in good health. Access to primary care is very, very important because this is where people would have received a diagnosis.”

The province has taken some steps to address the shortage of family physicians in Victoria and across BC Earlier this month, health minister Adrian Dix announced a new way for family doctors to get paid that takes into account overhead costs, the amount of time they spend with each patient, the number of patients attached to their practice, and the medical complexity of each patient.

The current fee-for-service model involves a flat rate of around $31 per patient visit, and family physicians who run their practices pay for overhead costs like rent, staff, and equipment out of that fee.

This change, if approved by Doctors of BC members who have until Dec. 4 to vote on the new Physician Master Agreement, will take effect on Feb. 1, 2023.

In the meantime, some doctors have taken the route of removing themselves from the province’s Medical Services Plan and charging their own subscription fees.

The Westshore reporter Zoë Ducklow broke 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. At least two Victoria clinics are now charging monthly fees for access to doctors.

For Dr. Brousselle, increasing family doctors’ salaries—current estimates say a full-time family doctor makes around $250,000 per year prior to taxes and overhead costs, and the new agreement will increase it to $385,000 per year—will not improve people’s access to primary care.

“Increasing income of primary care doctors has never been demonstrated as an effective measure for increasing access to primary care,” she said. “On the contrary, what we’ll probably experience is a reduced amount of hours worked or reduced volume of patients seen because of the income effect.”

According to Dr. Brousselle, governments need to improve continuity of care for patients—especially those with complex care needs—by improving access to a variety of healthcare professionals and services, like nurses and lab technologists.

“The healthcare system is really struggling due to the pandemic and to other factors,” Dr. Brousselle said. “In answering this situation, we need to have a comprehensive view of the system and not just have ad hoc measures implemented here and there.”