BC’s healthcare providers work in an environment that Adriane Gear, the president of the British Columbia Nurses’ Union (BCNU), describes as “bleak” and even “desperate in some instances.”

Our province’s healthcare system is understaffed and underfunded. It often functions on the goodwill of hard-working providers holding it all together in the face of mistreatment, miscommunication, and overcapacity. According to a 2022 Angus Reid Institute poll, British Columbians reported the second-worst access to healthcare in Canada—with over one-third citing “chronic difficulty.”

The understaffing in busy hospitals is not situational, says Gear—it’s systemic.

“It’s not unusual for a unit where there should be 10 nurses rostered for a day shift and there are five,” she says. “It’s not like they’re just missing 10 per cent of the team. They’re missing 50 per cent.” According to Gear, BC currently has 5,745 nursing job vacancies.

This shortage is not just in acute or hospital care, either: “It’s your public health nurses, your home and community nurses, nurses working in long-term care,” Gear explains. “All areas, all care components, are experiencing this shortage.”

The problem can largely be traced back to the early 2000s. Gear attributes the current crisis to a combination of poor planning and human resource forecasting, as well as a lack of investments and not listening to unions. The Covid-19 pandemic only made the situation worse.

The increased demand for healthcare and the low supply—and attrition—of providers is one factor, but poor treatment isn’t doing anything to encourage already burned-out nurses to stay.

“Nurses aren’t shy from working hard,” Gear says. “It’s understood that it’s a job with high demands.” But nurses are dealing with inaccurate pay, violent and unsafe workplaces, and working mandated overtime on top of 12-hour shifts; understandably, it’s hard to ask more of people who are already barely hanging on.

But it’s not just nurses working short and burning out. According to Doctors of BC, almost one million British Columbians don’t have a family doctor. With over one-third of family doctors in BC expected to retire in the next 10 years, even more British Columbians could be left without a first point of access to healthcare if there are not enough entering the profession to replace them.

Dr. Videsh Kapoor, who has been a family physician in the province for over 25 years and is a clinical assistant professor at UBC’s Department of Family Medicine, says the shortage of general practitioners has occurred gradually, as fewer trainees choose family medicine over specialties, which are traditionally better funded.

“When your patient load is super high, when you’re working with limited resources, when the wait times to get your patients in to see a specialist or have certain procedures or treatments is long, and when you feel like you can’t do anything to accelerate it, it’s stressful for you,” she explains. “It’s stressful for the patient and it’s stressful for that patient’s family.”

Despite the pressures, Kapoor still loves her job. “Having that longitudinal relationship with your patients—it makes a difference in how you care for them,” she offers. “It’s a real partnership with your patients and the community that you work in.”

Fostering partnerships between healthcare and the community, however, is even more difficult in rural parts of BC. In northern towns like Hazelton, where the surrounding population is proportionately Indigenous, much of the maternal healthcare is provided by midwives, says Ari Getzlaf, a second-year UBC midwifery student who just finished her six-week placement there.

One of the biggest issues she noticed was the emergency room at Wrinch Memorial Hospital often going on diversion, which is when an emergency room, or sometimes an entire hospital, will close due to inadequate staffing and direct people to the nearest alternative.

“In a country that purportedly has incredible healthcare and incredible access to healthcare, you’re finding out from a Facebook post that you’re not going to be able to go to the emergency room tonight and you’re going to have to drive further,” she says. “It’s shocking and it’s upsetting.”

The closest hospital to Wrinch Memorial is Bulkley Valley District Hospital in Smithers, roughly 55 minutes away. It’s a big deal in maternal care, Getzlaf explains, especially when driving in foggy or winter conditions at night extends the trip even more. Add ambulance shortages on top of that, and it becomes a serious worry for midwives.

“Rural Indigenous birthers face incredible pressure...from healthcare providers to evacuate their communities for birth because there are no smaller maternity services in many rural and remote communities,” Getzlaf explains, adding it can be an unsafe disruption and isolation from their community and land.

Getzlaf thinks there’s more that midwives could be doing to ease the burden on BC’s health system, like providing access to reproductive care. If they could provide medical terminations (a procedure where medication is used to end a pregnancy), for example, “it would ease the load on the healthcare system and ultimately give pregnant people more time to think about their options.”

Given the crisis across the province, the federal government has stepped up to increase investments and support, such as a $1.2 billion agreement over the next three years and the steps to reduce barriers for internationally-educated providers to register in BC. On the provincial level, the health ministry has been working to expand registration and hiring across care-providing professions and in medical schools—including UBC’s midwifery program, which added 20 seats in 2023.

To attract more doctors to family medicine, the Province launched the Longitudinal Family Physician (LFP) Payment Model in February 2023. In the LFP model, doctors are compensated based on the number of patients they see and the complexity of their visit, as opposed to the previous fee-for-service system which paid the same per patient, no matter their condition.

Under this framework, the average family physician will see a raise of roughly $135,000. 

“I do notice that some family doctors are returning to practice because of some new funding models that the Province has implemented,” says Kapoor. Still, it will take a while before we know how much of a difference it can make.

There’s reason to be cautiously optimistic for nurses, too, according to Gear.

In April, when the BCNU ratified their collective agreement, they negotiated with the provincial government on minimum nurse-to-patient ratios. If implemented, this could be a significant step forward in improving short-staffing, feelings of burnout, and the quality of care, Gear says. Nurse-to-patient ratios have seen success in other places like California and Australia.

“From my perspective, I feel like the government is putting in a significant effort into making this happen,” Gear says, “and they’ve also backed it up with $750 million worth of funding over three years.” She can’t say when it is due to go into effect, but is adamant that the union will hold the government accountable and that “all of Canada’s watching” what happens here.

“Right now is a moment in time,” Gear says. “It’s a long moment in time, but we will get through this.”