Virtual clinical support from the Rural Coordination Centre of BC (RCCbc) team is vital to keeping rural doctors in their community.
The Real-Time Virtual Support program, administered by RCCbc and funded by the BC Ministry of Health, provided overnight hospital support in April and May in nine rural communities. A total of 16 rural communities have been supported since the program began.
A doctor from one of those communities has spoken out about how much the support means to him and his colleagues.
Dr. Craig Courchesne, who has worked in Nakusp for the past six years, said the overnight RTVS support—known as Virtual Emergency Room Rural Assistance (VERRa)—has been instrumental in retaining physicians to Arrow Lakes Hospital, which supports a rural population of 5,000.
“Our doctor community was on the brink of collapse,” he revealed. “A year ago, there were three of us wanting to stay. The fourth was going to leave. We were looking at each other knowing if that happened, we would fall apart. We could not have handled that workload. We were thinking, ‘This is not worth it. We can’t sacrifice that much of our life living at a hospital.’ [VERRa] was part of the fuel that kept us going,” he said.
“Moving forward with VERRa, it just made the week a little bit more manageable, especially for the doc that was considering leaving. They didn’t end up leaving, and stayed.”
VERRa, previously known as RUDi MRP, is a team of virtual Emergency Medicine physicians who step in during hospital physician staffing shortages. The team works with rural RNs to provide overnight coverage at rural hospitals.
With its team of virtual physicians, available by video or phone, VERRa supports physician recruitment and retention and can prevent closures and diversions so people in rural and remote areas that get the VERRa support are not forced to travel even longer distances to access care.
Craig said that if VERRa was no longer available, and if the physician team remained small, he would no longer be able to stay in Nakusp.
He said: “No, I couldn’t handle that. We were at the brink of throwing our hands up and saying: ‘We’re done.’ With three docs we survived a while waiting for another doctor, which was brutal. It was not sustainable. I considered going somewhere to find a group that would be supported with more depth.”
Dr. Caroline Walker, who works in Masset on Haida Gwaii and is the Co-lead of the VERRa program, understands Craig’s situation.
“As a rural provider in a similar community, I know what it’s like. When they’re on call, docs are happy to come in for true emergencies and help out. But what feels like a burden is getting called for things that are not high acuity that come in overnight and getting called about things that, frankly, would be probably more appropriate to be managed during the daytime, or be redirected to the daytime. But often these small communities look at their emergency rooms almost like their clinic.”
She said the burden of being on call every two or three days was a recipe for burnout and that is why it’s vital for a program like VERRa to exist.
“I think that one of the things that becomes a challenge, especially when you’re short-staffed, is your schedule becomes unpredictable. And when you’re asked to be picking up more call than what you originally had intended or agreed to. And there is a limit to just how available people are willing to be,” she said.
It’s not only unattractive for the people that work there, it’s also unattractive to people you are trying to recruit.
Caroline said: “You’re not going to attract anyone to come and work where there’s unpredictability about how often you’re going to be on call. Because it impacts whether or not you’re going to have free time. And so, if VERRa can be used as a way to add predictability into a model and add some sense of reliability, it can be a useful tool for recruitment.”
Arrow Lakes Hospital serves the communities within the Arrow Lakes region, including Nakusp, Edgewood, Fauquier, Burton, Trout Lake, New Denver, and Silverton. This area is situated in the Kootenay Boundary health service area between Nelson and Vernon. The hospital caters to a population of nearly 5,000 residents across these communities.
Dr. Courchesne and his colleagues would love to have even more VERRa support and additional funding could make that happen. “One of the biggest burdens of our job is being on call. It’s a 24-hour shift 2-3 times a week. It’s time I can’t be around my family. I can’t plan anything at home. I’m often not home for dinner. Often, I have a meeting one night of the week, and then I’m on call 2 nights. That’s 3 nights of the week that I’m not home with my family. That’s a big part of my life as well. Having a doctor covering just for the night to allow me to have some wind down time helps me be more present with my family. It matters.”
Caroline said VERRa not only supports acute care, but it also supports primary care.
She explained: “Where you get short staffed, you end up spending more time covering acute care because you want to keep it open. Then there’s less time for primary care. And so it ends up, rolling down the hill, and more things end up coming through the ER that might not be appropriate for ER, because the population is just struggling for access to a doctor. So if we have a system where physicians can reliably sleep overnight, potentially they can expand what they can offer in terms of primary care. That would lead to lower demand overall on your acute care services.”
The Ministry of Health’s Health Services Integration Team said: “Formally known as the Rural Urgent Doctor in-aid Most Responsible Provider (RUDi MRP) program, the Virtual Emergency Room Rural assistance (VERRa) pathway leverages communication technologies to provide overnight hospital support in rural communities across BC. We express our immense gratitude to the team of VERRa providers and staff members who work tirelessly to support rural emergency rooms and ensure that British Columbians are able to access quality health care services when they need them the most.”
