When Faye checked into the emergency department (ED) with severe dehydration last year, all the beds were full.
Faye, a UBC computer science student whose name has been changed due to privacy concerns, had realized the night before that something was wrong — their muscles were weak and sore and their urine was dark brown.
Patients filled every seat in the Vancouver General Hospital waiting room, some in visible distress. The staff, while quick to help once they realized Faye’s case was urgent, were clearly overextended.
“I felt like I was slipping through the cracks — there wasn’t a bed for me to crash on so I was in a bed in the hallway,” Faye said. After two hours, Faye was diagnosed and treated for rhabdomyolysis, an uncommon condition that causes your muscles to disintegrate. Left untreated, it can lead to kidney failure and death.
While at first Faye felt frustrated by the ED staff’s brusqueness, they understood that it wasn’t the workers’ fault — the ED doctors and nurses were exhausted too.
“They are trying their best,” said Faye. “There are so many people here and the staff are just trying to get people through … they have the right to be burned out and pissed.”
According to UBC medical student Adrianna Paiero-Keeler, BC EDs are experiencing record levels of overcrowding and understaffing. Paiero-Keeler is part of a group of UBC medical students advocating to the provincial government for policies and funding to ease an emergency medicine system in chronic crisis.
The group, called the UBC Medicine Political Advocacy Committee (PAC), wrote a policy paper called “Enough Waiting: A Call to Resuscitate BC’s Emergency Departments.” They presented it to BC Health Minister Adrian Dix in Victoria on March 4. Medical students like Paiero-Keeler are graduating into the frontlines of a crisis, and everyone knows it.
Family doctor shortage
Faye would have preferred to see a general practitioner given their symptoms instead of waiting at the ED. But, like 18 per cent of BC residents (per the 2019 census), they don’t have one. For students, that statistic is even greater.
According to Paiero-Keeler, students transitioning into adulthood, and away from the clinics that saw them grow up, are left with a gap in their health care team.
“That transition is something that we specifically learn is really, really difficult,” she said. “That means that we have a lot of unattached students.”
Second-year psychology student Kaela Branson is one of them. She described the struggle of having to fill in each new health care provider on her medical history, which includes mono, strep throat and multiple concussions.
“When I’m going to rehab for my concussions, they’re asking me the history of my concussions and what my doctors prescribed for me, and all this stuff. And I don’t know, because it’s been from eight different places,” said Branson.
Without a consistent family doctor, Branson has had frequent ED visits over the past two years. She said she once waited for 11 hours.
According to the Canadian Institute for Health Information, 9 out of 10 Vancouverites wait for less than 3.5 hours in ED for an initial assessment if they aren’t admitted. Patients with symptoms that warrant admission end up waiting much longer with 9 out of 10 visits completed in 55 hours.
Patients aren’t the only ones struggling under the family doctor shortage. A 2020 study found that a staggering 86.1 per cent of Canadian ED physicians met at least one of the criteria for burnout — and that was using data from before the COVID-19 pandemic.
Medical students entering the field are keenly aware of the stress they’ll be under.
“Speaking to people who are in third and fourth year and hearing stories of them … having to tell someone that they have stage four cancer … in a corner where everyone can kind of hear the conversation, I know it’s going to be challenging,” said Paiero-Keeler.
“I’m probably going to have to go home and decompress and reflect to be able to care for my own mental health.”
Swimming upstream
ED staff in mental health slumps themselves are also often caring for patients experiencing mental health struggles.
Many of their crises could have been averted by earlier and more accessible care. According to Paiero-Keeler, mental health support is one of the biggest things governments can do to take the strain off of EDs while improving public health.
“Mental health [crises] and suicidality … are often going to the emergency department,” said Paiero-Keeler.
The report recommends extending MSP coverage beyond psychiatry to include counselling. She highlighted mental health care for students and youth as a specific priority.
On the other end of the age spectrum, investing in senior care can ease both EDs and the quality of life of elders and their families. Paiero-Keeler said that older people often go to EDs for treatment for acute health issues, but EDs don’t have the beds or the funds to provide the longer-term care they need.
The report recommends creating a program, modelled after similar ones in Ontario and Alberta, to bridge EDs with community support services to provide seniors with care and a place to stay.
Adding to the team
Addressing the doctor shortage also starts with simply training more doctors.
“What we’re seeing right now in BC is that we’re not graduating enough doctors,” said Paiero-Keeler. A new medical school will open at SFU next year, but Paiero-Keeler said it’s not enough, considering the growth in the region.
The provincial government controls enrolment spots. Funding more medical school spots also requires making sure there are enough residency spots for physicians to complete their training and making sure that students are incentivized to become family doctors.
Fortunately, UBC has seen success in filling its family medicine residency spots, welcoming 186 resident family doctors for training across BC last year.
EDs and medical care are also not distributed equally. In Northern BC, a wave of hospital closures during a heat wave prompted protests in July. Health care in rural areas and Indigenous communities have been disinvested in for years.
UBC Med PAC also recommended shifting to a state funding model that pays hospitals per patient, called “activity-based funding,” which is common in almost every other universal health care system. This would incentivize hospitals to provide more care, while ensuring that they have the funding to match each patient.
Political advocacy
The UBC Med PAC met with 40 members of the Legislative Assembly in March with their recommendations, who Paiero-Keeler described as “very receptive.” As the provincial elections approach in October, all eyes are on candidates’ health care records and proposals to deal with the crisis while preparing for an expanding population.
“I have a strong belief that it’s all of our responsibilities to read up on different platforms of people and vote according to our belief and trust in that entire platform and their capacity to achieve that goal,” said Paiero-Keeler.
The ER crisis is also inseparable from other issues, including the housing and toxic drug crises.
In a 2023 article, a member of the Hospital Workers’ Union told Global News that street sweeps and decampments of unhoused people harm their health, putting more strain on the care system.
While doctors don’t usually deal with politics, when they impact public health, Paiero-Keeler sees an overlap.
“[We’re] seeing a lot of emergency room doctors actually standing up and speaking out, because they’re like, enough is enough, and if we don’t get involved it is going to continue to get worse.”
With the provincial elections coming up in November, she recommends keeping your health care priorities in mind as you’re voting.
“Medicine shouldn’t be political. But it is political, because it’s funded by the government, right? Anything that’s funded by the government has to be political, because they hold the purse strings."
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