As another clinic closes, doctors say after-hours care is set up to fail

An after-hours medical clinic in Moncton, attached to the Main Street Atlantic Superstore, now has a sign on the door announcing its permanent closure.

Doctors say that more after-hours clinics might meet the same fate — and some point to a billing system that pays physicians less for after-hours clinic care. 

But Nick Spence, who was the general manager of the Main Street Primary Medical Clinic, believes it's hard to point to one reason for its closure.

As the province aims to boost access to primary care and allocates resources in that direction, Spence said the after-hours clinic is an unfortunate casualty. 

"It is a shame, because there is a need for it," Spence said. "But, it's just one of those things that, you can't keep the resources in walk-in clinics full time, and also at the same time get everyone attached to a primary health-care provider.

"There's not enough resources to do both. So as you transition, you've got to pull some way from here to go over there, and this is just kind of what happens."

Spence, who is not a doctor, said his wife has been practising at the clinic for 10 years and putting in 80-hour weeks trying to keep it open.

He doesn't blame the province and sees giving everyone access to continuous primary care as a priority. But he also can see the impact that closing down will have on patients.

"It does suck, because there's a lot of patients that used our clinic, and I don't know where they're going to go." 

A few years ago Dr. Brian Davidson also closed his after-hours clinic in the Moncton area, after he, too, was unable to find enough physicians to staff it. 

"After-hours clinics are just a symptom of a bigger problem, that we can't recruit to the community," Davidson said in an interview. "People don't want to do that kind of work. It doesn't pay as well, there's more frustration with it, there's more paperwork."

He said doctors are paid significantly less for working in after-hours clinics, compared with other settings, including virtual care.

The rate of pay for after-hours care, according to Davidson and Spence, hasn't increased in at least a decade.

Because after-hours clinics also have overhead costs, Davidson said, ultimately physicians at the clinic were taking home half of what they would make if they worked elsewhere.