Colwood, British Columbia has pioneered a unique approach to addressing doctor shortages and strengthening public health by directly employing physicians as city staff, offering pensions, benefits, and reducing administrative burdens. This model provides valuable lessons for other cities.
What Colwood is Doing
- Created a municipally-run clinic, hiring family physicians as city employees.
- Doctors receive full medical benefits, vacation, parental leave, and defined pension via the Municipal Pension Plan.
- Uses provincial funding (Longitudinal Family Physician Payment program) for billing, reducing municipal financial risk.
- City manages clinic operations (staff, administration), so physicians focus on care.
- Initial goal: recruit 8 doctors over three years to cover thousands of residents.
Lessons Cities Can Learn
Employ physicians directly
Provides control, reduces administrative hassles, and attracts doctors discouraged by solo practice burdens.
Offer benefits and pensions
Improves attractiveness, retention, and work-life balance.
Secure sustainable funding
Partnership with higher-level government ensures stability.
Take on administration
Reduces non-clinical workload, allowing physicians to focus on patient care.
Pilot and scale gradually
Allows evaluation and adjustment before expansion.
Integrate pharmacy and diagnostics
Supports comprehensive community health.
Address non-financial barriers
Removes obstacles like paperwork and staff shortages.
Challenges and Caveats
- Legal and regulatory constraints may require higher-level approval.
- Funding stability is critical to avoid municipal budget strain.
- Recruitment of sufficient physicians can be difficult.
- Running clinics requires operational and compliance expertise.
- Scaling will need infrastructure, pharmacies, labs, and diagnostics.
- Physician autonomy must be balanced with oversight.
How Other Cities Could Adapt This
- Open municipal primary care clinics staffed by city-employed physicians.
- Offer incentive packages (housing, relocation, student loan relief).
- Integrate pharmacies, labs, and diagnostic services with clinics.
- Invest in preventive public health programs (nutrition, wellness, mental health).
- Work with states/provinces to enable billing through public health systems.
- Ensure equity and measure outcomes (wait times, health results).
Key Take-Away Principles
- Align incentives to prioritize patient care over business operations.
- Make employment attractive with benefits, pensions, and support.
- Foster partnerships across government levels.
- Design with scale and sustainability in mind.
- Integrate services for holistic community health.
- Start with pilot projects to refine the model.