CHASE - The charm of this community is that it is small - 2,500 people small - and it's the western gateway to the Shuswap while being less than an hour's drive to Kamloops to the west and Salmon Arm to the east.
Chase has more than its share of residents 45 years or older: 1,500 of them - more than half of the population. As residents age, their health-care needs rise.
Also rising is the popularity of the Shuswap, which swells from perhaps a few thousand in total to 40,000 or more during the summer months. When injuries befall tourists, cabin dwellers or locals, the emergency room at Chase's health centre is the closest place to go.
But the health centre has undergone dramatic changes over the decades, particularly back in 2002 when it was transformed into B.C.'s first primary-care pilot project. Doctors were paid by salary instead of fee for service, and other staffers were brought in to give patients a variety of care options, including registered nurses, a dietitian, counsellor and respiratory therapist.
It seemed to work well, so the primary-care model spread to Logan Lake and other similar-sized communities.
But in the last several years, the Chase Health Centre has been a revolving door, with doctors staying for a year or two at most. Doctors were brought in on short-term locums while residents could see a different face every time they went in for an appointment.
Patients had to turn to the emergency room because they couldn't get timely appointments.
Then the emergency room, which runs Monday to Friday, began closing frequently because there weren't enough doctors to provide service.
That ER closed 16 times between April 1, 2011, and March 31, 2012. Between April 1 and Sept. 7 this year, it closed 27 times.
From spring to mid-summer, the one doctor who moved to Chase a year ago found himself alone, with only a nurse-practitioner to help. He couldn't juggle patient appointments and ER coverage without burning out.
It wasn't always this way. For three decades, Chase had a long-term group of three to five doctors, so the unpredictability of the past several years left residents worried. Many doctors came and went, and no one was putting down roots despite recruitment efforts.
It all changed again recently. A long-expected second doctor got through immigration paperwork and arrived in July. A third doctor, who has previously worked in Barriere and done locums in Chase, put up his shingle on Sept. 4.
Village residents were relieved, but guarded. Will the doctors stay?
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About two years ago, Chase thought it had scored big with a married couple in pre-retirement who like small towns.
Doctors Ken and Janet Bates expected he would work full-time in Chase, while she worked part-time at a clinic in Scotch Creek, 30 kilometres east, where they bought an acreage and began building a house.
They grew up in rural B.C. communities and practised in other parts of the province and in the U.S. before arriving in Chase.
As musicians who also love gardening, the doctors wanted a large property and a practice at the Shuswap was an ideal way to ease into retirement.
Ken Bates stayed in Chase for about a year, then joined his wife in Scotch Creek where they set up their own practice, each working part-time.
"Everything to do with Interior Health was so complicated," Janet Bates said. She saw a lot of effort going into recruiting doctors, but not enough into keeping them.
"You need to look at doctors, look at their needs and make it enjoyable for them."
Her husband, a trained ER doctor, offered to work in Chase in private practice because he didn't like the way things were working at the primary-care health centre.
"We were told you work for Interior Health or not at all in Chase," she said.
Bryan Redford, community area director for Interior Health West, said what fits for one doctor doesn't always fit for another.
"It wasn't working the way they wanted it to work. They wanted a degree of auto-nomy," he said. "It's really been about what the individual's looking for."
So the Bateses live and work 40 kilometres past Chase, in Scotch Creek, with the backing of a newly formed non-profit, the North Shuswap Health Society. Their clinic has 1,400 patients, a part-time paramedic and registered nurse.
"We really do have a lot of patients from Chase," said Bates.
"They saw a different opportunity that fit them better," said Redford. Scotch Creek is close enough that having two doctors there can help ease some of the pressures in Chase.
However, there are those who can't drive who have to rely on the services available in the village itself.
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A good number of doctors and a primary-care centre seven years ago made Chase seem like a safer place than Anglemont on the North Shuswap for Dyan Banting and her partner, who had cancer and other serious medical problems.
"We moved here for health services," said Banting, 73, who has trouble breathing during the hot summers due to a heart condition.
Six months after the move, however, her partner died. Banting remained and shares her home with her son, daughter-in-law and seven-year-old grandson.
Last year, she had a feeling her regular doctor wasn't going to stay much longer, so she switched to the other, recently arrived physician. Her hunch was right; shortly after, her former doctor moved to Ontario.
She hopes her current doctor, who has a young family, doesn't do the same.
"I'm just keeping my fingers crossed that he'll stay."
She thinks the village should offer doctors a free house, maybe free office space, and the province should give them more pay. Anything to keep them in town.
Neither Banting nor Mary Sennweld are able to drive. The two have never met, but both had similar reasons for moving to Chase.
"When I moved here five years ago, health care was a big consideration," said Sennweld.
She left Cherry Creek because it has no medical services and at 60, she has problems with blood clots, low blood pressure, colitis and immune-system problems. Some days she can't walk. She wears an alarm around her neck.
She lives in a trailer with her Chihuahua, Maru, and is considering selling her home to move somewhere bigger, somewhere with a doctor available to care for her and an open ER when she needs it.
"Chase is dying. People are moving, people are leaving. We've got no health care," she said.
"I am constantly worried about myself."
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Chase is the last community in IH West that pays some doctors by salary, said Redford. Currently, two doctors are given a minimum wage guarantee and the third opted for fee for service.
The primary-care model considered so ideal a decade ago needed changing, especially with most doctors wanting to be paid by fee for service, he said.
"It's about the primary-care model evolving," he said. "We're always trying to figure out how can we help, how can we support physicians? It's about a continued dialogue, things that would help them in terms of their practice."
Keeping doctors in rural communities involves five factors, he said: a good fit
for the physician, proximity to resources and services, relations with patients, the doctor's family considerations and ease of setting up practice.
Redford said rural doctors should expect to do emergency work. While Chase's ER was closed numerous times due to a lack of doctors, he pointed out that it was also kept open for hundreds of days because of locum physicians who helped out.
Doctor recruitment and retention has been a worry for rural communities for years, but Chase had it good for a long time, said former mayor Harry Danyluk, who used to sit on the Thompson-Nicola Regional District's hospital region board.
"Every community in the TNRD is hurting," he said.
In the last few years, he has faced prostate cancer and lost his wife to cancer. While he has become used to a different doctor with every visit, he was grateful to have the ER in town in his wife's final months, so he didn't have to drive her into Kamloops as much.
People in Chase are relieved to have a full contingent of three doctors again. It means getting appointments is easier, and the ER won't experience closures.
"People here rely on that emerg," he said. "The lifestyle is going to be the biggest thing to retain a doctor."
Another Chase resident, Len McLean, was also concerned about the doctor shortage.
"With one or two doctors here, it's almost a guarantee for failure. These guys are going to burn out," said McLean.
His fear was if the Chase ER closures had continued, more people would have gone to Salmon Arm or Kamloops. That would have had a severe impact on the Chase clinic's numbers - and that, he believed, could affect funding and recruitment efforts.
Paramedic Val Donnelly also worked on the doctor issue. She believed part of the problem was in the salary system.
"The way I see it, they get paid a salary no matter how many patients they see. So they're not encouraged to see more people," she said.
Younger doctors are still dealing with student loans, so they may be more driven to go for a fee-for-service setup, she said.
Lab and X-ray hours have been cut back at the clinic, which is another hurdle, she said.
When the ER was closed in Chase, people had to drive to Salmon Arm or Kamloops to hospitals that were already putting patients in the halls and dealing with several-hour waits in the emergency rooms, she noted.
"What is going to happen to Royal Inland when all these little places, Chase, Logan Lake, etc., when they are closed?" Donnelly said.
"The larger hospitals are plugged to the gills and they don't need people coming to the ER with something that could be handled by a regular doctor," he said.
Danyluk said he has heard the latest doctor to arrive in Chase shares similar interests in the outdoors. If it'll help, he'll help tour the new guy around. "Heck I don't mind taking the doctor out fishing."
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Chase Health Centre by the numbers
Population of Chase: 2,500
Main health facility: Chase Health Centre, built in 1987 with 1996 expansion.
Number of beds: 0
Number of Chase patients admitted to RIH in 2001/02: 483
Number of Chase patients admitted to RIH in 2010/11: 395
Number of family physicians in Chase: In 2002, five; in 2012, it has gone from one to three.
Emergency services: Monday to Friday, 8 a.m. to 3 p.m. (was 8:30 a.m. to 5 p.m. until April 2010).
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