The District of North Vancouver Can Learn From Colwood’s Bold Solution to the Doctor Shortage
- treybellcouncil
- Jan 3
- 4 min read
Finding a family doctor has become one of the most pressing quality-of-life issues facing communities across Canada. The District of North Vancouver is no exception. Thousands of residents struggle to access primary care, and families are being left without that essential family doctor that many of us who grew up in North Vancouver had the benefit of. That is why we should be closely studying what Colwood, B.C. has done and seriously consider working toward our own municipally employed team of family doctors.
When Colwood lost its last family physician, Mayor Doug Kobayashi refused to wait for a distant fix. Instead, the city stepped in with a practical, innovative model: family doctors as municipal employees. By offering salaried positions with benefits, administrative support, and a predictable work-life balance, Colwood made it possible for doctors to focus on what they are trained to do; care for patients. Early results show the model is both attractive to physicians and financially sustainable for the municipality.
There is also a strong economic argument for North Vancouver to explore this approach. Communities compete not just for residents, but for professionals, families, and employers. Access to primary health care is a foundational service. When people cannot find a doctor, they delay care, miss work, and sometimes leave altogether. A municipal clinic model could help anchor families and skilled workers in our district, supporting local businesses and long-term economic stability.
Importantly, this does not require building massive new infrastructure overnight. Doctor offices could be distributed throughout the district using already-built public assets such as community centres or other district-owned buildings. Over time, the district could dedicate land or strategically purchase properties to expand the program. The goal should be to start small, perhaps with one clinic, then evaluate outcomes, and if the model is indeed sustainable, expand methodically to serve all areas of North Vancouver over a defined timeline.
Health care delivery may be a provincial responsibility, but municipalities are closest to the lived reality of residents. Colwood has shown that local leadership, creativity, and partnership with the province can break through long-standing barriers. North Vancouver should not reinvent the wheel, we should study this model carefully, learn from its challenges, and work toward a solution that puts people, families, and community well-being first.
How the Model Works for the Municipality
Under this model, the municipality acts as the clinic operator and employer, while the province remains the payer for insured medical services under the Medical Services Plan (MSP).
1. Revenue: What the Municipality Bills the Province For
The municipality bills the Province of B.C. (via MSP) for insured physician services, just as private clinics do now.
This includes:
Patient visits
Assessments and diagnoses
Follow-ups and ongoing care
Any MSP-insured procedures provided by family physicians
Key point:
The city does not bill per doctor salary. It bills per patient service rendered, using standard provincial billing codes.
The province pays:
MSP fee-for-service payments or
Alternative payment plan (APP) / blended funding (depending on how the clinic is structured and approved)
That provincial revenue is then used by the municipality to:
Pay physician salaries
Offset clinic operating costs
2. Costs the Municipality Typically Covers
These are the startup and operational costs the municipality carries—at least initially.
A. Physician Employment Costs
Salaries (fixed, predictable compensation)
Benefits (health, pension, vacation)
Professional liability insurance (often partially recoverable)
B. Clinic Operations
Rent or use of municipal space
Utilities and maintenance
Medical equipment and IT systems
EMR (electronic medical records) licensing
Cleaning and security
C. Staffing & Administration
Medical Office Assistants (MOAs)
Clinic managers
Scheduling and billing staff
HR and payroll services
3. What Makes It Viable (and Potentially Cost-Neutral)
Colwood structured the clinic so that:
MSP billings flow to the municipality
Physician schedules are optimized (full panels, predictable hours)
Overhead is lower due to municipal-owned space and centralized administration
Doctors are 100% clinical (no unpaid admin time)
This is why Colwood reports the model as revenue-neutral over time once established.
Council allocated startup funding (about $500,000), but ongoing operations are designed to be sustained through provincial billings.
4. What the Municipality Does Not Pay For:
The municipality does not pay for:
Hospital care
Specialists
Labs, imaging, or prescriptions
MSP funding itself (this remains provincial)
Those remain entirely provincial responsibilities.
5. Why the Province Accepts This Model
From the province’s perspective:
It is not paying more per patient
It is reducing ER visits and late-stage care
It is retaining doctors who might otherwise leave family medicine
It improves access without building new provincial infrastructure
6. Why This Matters for the District of North Vancouver
Municipal land and facilities lower overhead
Population density supports full physician panels
Retention of families and professionals strengthens the tax base
Start small → expand geographically over time
This is not a takeover of health care—it is municipal delivery of provincially funded care, similar in principle to how cities operate fire services under provincial frameworks.
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