TOFINO - Physicians are so overworked at Tofino General Hospital that they're burning out, frustrated and at risk of leaving the community, says a recently completed report.

The Coastal Health Care Committee suggests in a December 2007 report that medical services will suffer and the hospital could eventually close if the Vancouver Island Health Authority doesn't make the recruitment and retention of doctors and nurses its highest priority.

Further, the hospital is so decrepit, it's contributing to the inability to hang on to doctors, said the report.

A copy of it was obtained by the Westcoaster.ca.

"The steady decline of available physicians and nurses with comprehensive rural medicine skills in the area has been accompanied by a severe loss of morale, and ongoing concerns related to the management of (the hospital,)" the report says.

The committee is made up of local mayors, long-time residents, doctors and area business leaders.

They warn that without immediate measures, the hospital is at risk of closing.

A spokesman for the Vancouver Island Health Authority said the authority is well aware of the problems and has been working with the committee for months to come up with a solution.

But Tofino - like many small, isolated communities across Canada - poses some challenges, said Grant Hollett, director of planning for the authority.

And he acknowledged that something needs to be done about the state of the hospital.

The report recommended the health authority hire at least three more full-time physicians and aggressively recruit one full-time registered nurse and more casual nurses.

One physician estimated that 80 per cent of clinic days are interrupted by calls to the hospital's emergency room.

The calls can last up to six hours, forcing patients at the clinic to wait hours to see a doctor or to reschedule their appointment.

Doctors often work late to complete paper work and attend to patients who need more time than is allotted for a clinic visit and because of their on-call duties, physicians have little time for education.

"These conditions have resulted in physicians who are burning out, frustrated, and at risk of departing," the report states.

Meantime, the hospital's nurses are working too many overtime shifts.

In October, local doctors announced the suspension of obstetrical services mainly because of a shortage of trained nurses.

"Closure of all obstetrical services at Tofino General Hospital is neither a realistic nor safe option, since unplanned and premature deliveries will certainly continue to occur," states the report.

But recruiting to Tofino is difficult, the report notes, because of a national shortage of doctors and nurses, the high cost of local housing and the fact many don't want to practise in a small rural community.

Hollett said the community is caught in a Catch-22.

Its size means it can support three doctors.

"They really do need some kind of emergency department function, but you need to have a doctor on call to support that. So, if the community supports three doctors, they're doing a one-in-three call rotation."

That quickly leads to burnout. But hiring more doctors for Tofino isn't the answer either because there isn't enough on-call work to sustain an extra physician, Hollett said.

"Finding the middle of the road is really difficult."

Another part of the problem is the spikes in the traffic at the Tofino hospital, Hollett said. With the increasing number of tourists in the summer, hospital visits soar, then drop off in the winter.

Dr. John Armstrong, who worked on the report, said the community needs at least five full-time equivalent physicians and eventually six to reduce workloads at the hospital.

Filling those positions would mean doctors would only have to work one night a week and one weekend in five at the hospital.

Currently, he said, staffing levels mean physicians can't leave town every second weekend because of hospital duties.

Beyond the personnel issues, the hospital itself has some serious problems, the report concluded.

In fact, the current Tofino General Hospital should be replaced with a new one, the report notes.

"I came here and almost walked out the door," one unidentified staff member is quoted in the report. "It's the most decrepit hospital I've ever been in."

"A paint job inside would be great," added another staff member.

"Most of the halls, offices, and patient rooms haven't been painted in many years and are in need of repair from holes and scrapes to the baseboards, never mind the bare Gyprock."

The current facility was built in 1954 and has been upgraded over the years with a new generator, a new roof, sprinkler systems, new medical gas, a vacuum pump, and new boilers, but all are half-way through their lifespan and some are well overdue for replacement.

The electrical system was last upgraded in 1977 "and is absolutely inadequate for a modern hospital," the report notes.

Seals on the delivery-room windows leak, paint flakes off walls during cleaning, and the drywall in the pediatric ward still remains unpainted.

Hollett said design of hospitals have changed dramatically since the Tofino hospital was built.

So simply replacing the hospital isn't in the works.

Instead, Tofino and Ucluelet will likely get some sort of integrated facility that brings together clinics and in-hospital services, he said.