For many of us, the closure of the pediatric inpatient unit at Kelowna General Hospital in May 2025 did not come as a surprise. Pediatricians in the region had been raising concerns about safety and sustainability for years. When no action followed, they began to leave. The result was a total shutdown of hospital pediatric care in one of the fastest-growing urban centres in the province. The subsequent scramble to stabilize care—urgent negotiation, expansion of locum coverage, and solicitation of ad hoc support from maternity and emergency services—laid bare the fragility of the system we depend on to care for children in BC.

Over the last decade, pediatricians have seen surging demand for care and increased patient complexity across the board. The system is struggling to keep up. Children with routine, but serious, concerns—such as developmental delays, mental health challenges, and chronic conditions—now wait up to 3 years for subspecialty assessment, often while their conditions worsen and their families struggle to cope in the absence of a diagnosis and coordinated support.

There are growing geographical disparities in the provision of care as well. In the face of unrelenting caseloads, limited support, and few incentives, many pediatricians are choosing urban practice instead of work in rural and remote communities. In many parts of the province, there are no pediatricians at all. Fort St. John, for example, the epicentre of BC’s current measles outbreak, has no local pediatrician coverage. Individual initiatives, such as the CHARLiE program for pediatric real-time virtual support (https://rccbc.ca/initiatives/rtvs/charlie [11]), offer some resources for clinicians, but these models of care are unable to provide the continuity and relational care that are so fundamental to pediatric practice. Moreover, they face constant human resource and financial challenges of their own.

At the same time, we are losing new medical graduates to other areas of medicine. Many young physicians, aware of the demands placed on pediatricians and a remuneration schedule that is not competitive with other medical and surgical disciplines, choose otherwise. While medical student classes have ballooned and competition for residency positions is higher than ever, pediatrics residency programs are seeing an unprecedented number of unmatched spots.

The situation is not due to lack of effort. Pediatricians are consistently answering the call to provide emergency locum coverage throughout the province, often above and beyond their own local practice; developing innovative programs to provide pediatric support in underserved communities; and working at well over 100% capacity in pediatric subspecialty areas at BC Children’s Hospital to reduce wait lists. The strain is not borne only by pediatricians. Family physicians, already stretched thin, are increasingly asked to take on complex pediatric care without ready access to consultation. Maternity providers find themselves managing both mothers and newborns, with an increasingly complex set of concerns. Emergency physicians carry the burden of stabilizing children who should have been admitted to a pediatric unit and then spend hours coordinating transfers to distant hospitals.

What is happening in Kelowna is not an isolated operational anomaly; it is a high-profile symptom of a deep and long-standing provincial failure to develop a robust and cohesive strategy for child health care, one that prioritizes the unique needs of children and places equitable access to high-quality services at its core. The system needs to be resourced appropriately, and we need to respect the clinicians providing the care. We are at an inflection point. There can be no more excuses preventing us from establishing this strategy now. The future of the next generation in the province depends on it.
—Kristopher Kang, MD, FRCPC

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