A local psychiatrist says he will close his practice and leave the territory unless the Yukon government allows him to work under contract instead of forcing him to work in a fee-for-service system that pays him per patient-visit.

Dr. Leo Elwell says his practice, Soulshine Health, will close on March 29, 2024 if he cannot resolve this issue before his lease renewal date on Nov. 30.

“This is our last resort,” Elwell told the Star on Tuesday afternoon. “I didn’t want to do this.”

He says the government is handing out contracts to other providers – but, without giving him a reason, has stopped awarding them to his practice.

“The government is completely playing unfair,” he said. “It is not a level playing field, even remotely.”

His practice currently has about 300 patients, with 40 more on a waiting list. Elwell has worked in the Yukon for a decade.

Last Friday, he sent a letter to his patients and to opposition party MLAs.

He urged them to contact both Premier Ranj Pillai and Health Minister Tracy-Anne McPhee to help “resolve this inequity to prevent Yukon from losing valuable and much needed mental health services.”

McPhee says the government is trying to resolve the issue, but called Elwell’s tactics in trying to settle the issue “disturbing” while speaking to reporters on Tuesday afternoon.

Elwell says he provides “low-barrier” treatment for individuals struggling with addiction and mental health crises, and because these clients are more likely to miss appointments, he loses out. When they don’t show up, he doesn’t get paid.

His letter says that for 12 months, he has been trying to get the government to recognize the unique individuals he works with and help him to get paid under a model that considers this.

“Even with the best of assistants, and the best phone calls and reminding people and texting them, you still have probably an easy 10 per cent no-show rate or cancellations at the last minute,” Elwell said.

He also loses out on money in this system at times when he goes to work at Whitehorse General Hospital.

“When I was working with the hospital, if I came into the SMU (secure medical unit) and it was full, then I can make a decent wage out of that day,” Elwell said.

“But if there is nobody in the SMU, then I totally lose out on a day’s worth of income.”

Another problem is business operating costs. Working on fee-for-service doesn’t take this into account, Elwell says.

“On the contract model, they were covering office overhead, and office overhead in the Yukon is not cheap,” he said.

In an email to the Star today, a patient of Elwell’s — who wished to remain anonymous — said he was the only doctor who could prescribe the specific medication she needs, and seeing him is helping her “tremendously.

“Now I hear that he has to close because (the government) is picking favourites in terms of pay models?” she asks in her email.

The patient goes on to say Elwell has been a pioneer in Yukon psychiatric care, and has many Indigenous patients.

“He should be paid in the same way as his colleagues,” she said.

The issue was raised in the legislature Tuesday. The Yukon Party presented it as further evidence of the government’s failure to provide adequate health care.

“Under this Liberal government, our health care system is beginning to crumble,” said Yukon Party MLA Brad Cathers.

“There’s a shortage of psychiatrists, and we have heard from Yukoners upset that one long-time resident psychiatrist is now closing his practice.”

McPhee would not comment on the specifics of Elwell’s case in the legislature.

While speaking to reporters afterward, she did say the government is working on it.

“We are committed to pursuing his request,” McPhee said.

But a government spokesperson handed out a list of Elwell’s past government contracts, and McPhee pointed to this is evidence that Elwell does not have much to complain about.

“I think you’ve been given information that he’s had lots of contracts with government since 2013, including with Health and Social Services and with the Department of Justice,” McPhee said. “Which is great.”

Looking at the contracts, however, there is a steep drop-off this year. Elwell’s practice received only $25,000 for this fiscal year, but had contracts in previous years totalling several hundred thousand dollars.

“That was a long time ago,” Elwell said. “That’s not the current day.”

He also took issue with McPhee’s spokesperson handing out the contract list to try to counter his arguments.

“Not letting me know that they were going to do that and then not answering any of my requests for working constructively on this together, that’s pretty underhanded,” he said.

Though he has received no responses from McPhee, Elwell did say the premier and other government officials have met with him.

But in all of his communications with the government, Elwell says, he has never been given a clear reason why he is not getting contracts.

“The reasons keep changing, which again, makes me think that I’m being gaslighted,” he said.

“They say, ‘oh, there’s no money in the budget,’ then there was money in the budget.

“Then they’re saying, ‘oh, you don’t fit into the model.’ Oh; what’s the model?

“‘Oh, we don’t have a model.’”

McPhee said there is a process by which these contracts are put out for bid or given a direct award, but they need to take into account what is being paid for in terms of quantity of services.

“If a doctor wants a contract for X dollars, we need to make sure that X dollars result in X patients getting service,” McPhee said.

If he’s continued to be forced to work under that system, Elwell says, he will leave.

“I’ve tried now for the last couple of years to make this fee-for-service thing work,” he said. “And it doesn’t.”