As a family physician in Victoria for the past 38 years, I have witnessed a marked transformation in medical-care delivery.
The family physician 30 years ago had a very rewarding and balanced professional and family life. These doctors looked after families from birth to death, in the office, home and hospital. They had time to spend with the patient. They also made a respectable income as befitted their training and experience.
Fast forward 30 years and we see that family medicine is under duress as never before. Financial constraints, regulatory constraints and patient demands have made the practice of medicine onerous.
Why is the status quo what it is? The UBC Medical School graduates 288 annually from its four provincial sites. The attrition rate of B.C. doctors has been more than 450 for the past 10 years. We need to attract doctors from across the country and around the world. Sadly, those places are also short of family doctors.
Traditionally, one-half of UBC medical grads would enter family medicine. But as student debt has risen, often to $200,000, more trainees choose a more lucrative career as a specialist. This year, I have been informed that there are 24 family-practice doctors graduating from the UBC-Island program. Of those 24, none is going to start a family practice.
Why, you might ask? These young doctors have big debt, start earning later in life and want a better work/life balance. They do not want to rent or own an office, hire staff and manage a business, as the economics no longer work. These young family physicians will need incentives and support to establish a practice.
Due to these financial constraints, many family doctors have closed their practices and moved into the hospitals as GP hospitalists, or work for WorkSafe B.C., etc. There, they get paid well with no overhead costs of running a practice, and get benefits.
More than 60,000 people in Victoria are without a family physician. That number will grow. The health minister has stated that we have more doctors per unit population than ever before. Tell that to the people lining up and waiting four or more hours to see a walk-in clinic doctor, or waiting six to eight weeks for a booked appointment with their family practitioner. There might be more doctors, but they are not available to serve as community physicians.
Most people do not realize that physicians spend as much time after the patient visit charting, ordering tests and referrals, then reviewing these when later received. For this total service they are paid a whopping $31 by the medical services plan (for ages two to 49). Out of this fee, the physician pays overhead expenses that run on average 35 to 40 per cent. This work is a real bargain for the province, but does not value the doctor’s time and expertise.
There is no time in the work day to fill out today’s numerous forms, meaning these have to be completed in our “off time” at home. It all points to less person-to-person time with our patients, and more and more time in documentation and paperwork.
It is no wonder that primary-care physicians working in non-group settings are leaving in increasing numbers. Their net incomes have been declining for years. It is simply economics.
Does the public value primary medical care? If so, we urgently need dialogue on solutions. We cannot expect to encourage young family practitioners to establish a practice and accept patients if they cannot expect to earn a professional-standard income.
As GP hospitalists have accomplished a better work/life balance with better remuneration than their community-based colleagues, a similar model where the health authority provided relief of the increasing overhead costs of a community practice might be one solution.
The other approach would be to pay community primary-care physicians appropriately in keeping with their skills and training, and the increasingly complex patient-health issues they manage as the hospitals discharge patients earlier.
I hope all B.C. citizens who are unhappy with their access to primary medical care ask their local candidates, future MLAs and future health minister what they are going to do to improve this situation. Canadians tend not to complain, but if we are going to stop the severe erosion of primary-care medicine, they must discuss the issues and formulate new ideas and solutions.
James Houston is a hoping-to-retire family physician. He lives in Victoria.
