Valuing time and care

Morale of the average family physician of the longitudinal full-service variety is at a very low level in our province. In fact, fatigue from the pandemic, demands from stressed patients, increased paperwork, and rising overhead costs are all factors causing many BC physicians’ morale to drop, not only full-service longitudinal-care family physicians. These physicians are crying foul at the stagnation in their take-home pay relative to other physicians, other health care providers, and other occupations.

I don’t begrudge my hardworking colleagues who are earning more than I am, and I certainly don’t want to divide our profession. At present, there is no incentive for family physicians to work in a practice that provides full-service longitudinal care. First, we are not trained in medical school to run a small business. Second, overhead costs are rising at a much faster rate than our fee schedule. This point is very important, I believe, and applies to all physicians running their own offices.

A number of years ago, Doctors of BC (then the BCMA), set an hourly rate (currently $160) intended to compensate family physicians for the work they did outside of their practice—for example, committee work for the association. This rate is now used as a guideline for contracts with family physicians working as hospitalists or in urgent and primary care clinics. What seems to have been forgotten is that the hourly rate was originally designed to include an amount for office overhead costs, based on the premise that our office overhead continues whether we are in our offices or not. I am not suggesting that hospitalists be paid less. My hospitalist colleagues work hard and deserve every penny they earn. What I am suggesting is that the puny Business Cost Premium does not even come close to compensating us for the added costs of running an office practice, over and above what family physicians who don’t have business costs earn.

Newly qualified family physicians are voting with their feet. Very few are heading into office-based practices with overhead. Family physicians with years of experience are doing likewise by working less or shutting down their offices in favor of retirement or other work—for example, as hospitalists or as urgent and primary care clinic physicians. As a result, the number of unattached patients is growing steadily. It’s ironic that urgent and primary care clinics were meant to be the government’s solution to the growing number of unattached patients.

As Doctors of BC and the BC government negotiate a new Physician Master Agreement, they need to come up with creative ways of compensating physicians who own and work in their practices, which differentiates them from physicians who don’t pay business costs. This compensation should not be available to medical clinic owners who do not work as physicians in those clinics, and it should reward full-service longitudinal family physicians fairly, relative to their colleagues who provide episodic care, those who don’t operate small businesses, and those who offer only virtual care.

Ultimately, it comes down to what each person at the negotiating table wants from their family physician. What I want from my family physician is someone who has the time to get to know me and care about me, and someone who is not stressed by having to run their own practice with rising business costs and increasing intensity of their work.

I can’t write such a gloomy editorial without throwing in a small piece of humanity. I was standing in a long line at the bank recently, when an elderly lady holding a cane took her place behind me in the line. I offered to let her go ahead of me. She was quite feisty and asked me why I thought that she deserved to go ahead of me in line. I told her it was because she was holding a cane. Her response, with a cheeky grin, was that she was just holding it, and that she didn’t need to use it. She eventually took me up on my offer and moved ahead of me.

A few minutes later, a very frail-looking elderly lady with a cane joined the line. She could barely stand and was leaning heavily on her cane and the railing. I assisted her to the front of the line and into the bank, where a bank employee found her a chair. As I walked back to my place in line, the first lady I had helped remarked that there was always someone worse off than oneself. Despite my sombre tone, I am always cognizant of the fact that there are many people worse off than I am.
—David Chapman, MBChB

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