Doctor shortage

The current family doctor shortage is a crisis. It is especially bad where I live, in Parksville on Vancouver Island. Why has the situation become so dire? In my opinion, it has happened because of gross incompetence at multiple levels of the medical profession and government. I am a retired family physician. I am a UK graduate. I was in full-time family practice in Alberta for 6 years and BC for 28 years before semi-retiring to Parksville in 2012, where I worked as a rural locum and urgent care physician part-time until I fully retired from practice in 2016, aged 69, after 46 years of medical practice. As far back as the late 1980s and early 1990s, it was well known that the average age of family physicians in BC was in the 50s. It was becoming clear to us practising family doctors that the family practice model we were all working in was becoming less attractive to the next generation of doctors, who were able to work in walk-in clinics, where they could see large numbers of people with relatively minor complaints and would not have to become involved with older patients with more chronic complaints, who require care on a more longitudinal basis. Since then, the Medical Services Plan has made changes to increase the payments for older patients with chronic conditions, which certainly helped, but none of the changes have turned the tide to attract more young physicians to enter full-time family practice. In the mid-2000s one of my partners tragically died in his early 60s of cancer. We were unable to find anybody to take over his extremely large practice consisting mainly of older patients. The only way I could not leave my own patients in the lurch when I retired from my practice was to move my charts and practice to a clinic that was a hybrid walk-in family practice, which took over all my charts so I could walk away.

I believe that action should have been taken over 20 years ago, which may have prevented the crisis we find ourselves in today. Full-service longitudinal family practice needs to become more attractive. Many young physicians do not relish the thought of running a small business, which means acquiring somewhere to develop a medical office, employing staff, ordering supplies, and paying a mortgage or rent, just to mention some of the expenses involved. It appears that many young physicians prefer to work under a different model, such as a salaried system with good benefits, vacation time, and paid continuing medical education in a team-based model with nurses, social workers, and other support workers under the same roof. This model has been shown to be successful in many parts of Canada.

The government and the profession must work harder to find ways to provide every citizen access to a local family physician. It does not appear that this is happening now. Clearly, inadequate numbers of family physicians are being trained, and the trained physicians are not coming to places like Parksville or Qualicum. It is difficult for young physicians who trained overseas to return to Canada, their home, to practise here. Canada is not providing enough places in medical schools to maintain the supply of physicians that the country requires, which is one of the reasons many young Canadians go overseas for their medical education.

Parksville is experiencing a building boom, and in a few years, there will be thousands more people living here. Who is going to look after all of us?
—Jonathan M. Winner, MD

Jonathan M. Winner, MD. Doctor shortage. BCMJ, Vol. 62, No. 2, March, 2020, Page(s) 48 - Letters.

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robert brown says: reply

Johnathan Winner is correct in his critique. As I mentioned in my article last month in the Journal, the problem is being ignored by government, which has undervalued Family Medicine for decades. This problem has now come home to roost. New patients to the greater Victoria area will have a very difficult time finding a Family Physician. We have several people coming to our Sidney office every day pleading to be taken on and only to be turned away. We MUST be paid an adequate amount for our services such that we can be incentivized to stay in Family Medicine and organize the care which Canadians need and deserve.

abraham tio says: reply

i'm a canadian medical graduate living in bc. i chose not to complete residency training when i graduated so i could pursue other things.
i tried for 3 years starting in 2017 to re-enter the medical field, but was not granted any interviews across the many residency training programs across the country where i applied via carms.

i'd like to setup a family practice in bc, but it doesn't look like i ever will.

what i find nonsensical are the following:

a. only recently did we stop training foreign doctors to go back to their countries after training here. we could have used those resources to train doctors for canada.
b. annually, there are canadian medical graduates that can't continue on to residency training because they don't match to a residency training program, and canada is seemingly ok with that.
c. in the case of bc, if i could complete my training, i would only ever practice in bc, but there is no route for me to complete my training in bc because there are never any openings in the 2nd carms match for family medicine in bc. i'm not a graduate of the current year in any year i apply so i can't participate in the first carms match which would have such opportunities. carms considers my canadian medical degree as no more valuable than a foreign medical degree, despite the fact that i would complete my training to practice in canada while the foreign grads would likely just leave canada when they complete the program.

i recognize that adding more doctors isn't the entire solution, but if it's at all a part of the solution, canada ( in particular the rural part of bc where i want to setup a practice ) is missing out on an opportunity in having at least myself complete a family residency, possibly others that are similarly marginalized.

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