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
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