Finding a family physician

Coming home from the short vacation between the third and fourth year of medical school, I found myself quite ill with a paroxysmal cough that induced a few episodes of post-tussive vomiting. I was just starting an elective in medical microbiology, and in a classic case of medical student hypochondria, I began to wonder whether, during my travels abroad, I had acquired pertussis. It certainly had been more than a decade since my last DTaP booster. Never had I a cough this bad before. Fully aware of the admonishment “physician heal thyself,” a jibe towards the medical profession so old that even in the Bible it was already known as a proverb, I longed to seek medical care from my family physician.

The only problem was that my FP had retired several years ago. Luckily, I had never needed to seek medical attention since then. When his office closed, with no one willing to take on his complete practice, my medical file had been shipped off to a walk-in clinic, on the far side of town, under the name of a doctor who I had never met before. My father since had the occasion to visit the walk-in clinic and complained that he never seemed to be able to see the same doctor twice and that the pace of this new walk-in clinic was far more hurried than that of our old FP. Luckily, after our doc’s retirement, a friend referred the female members of my family to an FP, one from whom they have been receiving excellent care. Unfortunately for my father and me, this doctor did not accept male patients.

Several reasons now drove my own search for a “proper, old fashioned FP” (i.e., someone who I thought would provide continuity of care, anticipate future health problems, and provide a good strategy for preventive care). I was motivated by my current ill-feeling state and my father’s need for an FP. Also, I would be getting married next year and starting a family of my own. We all would need an FP to see us through the years. I thought, “What better time to get it organized than now?” Unfortunately, none of the great docs I had met in the last few years were taking any new patients. Naturally, I started my search at the BC College of Physicians and Surgeons web site listing Physicians Accepting New Patients.[1] During clinical clerkships, I had often directed patients to the same list.

With an eye to the future, I scanned the list for an FP that was reasonably close. After calling five of the nearest offices and finding that they were all no longer taking new patients, I became mildly frustrated. Out of frustrated curiosity, I called another 30 or so Vancouver offices on the list. I found that roughly half of the offices listed were no longer taking patients. Although the sampling technique was hardly scientific, one would still expect that the physicians on a “Physicians Accepting New Patients” list would in fact do as advertised.

Some of the offices accepting patients were doing so conditionally. “Only accepting new pregnant patients? Oops, not me, sorry, thank you, I’ll try another office.” “I have to apply and be approved before I can make an appointment?” A recent article examined the workloads of family physicians in Winnipeg.[2] Although they found that the rates of family practitioner use over the years were stable, they suggested that the answer to the public perception of inadequacy in FP supply “may lie in the relatively new phenomenon of family practice being closed or restricted in accepting new patients.” It certainly seemed to be a factor with my current experience. The data showed that in 2000–2001, physicians aged between 30–49 provided roughly 20% less patient visits a year than their same-aged peers did a decade prior. The paper subtly suggested that these FPs may also be the ones most likely to limit their practices, a trend that will probably continue when my generation is out practising.

Regardless of the reasons for limiting practices and opting to see fewer patients per year, the result is that patient choice becomes limited. In the current climate, it seemed challenging enough to find any FP, let alone having the choice of an FP whose practice style fit my family and me. If patients were buyers, it certainly was a seller’s market. Recognizing the importance of having an FP, my simple goals in writing this letter were to gain some empathy for those patients still seeking an FP and also to prompt the BC College of Physicians and Surgeons to find a more effective way of connecting patients to an FP. The College should not rely on already busy physicians to keep the College informed of their office’s current status on accepting new patients. The list on the web site is supposed to be a public resource and thus one which the College should be more actively keeping up to date. Perhaps this relatively small effort would help increase patient access to FPs.

—Miguel Imperial
UBC Medical Student
Class of 2005

The College responds

The College applauds Mr Imperial for attempting to find a family physician through the usual channels available to the public. That he had significant problems, made numerous telephone calls, and was ultimately not successful comes as no surprise to the College or any of its practising members. Many hundreds of thousands of BC residents cannot find a family doctor. Mr Imperial has walked the proverbial mile in these people’s moccasins.

Mr Imperial has unfortunately misunderstood the College’s mandate to serve and protect the public, which is different from being an individual patient advocate. Among its many duties, the College is responsible for setting standards of education and qualifications for registration of members. The College also establishes standards of practice and strives to reduce incompetent, impaired, or unethical practice amongst its members. Furthermore, the College has the authority to discipline members or remove them from practice if needed, based on the principle of public interest.

Historically, the British Columbia Medical Association, in addition to its role as representative of its members, has acted as the patient advocate and has a long track record of successful health care promotion and disease prevention initiatives. Both federally and provincially, medical associations have been ringing the alarm bells of the health human resources that currently exist and will only grow over the next decade. Acknowledging and correcting the reality of the physician shortages is not the purview of regulatory authorities, other than identifying the problem.

The College of Physicians and Surgeons of British Columbia does, on a courtesy basis, offer general practitioners the opportunity to use the College web site to list their practices as accepting new patients. This list is updated either during the annual fee process, which includes a questionnaire, or if the physician personally contacts the College. The College does respond to telephone inquiries from the public and will use this same list to offer patients information regarding practices accepting new patients. The College does not verify the accuracy of this list or attempt to facilitate patients’ access to a particular physician.

Mr Imperial’s correspondence does raise a care concern. He was unable to access a family doctor, as many residents of BC have experienced. The reality is the health system has, for a variety of reasons, produced a lack of adequate physician resources with resulting difficult access to primary care.

The question is: Who does have the responsibility for connecting patients with a family physician?

—Heidi Oetter, MD
Deputy Registrar, 
College of Physicians and Surgeons of British Columbia

References

1. Physicians Accepting New Patients. Vancouver (BC); The College of Physicians and Surgeons of British Columbia. www.cpsbc.ca/patient/accepting/AcceptIndex.htm (accessed 26 September 2004).
2. Watson DE, Katz A, Reid RJ, et al. Family physician workloads and access to care in Winnipeg: 1991 to 2001. CMAJ 2004;171:339-342. PubMed Abstract Full Text