Quiet resignation

I was pleased to read the editorial by JAW in the September issue of theBCMJ (2005;47[7]:344-350) entitled, “Who will be the gatekeeper?” It was a well-written, nostalgic, and accurate commentary on the current sad state of family medicine in British Columbia. The article truly reflects the atmosphere of quiet resignation that now pervades not only our association, but also affects many physicians who still hang onto their practices against all odds.

In our society, value is usually based on remuneration and at a professional consultation fee of $27.50, the general practitioner has come to accept that the service provided has almost no worth. Why bother to fight for something that is valueless? The problem is that this line of argument contrasts sharply with the reality that our patients believe our services to be very valuable and as physicians we know that we are making a huge contribution to their ongoing health care. This of course could all be attributed to misguided perceptions. However, an examination of the current literature which focused on the value of family practice revealed some interesting data and shed considerable light on this question. Starfield et al. wrote in Health Affairs March 2005, that the higher the rate of family docs to the population, the lower the hospitalization rates. An increase of one primary care MD per 100 000 persons was associated with a reduction of 35 deaths per 100 000 population. Stats Can has published recently that patients with no family doctor are 3.5 times more likely to end up in the ER. Diane Watson, UBC policy analyst, writes that longitudinal care results in better recognition, more appropriate use of specialized services (including emergency rooms), improved medication compliance, fewer physician visits, and lower medical costs among the general population. An article in the Annals of Internal Medicine in July 2005 states that hospitalization rates and expenditures for diabetes and congestive heart failure are higher in areas with fewer family physicians. Primary care physicians using fewer resources deliver care similar in quality to that of specialists for many conditions.

Canada now has the lowest number of doctors per person of any industrialized nation and even less than some developing countries. British Columbia is worse than most provinces in ensuring that citizens have access to a regular family doctor. An estimated 200000 people in the Lower Mainland can no longer find a general practitioner and many more will soon join that group. Family medicine in this province is valuable and is now facing extinction. This is a crisis. It is not appropriate that the message of quiet resignation should be the language of our association and journal. It does a great disservice to the citizens of this province who deserve much more. Surely it is time to speak out clearly and loudly. If not now, when?

—Michael Goldberger, MD
Burnaby