Re: The crisis facing family practice

I read with considerable sympathy Dr Manes’ letter (BCMJ 2004;[4]:168-169). Later in the day I read the two-page spread in the Vancouver Sun (28 May 2004) entitled “Family Doctors Squeezed Out,” which detailed the same glaring problem. It is a problem which must be addressed without delay.

Many years ago this Winnipeg native, during a visit to the old hometown, took a nostalgic stroll through Eaton’s store (R.I.P.). I was alarmed to find within that familiar building something I had never before encountered—a walk-in clinic! On my return to Vancouver, I wrote letters to the MSPBC and the BCMA suggesting a course of action which I shall describe later herein.

An old English adage advises that “what you lose on the swings you will get back on the roundabouts.” But that is rather unlikely if someone else (the walk-in clinics) occupies the roundabouts. The walk-in clinics are cream skimmers that leave the difficult curds and whey for the family doctors to digest. Many frustrated family doctors are defecting and entering the ranks of the walk-in clinics. (If you can’t lick ‘em, join ‘em.) Both groups receive the same per-visit remuneration. This is ridiculously unfair.

I would like to assure Dr Manes that many specialists, myself included, harbor no misperception of family practice. I always regarded family practice as being too difficult for me. Any sensible specialist attends a GP for self and family care and any reasonable specialist favors adequate remuneration for GP services.

Many solutions to the problem have been suggested including increasing medical school enrollment, increasing the availability of family practice residencies, and increasing teaching by family physicians. All would be reasonable measures. But to strike at the heart of the problem I would suggest now (as I did many years ago to the MSPBC and the BCMA) that without further delay walk-in clinic per visit fees be reduced significantly and that the money saved be used to prop up the per visit fees of family doctors. Simplistic yes! Effective?

—A.M. Krisman, MD
Vancouver