I completely agree with this insightful editorial [“Ah, the good ol’ days. Nary an orphan in sight.” BCMJ 2016:58(5):244]. Why are there orphans now when there were none in the past? UBC Medicine graduated approximately 50 doctors in the early to mid-1960s compared to close to 300 currently. That’s 5 to 6 times as many for a population that has increased only about 2.6 times, and the number of doctors in the province then (no orphans) was 1 for every 800 in the population, and now (a lot of orphans—200 000 with no FPs) is 1 for fewer than every 400. Doctors literally fought over patients in the past—some, so I’m told, were armed!
Heads of clinics in the Interior met uninvited incoming GPs at the rail station and told them to move on.
I agree that the solution is not clear, but the causes are, and it starts with the discontinuation of the rotating internship as was pointed out by an editorial in the Canadian Journal of Plastic Surgery some years ago. The outcome of a rotating internship was that 100%—everyone—was licensable to practise as a GP, which many did, most of whom would go into practice with a group or clinic and have hospital privileges (that being requirement to practise). Some would then go on to a specialty being better informed; many would stay as very competent GPs. Contrary to what the universities think, the experience of a neophyte GP in these circumstances was hugely educational, and the mentoring received by being in contact with many varied doctors was immense. Not formally a team, but it absolutely was.
This is in stark contrast to recent reports that 52% of graduates are now choosing general/family practice, clearly not something to be proud of.
The other causes, which include doctors and nurses no longer running the hospitals; the hostile environment of hospitals to GPs-FPs, as was pointed out by a previous president of Doctors of BC; administrators being not well-informed administrators and often, it seems, functioning for their own benefit, have contributed hugely to this current, hugely unfortunate, and clearly avoidable situation.
—Michael M. O’Brien, MD, FRCPC
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