Several days after reading Dr Jeff Purkis’ excellent letter in the BCMA Journal [Please fix walk-in problem. BCMJ 2001;43(2): 71], I had a discussion with a patient during the course of a visit that I thought would be illustrative and complementary to Dr Purkis’ letter.
While in the process of seeing a patient regarding low back pain, cervical myofascial pain, and depression, the patient proceeded to inquire as to whether I had yet found a replacement for my recently departed associate. I advised the patient that I had been unable to find a new associate and that it was unlikely that this would come about. When asked why, I responded that young medical practitioners were pursuing other areas of medicine in preference to family practice and that walk-in clinic medicine was much preferred by young practitioners because one can generate roughly the same income in less than half the time, with no requirement to provide after-hours coverage or ongoing hospital care for patients.
I then pointed out that I had seen her today and dealt with three separate complaints and would receive the same fee as a walk-in clinic physician would receive for a short 2-minute appointment with no ongoing responsibility required beyond the initial visit. The patient was aghast with disbelief. She had assumed that family practitioners were paid a significantly higher fee than the walk-in clinic physician.
Four years ago, at approximately the same time that Dr Purkis and other White Rock physicians had confronted the Section of General Practice regarding the walk-in clinic problem, I had also written the head of the section regarding this same issue. Regular readers may also recall a letter written by Dr Ian Cappon outlining a practical solution to this problem. No constructive response ensued as a result of these efforts.
In the Abbotsford area, we have over the past few years, lost, in my estimation, nine family practitioner equivalents with no replacements having been recruited. This situation, compounded by the acute shortage of locums and the significant increase in the intensity of the average visit, has accelerated the degree of job dissatisfaction and burnout in family practice.
Ongoing attrition of the family physician ranks cannot be attributed solely to demographics. The fee schedule for general practice must be revised, so that family physicians providing high-quality, high-intensity care for their patients are compensated adequately relative to the walk-in clinic physician who in most cases is not providing, nor can be expected to provide, the same level of care given the limited time allotted to the patient visit and the lack of continuity. Only then will we be able to attract young practitioners to a very necessary area of medicine. If this does not come about, family practice will continue to die a slow death.
—J.L. Cochlin, MD
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