The concerns of Drs Purkis [BCMJ 2001;43(2):71] and Toewes [BCMJ 2001;43(4):195] are certainly not exaggerated and I would not like to see them go unheeded. A little elaboration may be of help.
Urban general practice is now very rapidly coming to crisis stage. This may sound jaded in view of all the other daily cliches about “health care crisis” in the daily news, but it is now an absolute fact.
During the current year 2001, the number of family physician retirements in the New Westminster/Tri-Cities area has produced a critical number of orphaned patients. These unfortunate souls have been set loose, often with short notice by their ill, ageing, or burned-out physicians, and are frantically searching for a new family physician—in vain. There are no new physicians setting up in a traditional family practice. Why is this so? Here are some of the reasons:
• Brain drain.
• Practices are full.
• Retiring physicians can’t give away a practice—let alone sell it. As recently as 10 to 15 years ago a practice was a valuable asset, worth up to $100,000.
• No locums are available to spell us off. Of the very few locums available, many won’t assume full practice responsibility of on call and hospital duties. They are demanding a higher percentage of gross, and frequently demand a minimum guarantee.
• Even in a multi-practice physician’s office, because of full practices, it is difficult for the partners to cover the extra load.
• The locum pool is in full- or part-time practice in walk-in clinics—no stress, high volume, no on call, no difficult chronic illnesses, no nursing homes, no hospitals, minimal paperwork, no meetings in the hospitals.
Due to this, we can’t get time off.
We must make traditional family practice more attractive to the up and coming group of young physicians, as well as the incumbents. We must have a differential between us and the walk-in clinics. We have to get a premium for dealing with phone calls, on call, paper work, dealing with hospitals and nursing homes, and running an office. General practice needs to attract new physicians and retain the old.
—G. Kenefick, MB