Dr Purkis’ concerns ("Please fix walk-in problem" [BCMJ 2001;43(2):71]) about the demise of general practice in White Rock are not exaggerated. Our communities of New Westminster and the Tri-Cities are witnessing a similar exit of family physicians from practice with no one to replace them.
Those of us brave or foolish enough to remain in our offices face a daily barrage of phone calls from orphaned patients begging us to take them in. What can be done?
I would like to propose three solutions:
1. Full-service family doctors must be compensated at a premium compared to walk-in physicians. Contrary to prevailing wisdom, it is possible to define a family physician: He is a doctor established at a fixed address who has implicitly contracted with his patients to provide them with medical services 7 days a week. This is done with the help of an answering service (not machine) and the assistance of colleagues to cover nights and weekends. He attends his patients in hospital unless there is a policy at the local hospital which keeps out family doctors, e.g., VGH.
Every patient knows the difference between a walk-in doctor and a family physician. Surely the fee schedule could define the difference as well.
2. Residency positions must be made available to those family physicians wishing to retrain as specialists. We will attract more doctors to family practice if they know that this is not a dead end. How many of us would have entered family practice or any other branch of medicine if we had known that it would preclude our future entry into another field? In my opinion, specialists with a background of practical experience in family practice will be happier, more committed, and more competent than those without such training.
3. If suggestions 1 or 2 don’t work, I would suggest lobbying the CRTC to pull ER from television and replace it with reruns of Marcus Welby MD. Now there was a real doctor.
There is not much time left to make changes. General practice as I knew it 10 years ago will cease to exist in the next 10 years unless action is taken immediately.
—B. Toews, MD
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