Re: Valuing time and care

Issue: BCMJ, vol. 64, No. 8, October 2022, Pages 341-342 Letters

While getting a haircut recently (for a price higher than the $31 average family practice fee) I was thinking about Dr David Chapman’s editorial, “Valuing time and care” [BCMJ 2022;64:197].

My 40 years as a GP began in 1967. In those days, I would bill MSA $6 for an office visit. Gold was $30 an ounce, and a full hour of work on my car at a dealership was $5. Office overheads were easily manageable, and my secretary could handle the office (and billing) with a typewriter and a telephone. MSA would increase insurance premiums as necessary to cover costs.

Now, health care policy has made MSP payments to family physicians unrealistic, and overheads have become huge. To function properly, a family practice needs a secretary, nurse, and office manager. Their salaries come out of the undervalued payments to family physicians from MSP. Rents have skyrocketed, along with the many other overhead costs.

Recently, my plumber charged $266 for a 15-minute job that needed no new parts. Asked why, the answer was “overheads.” My car dealership attaches an hour-rated fee to each service item, with a charge of well over $100/hour.

Family practice is an expensive business, but paying for those costs is hamstrung by the inability to pass them on to the customer. They have to come out of the payments from MSP, which have become limited in such a way that they are akin to a salary, without the perks of payments for sickness, holidays, or a pension.

It is no wonder that new physicians are shunning this branch of medicine.
—Anthony Walter, MD

This letter was submitted in response to “Valuing time and care.”


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Anthony Walter, MD. Re: Valuing time and care. BCMJ, Vol. 64, No. 8, October, 2022, Page(s) 341-342 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Dr. Bob Holmes says: reply

I arrived in Prince Rupert in March 1966 with my (same) wife, three children, and a British Fellowship in General Surgery.
Those were the days when doctors were looking for patients. We had our phone numbers in the phone book, were available night and day, and made phone calls free of charge. Dr. Walter came to Kitimat a year later and I think an office "first visit" was more like $2 rather than $6; BUT the annual CMPA charge was unbelievably small, something like $50 per annum for all branches of medicine. The BCMA published an annual Schedule of MINIMUM fees, which is what most physicians charged, and which formed the basis of our modern fee schedule.
There was no fee for a vasectomy, which had been a routine procedure in England following retropubic prostatectomy to prevent post-op epididymo orchitis. The demand for vasectomy was considerable, and my Canadian guide, philosopher, and friend, the late great Dr.L.M.Greene (Toronto 1937) suggested $100, as our clinic had to provide all the equipment, sterilization etc. I suspect that the MSP do not pay much more than that now.
I ran a vasectomy clinic once a week and we soon had Americans flying down from Ketchican (no road) as it was cheaper than a vasectomy in Seattle. Our Canadian dollar was stronger than the American and we had to charge the Alaskans
$115 . They happily paid with cash from their back pocket.
I could go on much longer with this post but it is worth mentioning that all physician recruitment was done by physicians themselves in those days, - a great saving to the taxpayer. After I answered an advertisement in the British Medical Journal Dr.Greene flew to London and interviewed me at the hotel where he was staying, the very expensive Grosvenor Hotel in Park Lane. This speaks volumes for the situation of BC physicians fifty six years ago compared to their status today where patients are looking for doctors and not finding them.
Canadian health "care" is good for its vast bureaucracy but not for Canadian doctors, especially family doctors.

Leave a Reply