Why I quit hospital medicine

Issue: BCMJ, vol. 45, No. 2, March 2003, Pages 166-167 Letters

Whereas there is money to pay the hospitalist to see my patients but not the same money to pay me, their family doctor, for providing care to them.

Whereas there is money to pay another doctor to take my patient as an orphan patient but not the same money to pay me, their family doctor, for providing care to them.

Whereas there is money to pay specialists to be on call, above and beyond MSP, but no money to pay me, their family doctor, for being available or arranging 24-hour, 7-days-a-week coverage for my patients.

Whereas there is money to pay midwives for looking after uncomplicated obstetrics but not the same money to pay me, their family doctor, for providing low- to moderate-risk care 24-hours-a-day, 7-days-a-week or even an obstetrician/gynecologist for complicated care.

Whereas there is money to pay a walk-in clinic doctor the same money to see a patient for one problem but no more for the family doctor who cares for several of his or her patients’ problems at the same visit.

Whereas the majority of new graduates are working a civil servant shift and enjoying their time off, and by being on call—for free—I don’t have the same luxury for personal and family time.

Whereas patients go to a walk-in clinic and accept whatever doctor is assigned to them or when they end up in a hospital other than the one for which I have an appointment (you notice that I do not use the term privilege), in other words they do just fine without my personal provision of care.

Whereas the government of BC is looking with contempt at the doctors of BC in the form of breach of agreement and consideration of Quebec’s conscription legislation or something along similar lines.

Whereas hospitals are naming their medical staff in lawsuits as third-party participants, even if the patient isn’t suing the doctor, so as to lessen their insurance costs and payouts.

Whereas we instantly become liable for patients dumped on us by emergency physicians who can no longer be bothered to provide care for them once they have done the initial assessment and/or admission.

Whereas any hospital “privilege” to admit my patients almost always requires an okay by an emergency room physician who often has less training and experience than I do and doesn’t know my patients or their circumstances to the depth that I do.

Whereas RNs who complain against physicians have their complaints fully pursued aggressively, but if a physician complains about a nurse or other hospital staff the follow-up is whitewashed and there is never any reporting back of any action taken to the physician who lodged the complaint as the administration is afraid of the unions, patient care be damned.

Whereas the doctor with the hospital appointment is treated with less respect, more demands, and more abuse than ever before by hospital bureaucrats and staff.

Whereas a doctor with a hospital appointment is charged for parking to come to the hospital and provide care to his or her patients.

Whereas at my hospital the doctors no longer even have a secure place to hang their coats (we used to have lockers) or a secretary to sort out our mail (referral letters, etc.) or access to 24-hour-a-day food when we are up all night with a sick or laboring patient.

And for so many other reasons… I QUIT THE HOSPITAL!

After almost 28 years of providing or arranging 24-hour, 7-days-a-week care for my patients, teaching for almost 20 years at UBC (for free, of course), giving up countless nights’ sleep and family time to be on call and/or deliver babies, even when not on call, I feel less appreciated and more abused and taken for granted than ever.

We all used to work together, helping each other for the betterment of the patient. We all used to do call for free (fools that we were/are) and work with the same ethic. But the rules of the game have changed, I have no say in the changes, and I don’t want to play the game anymore.

I resent the BCMA for keeping us hanging in, stating that this will be the agreement that will keep full-time family practitioners in hospital when, in fact, it was an agreement for specialists. (I don’t resent them. I congratulate them for their accomplishment.) I resent that I feel guilty leaving the total care package for my patients. But I have served my time and many have left before me and many more, I am sure, will leave after me.

I run my office efficiently and without frustration and I don’t feel hard done by by the ever-changing system that takes advantage of and abuses full-time family practitioners. Life is so much better, even in the few weeks since I have quit hospital medicine. I will miss it. I will lose some income. But there is a price to pay for peace of mind and already it is worth every penny.

—Stephen M. Shore, MD

Stephen Shore, MD, CCFP. Why I quit hospital medicine. BCMJ, Vol. 45, No. 2, March, 2003, Page(s) 166-167 - Letters.

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