Will family medicine survive?

Kudos to the BCMA and BC government for attracting 650 FPs to Vancouver for the joint symposium. Not only were the terms attractive but the importance of what is at stake well recognized.

There were several clear messages. There were some excellent, thought-provoking presentations, but the government’s representatives failed either to reassure or impress. While they may see the significance of family medicine, they gave no clue as to how it will be sustained.

I was puzzled as to why we heard two fine British FPs describe their achievements when British family medicine really does not apply here and never will without capitation. Most BC doctors do not want capitation. However, the British doctors clearly relayed that pay parity with specialists is what saved the GMS. The BCMA admits that past negotiations have left FPs well behind our specialist colleagues, although an explanation for this was not given.

At least we came away with some good ideas about improving practice. Electronic medical records, communicating well with our staff, employing RNs to their full capacity, and arranging to see today’s urgent calls today. However, I hope the BCMA and government heard that this is just too difficult at current remuneration and is not the career choice of enough new graduates. It does not help when a new graduate can earn as much in walk-in clinic medicine, with shorter hours and no on-call or ongoing responsibility. Despite being told at PQIDS, the BCMA chooses to overlook this critical issue. This is forcing many of us to offer less full-service family medicine and more short-visit urgent care medicine to compete and catch up financially. The results in the long term will be fewer FPs seeing more and more patients, for less intense care, with earlier referrals to the growing numbers of our specialist colleagues. But already specialists too decry this situation when they see how poor short-visit medicine can be and how difficult it is for a complex patient to have an FP with time to do the required, poorly paid work.

Despite this I remain a happy, still married FP and enjoy my work. I teach students every year and try to sow the seeds of good family medicine. Somehow we must solve the dilemma or we will all retire from a soon-to-be extinct group that was never adequately recognized or remunerated.

—Rick Potter-Cogan, CCFP, MICGP

Rick Potter-Cogan, MB BCh BAO. Will family medicine survive?. BCMJ, Vol. 47, No. 5, June, 2005, Page(s) 226 - Letters.

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