Doctor shortage

Issue: BCMJ, vol. 62, No. 2, March 2020, Page 48 Letters
By: Jonathan M. Winner, MD

The current family doctor shortage is a crisis. It is especially bad where I live, in Parksville on Vancouver Island. Why has the situation become so dire? In my opinion, it has happened because of gross incompetence at multiple levels of the medical profession and government. I am a retired family physician. I am a UK graduate. I was in full-time family practice in Alberta for 6 years and BC for 28 years before semi-retiring to Parksville in 2012, where I worked as a rural locum and urgent care physician part-time until I fully retired from practice in 2016, aged 69, after 46 years of medical practice. As far back as the late 1980s and early 1990s, it was well known that the average age of family physicians in BC was in the 50s. It was becoming clear to us practising family doctors that the family practice model we were all working in was becoming less attractive to the next generation of doctors, who were able to work in walk-in clinics, where they could see large numbers of people with relatively minor complaints and would not have to become involved with older patients with more chronic complaints, who require care on a more longitudinal basis. Since then, the Medical Services Plan has made changes to increase the payments for older patients with chronic conditions, which certainly helped, but none of the changes have turned the tide to attract more young physicians to enter full-time family practice. In the mid-2000s one of my partners tragically died in his early 60s of cancer. We were unable to find anybody to take over his extremely large practice consisting mainly of older patients. The only way I could not leave my own patients in the lurch when I retired from my practice was to move my charts and practice to a clinic that was a hybrid walk-in family practice, which took over all my charts so I could walk away.

I believe that action should have been taken over 20 years ago, which may have prevented the crisis we find ourselves in today. Full-service longitudinal family practice needs to become more attractive. Many young physicians do not relish the thought of running a small business, which means acquiring somewhere to develop a medical office, employing staff, ordering supplies, and paying a mortgage or rent, just to mention some of the expenses involved. It appears that many young physicians prefer to work under a different model, such as a salaried system with good benefits, vacation time, and paid continuing medical education in a team-based model with nurses, social workers, and other support workers under the same roof. This model has been shown to be successful in many parts of Canada.

The government and the profession must work harder to find ways to provide every citizen access to a local family physician. It does not appear that this is happening now. Clearly, inadequate numbers of family physicians are being trained, and the trained physicians are not coming to places like Parksville or Qualicum. It is difficult for young physicians who trained overseas to return to Canada, their home, to practise here. Canada is not providing enough places in medical schools to maintain the supply of physicians that the country requires, which is one of the reasons many young Canadians go overseas for their medical education.

Parksville is experiencing a building boom, and in a few years, there will be thousands more people living here. Who is going to look after all of us?
—Jonathan M. Winner, MD
Parksville

Jonathan M. Winner, MD. Doctor shortage. BCMJ, Vol. 62, No. 2, March, 2020, Page(s) 48 - Letters.


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robert brown says: reply

Johnathan Winner is correct in his critique. As I mentioned in my article last month in the Journal, the problem is being ignored by government, which has undervalued Family Medicine for decades. This problem has now come home to roost. New patients to the greater Victoria area will have a very difficult time finding a Family Physician. We have several people coming to our Sidney office every day pleading to be taken on and only to be turned away. We MUST be paid an adequate amount for our services such that we can be incentivized to stay in Family Medicine and organize the care which Canadians need and deserve.

abraham tio says: reply

i'm a canadian medical graduate living in bc. i chose not to complete residency training when i graduated so i could pursue other things.
i tried for 3 years starting in 2017 to re-enter the medical field, but was not granted any interviews across the many residency training programs across the country where i applied via carms.

i'd like to setup a family practice in bc, but it doesn't look like i ever will.

what i find nonsensical are the following:

a. only recently did we stop training foreign doctors to go back to their countries after training here. we could have used those resources to train doctors for canada.
b. annually, there are canadian medical graduates that can't continue on to residency training because they don't match to a residency training program, and canada is seemingly ok with that.
c. in the case of bc, if i could complete my training, i would only ever practice in bc, but there is no route for me to complete my training in bc because there are never any openings in the 2nd carms match for family medicine in bc. i'm not a graduate of the current year in any year i apply so i can't participate in the first carms match which would have such opportunities. carms considers my canadian medical degree as no more valuable than a foreign medical degree, despite the fact that i would complete my training to practice in canada while the foreign grads would likely just leave canada when they complete the program.

i recognize that adding more doctors isn't the entire solution, but if it's at all a part of the solution, canada ( in particular the rural part of bc where i want to setup a practice ) is missing out on an opportunity in having at least myself complete a family residency, possibly others that are similarly marginalized.

Yvonne Zarowny says: reply

The situation we are in in the Parksville/Qualicum Beach area is good compared to so many places in "rural' BC - and it is still inadequate. Surely we need to prioritize training doctors and nurses for BC as well as train foreign students to return to their own countries. The covid pandemic has made evident the desperate need for human contact ... and for citizens to have on-going contact with their primary physician. I was so very fortunate - my 'doctor of care' - once when my mother was visiting and had a medical 'crisis' - asked to see her as her situation was stressing me out impacting my health. With walk-in clinics there simply is not that caring relationship built up over time. Our model of health care needs to change ... so that all medical practicioners experience being valued and have the support they need to look after the rest of us. When I needed my upper arm and shoulder 'rebuilt' - the extremely good surgeon who took on the job was also the head of orthopaedic surgery in Nanaimo. One of my lasting impressions of this man is how excited he was about the new orthopaedic building going in as part of Nanaimo Regional ... as it would enable all the surgeons to be under one roof so they could more easily have team meetings to discuss approaches for patient care. I was very impressed that he was so excited about the realization of being able to be part of a team approach to patient care ... so not only would all the medical staff be supported as part of this team ... the patient would get the very best of what the team has to offer. We need to make changes ... lets ensure these changes are cost effective in that they support all the medical staff involved.

Jon Fisher says: reply

I had a GP when I first arrived in Victoria. Unfortunately she closed her practice.
It proved too much for her to keep her office running.
Rental overheads and a revolving door of secretary / receptionists
who, like GPs, move on because the salary so undercuts the level of dedication and set of professional skills required.
Several stresses leading to one big headache.

Now, I have to attempt to get through to walk-in clinics before fully booked for the day or try again tomorrow.
Exacerbated by Covid perhaps, but occurring well before it's arrival.

As a point of comparison, I've lived in the UK, France and the US, I've never experienced a medical system that creates barriers to prevent it's population from receiving basic medical care as in BC. In the US I had less difficulty finding medical treatment despite being an illegal alien for a major portion of my stay there (I entered as a student and overstayed), (plus my professional qualifications are not accepted in Canada either!).

GPs are the cornerstone of a healthy medical system. The first line of detection and diagnosis.
I'm astonished at the hoops one has to jump through to make a simple appointment for a walk-in clinic these days.
In a vibrant and wealthy a province as BC, Canada.

Like the retired doctor says, it's time to change an outdated model.

Jane Prystie says: reply

I am a registered nurse recently returned to Canada from the US.I graduated from Nursing school in Ontario and worked in Ontario Manitoba and BC before going south.It has taken me from February last year until this past November to regain my BC license.I understand the need to verify that I am a legitimate Healthcare worker.There is a nursing shortage as well as a doctor shortage.I am willing to work.I have 24 years experience in critical care and more recently community and Palliative care.When I apply for jobs I am told that they have chosen another candidate. Interesting...The more I see in the media about the current state of Healthcare and the increasingly hostile attitude toward people in Healthcare, the less interested I become.I could permanently retire as I approach seventy but I feel I still have more to give. The future of Healthcare in this country looks pretty bleak if changes aren't made, or , maybe it's too late.

Jesse H says: reply

2 years later, the situation has only worsened.
BC's Premier seems to be more interested in "foul language" than the issues we endure in this fouled system.
As a citizen born and raised in BC, I have been trying for years to obtain a GP without success.
It is overwhelming to speak about, how our provincial leaders consistently choose to be so careless toward its own citizens, especially when everyone in proximity to something healthcare-related has been desperately crying for change.

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