Where have all the family doctors gone?

Try to find a family doctor in BC and you will be sadly disappointed. Patients are now asking any specialist they see to help them with general medical issues, but specialists have neither the time nor the training to help. Nurse practitioners have a completely different skill set; they are not equipped to take over the role of a family physician. Where are the family doctors we were promised in the “A GP for Me” initiative? It hasn’t happened.

The following are but a few examples of the problem.

Linda Swain from Malahat wrote to the Times Colonist about access to urgent and primary care centres:

“Each UPCC is geographically based. To even apply to become a patient, two pieces of ID are required to prove residency within the established boundaries of each UPCC. And if the Westshore UPCC is anything to go by, this taxpayer-funded system is a dismal failure. I needed an X-ray requisition and dutifully arrived at 7:15 a.m. and lined up with 20 other people to wait for the 8 a.m. opening, only to be told at 8 a.m. that the facility was ‘at capacity’ because only one doctor had shown up for work that day! How can a sick person get the care they need when no one seems to care?”[1]

Since Swain wrote this letter, three more clinics in Victoria have closed. My own family physician, Dr G. Zabakolas, an excellent doctor, has quit.[2]

Consider a 93-year-old friend of mine who signed up to become a patient of the James Bay Urgent and Primary Care Centre 2 years ago. She still has no family physician. She never received an intake call.

Consider a young man who injured his neck and back in a motor vehicle accident. He waited at walk-in clinics and looked on Medimap for 4 days. No access. He eventually went to emergency and waited there for hours.

To emergency they go, for minor as well as major health issues. As a result, emergency rooms are overloaded. A Kamloops woman died in the waiting room of Royal Inland Hospital’s emergency department last September.[3]

In the past, the health care system worked because family physicians kept patients with minor ailments out of hospital emergency rooms. Serious medical issues were attended to expeditiously. What has happened?

Look no further than physician remuneration. Why do ophthalmologists make $1 000 000 per year and family physicians make $163 000 per year? Most other specialists make over $500 000 per year. Consider that overhead for a family physician’s office is 35% to 40% of gross income. Their net income is in the range of less than $100 000.[4]

Where can a family doctor make a better living? As a hospitalist. In the past 10 years, hospitals have been hiring family physicians to take care of complicated patients in the hospital. They are paid $240 000 to $280 000 per year, with no overhead costs. In Victoria, 72 family doctors have recently become hospitalists. In the Fraser Health region that number is 110. The population in Victoria, especially in the western communities, continues to grow but family doctors are getting out of the business as fast as they can.

Other family physicians are leaving practice to become surgical assistants or to practise virtual medicine. Others are taking early retirement or simply quitting from stress.[2]

Some are moving to other provinces. The average remuneration for family doctors in Ontario is $300 000; in Alberta it is $250  000 to $300 000. BC lags far behind.

The first step our government needs to take is to settle the unequal payments physicians receive, and they need to do it now.[5-7] The inequities in the medical funding model need to be addressed.[6] Only our provincial government can do this. The rest of Canada has tackled this problem with some success. BC needs to get on board.
—Suzanne Montemuro, MD, CCFP
Clinical Instructor, Faculty of Medicine, UBC

This letter endorsed by:

Darlene Hammell, MD, CCFP
Past President, College of Physicians and Surgeons of BC
Assistant Dean, Island Medical Program
Clinical Professor, Faculty of Medicine, UBC

Lorelei Johnson, MD, CCFP
Family Physician, Victoria

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References

1.    Swain L. A dismal failure of the medical system. Times Colonist [letters]. 24 July 2021. Accessed 7 March 2022. www.timescolonist.com/opinion/letters/letters-july-24-pros-and-cons-of-urgent-care-clinics-virus-puts-health-dollars-at-risk-4690889.

2.    Palmer V. NDP politicians yawn as doctors call it quits. Vancouver Sun. 27 January 2022. Accessed 7 March 2022. https://vancouversun.com/opinion/columnists/vaughn-palmer-ndp-politicians-yawn-as-doctors-call-it-quits.

3.    Brend Y. Death of 70-year-old waiting for care in BC emergency room to be reviewed, minister says. CBC News. 9 September 2021. Accessed 7 March 2022. www.cbc.ca/news/canada/british-columbia/70-year-old-patient-in-kamloops-emergency-room-1.6169654.

4.    BC Ministry of Health, Health Sector Information, Analysis and Reporting Division. Physician resource report 2011/2012–2020/2021. October 2021. Accessed 7 March 2022. www2.gov.bc.ca/assets/gov/health/practitioner-pro/medical-services-plan/msp_physician_resource_report_20112012_to_20202021.pdf.

5.    Corbella L. Canada’s health care system overrun by administrators and lacks doctors. Calgary Herald. 24 January 2022. Accessed 7 March 2022. https://calgaryherald.com/opinion/columnists/corbella-canadas-health-care-system-overrun-by-administrators-and-lacks-doctors.

6.    CBC News. Fee-for-service model is deterring aspiring family doctors from setting up practice: Report. 12 November 2021. Accessed 7 March 2022. www.cbc.ca/news/canada/british-columbia/fee-for-service-model-family-doctors-1.6247049.

7.    Change.org. Bring back our family doctors and our walk-in clinics [petition]. Accessed 7 March 2022. www.change.org/p/bring-back-our-family-doctors-and-our-walk-in-clinics.