When will they ever learn?

There has been a lot of press and commentary lately about the family medicine crisis in BC, and with good reason. As a full-service family physician, I and many of my colleagues feel this crisis on a daily basis. Although this editorial focuses on the family medicine crisis, I acknowledge that our specialist colleagues, in many cases, are also worried about the future of their disciplines.

As family physicians, we regularly navigate the health care system on behalf of our patients. Every day, I search the Pathways website to find specialists who will be able to see my patients in a timely fashion. It seems that specialists in certain disciplines are also leaving private practice for settings that do not involve them running an office with overhead costs. In my community, there are no psychiatrists in private practice. They all work in the hospital or mental health units funded by the health authority. There are fewer general internal medicine specialists in office-based practices in our community as well. They can be found working hard in our hospital CCU, medical wards, and outpatient clinics at our hospital. We no longer have an office-based dermatologist in our community. In fact, we have no dermatologist in our community, period.

Physician Master Agreement negotiations between Doctors of BC and the BC government are underway at the time of writing. I believe that the crisis in family medicine in BC is going to get much worse unless drastic measures are taken very soon. I have heard that the nurses’ and teachers’ unions are preparing to strike, which means that the BC government is having to look at the bigger picture. They need to look at the big picture of the health care needs of all their citizens, including their teachers and nurses, who all need family physicians.

Twenty-five years ago, the government introduced something called prorationing. When expenditures for medical services ran over budget, the government clawed back money from physicians. In response, the then–BC Medical Association introduced reduced activity days, where family doctors closed their offices, and anesthesiologists did not work on elective surgeries, effectively shutting down operating rooms on those days. There was public outcry, and eventually prorationing was stopped.

Twenty years ago, after agreeing to binding arbitration with doctors, the BC government passed a bill in the legislature to cancel the agreement, after a well-reasoned and fair judgment by a retired chief justice of the BC Supreme Court went in favor of doctors. Doctors were incensed, and gradually and increasingly withdrew services (does anybody remember education days?), until another agreement was reached. Today, doctors are again, in effect, withdrawing office-based family medicine services by going to work as hospitalists or UPCC physicians, or retiring earlier than planned, or just working less.

I hope that the government and Doctors of BC realize the magnitude of the problem and can come up with meaningful ways to solve it. I will leave you with a song, sung to the tune of “Where have all the flowers gone,” with apologies to Pete Seeger. In case you’re not familiar with the tune, here it is: https://youtu.be/bI3QVsW30j0.

Where have all the fam docs gone, long time passing?
Where have all the fam docs gone, long time ago?
Where have all the fam docs gone? Clinics picked them, every one.
When will they ever learn? When will they ever learn?

Where have all the clinic docs gone, long time passing?
Where have all the clinic docs gone, long time ago?
Where have all the clinic docs gone? Work in UPCCs, every one.
When will they ever learn? When will they ever learn?

Where have all the “oopsy” docs gone, long time passing?
Where have all the “oopsy” docs gone, long time ago?
Where have all the “oopsy” docs gone? Switched to hospitalists, every one.
When will they ever learn? When will they ever learn?

Where have all the hospitalists gone, long time passing?
Where have all the hospitalists gone, long time ago?
Where have all the hospitalists gone? Seeing orphaned patients, every one.
When will they ever learn? When will they ever learn?

Where have all the orphaned patients gone, long time passing?
Where have all the orphaned patients gone, long time ago?
Where have all the orphaned patients gone? Still looking for a fam doc, every one.
When will they ever learn? When will they ever learn?
—David Chapman, MBChB

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