See responses to this letter: 1 [9], 2 [10], 3 [11]

I just returned home from my 4-hour shift in our walk-in clinic. As in many communities, our hospital-based GPs opened a walk-in several years ago to offset the effect of the other walk-ins that had opened locally. Today I worked from 9 a.m. until 1 p.m. I was home by 1:35 p.m. I saw 55 patients. At least 10 were 70 years or older. You do the math.

Four years ago our community GPs threatened en masse to withdraw from the BCMA if something was not done about walk-in payment inequities. We raised a few feathers and were visited by an entourage of BCMA and SGP representatives who politely explained to us why the problem "wasn’t so simple." We were told that it was hard to define what a walk-in clinic is; that there were lots of walk-ins doing ongoing care and lots of non walk-in GPs doing high-volume, low-intensity work.

As a direct result of the inability of our associations to correct this problem, we are now in a crisis mode in general practice. New grads prefer the easy-money, low-stress, short-hour work of walk-in clinics. Even in an attractive urban community like ours, there are no new GPs interested in practice. Locum relief is a constant stress and near impossibility. Extra stress and financial burden is added as we are forced to take holidays without locum relief. Some just don’t take holidays; I’m not sure which is worse.

Family physicians have been pushed to the limit and cracks are beginning to appear. Stress leave is up and record numbers are leaving practice; either heading south or changing to salaried positions or other less stressful alternatives. I personally know of eight GPs who have left their practices in the past year. They will not be returning. The stress will only increase as we are forced to act as gatekeepers for a crumbling medical system and have to deal with increasingly hostile "instant gratification oriented" baby-boomers.

The problem is really quite straightforward. My day starts at 7:30 a.m. and usually ends at 7 p.m. I see a few hospital patients (usually total care) followed by 35 to 40 office patients each day. I take regular and maternity call. My daily take-home pay is about the same as for my 4-hour shift today. My usual daily stress level is about 20 times that of today’s.

We asked you to fix this problem 4 years ago and little has happened. The 13100 has helped a bit, but the walk-in still gets a premium fee to see a 70-year-old’s runny nose. Recent increases in hospital visit fees are a tiny step in the right direction. For the sake of quality patient care, I am asking you to address this issue immediately and enough with the excuses. As I write this letter, I have one foot out of the general practice door, and I know from my discussions with colleagues that there are dozens if not hundreds right behind me.

—Jeff Purkis, MD
White Rock