I am a family physician practising in Victoria. I sent this letter to Health Minister Adrian Dix.
I was born and raised in Victoria, completed my undergraduate and medical degrees in this province, and have been a practising family physician in this province for the past 16 years. I have also practised in the Northwest Territories, Alberta and Australia. I can say, with complete gravitas and no exaggeration, that I have never seen family medicine in such a state of crisis as it is right now in British Columbia.
We are at a crossroads. We can be complacent and allow the status quo to continue, which will end in the demise of family medicine, or we can pay attention to the family doctors of this province, who are pleading for change to salvage the high-quality medical care we have become used to receiving in B.C.
Ironically, just before sitting down to write this letter, I met with a colleague who is a specialist physician in Victoria. When I commented on the high rates of burnout and demoralization among family physicians in B.C., she looked startled, and exclaimed: “But family physicians are the underpinning of the medical system. Everything we do as specialists is predicated upon the knowledge that we can rely on family physicians to be the point person facilitating patients’ care. Our medical system would fail without family physicians.”
Family physicians are leaving practice in unprecedented numbers, often due to discouragement, frustration at inadequate compensation and burnout. New graduates are not choosing family medicine as a career because there are plenty of other options that are better remunerated, with no overhead or after-hours work. Never before have so many residents of British Columbia been without a family physician.
Studies have clearly shown that complex medical patients being attached to family physicians saves the health-care system thousands of dollars in annual health care costs when compared to those without a family physician. I have heard that, just across the border in Alberta, there are family physicians advertising for patients, and there is not the doctor shortage we are grappling with here. Why? Doctors in Alberta earn more, pay less tax and have a lower cost of living than doctors in B.C. As a new grad or someone planning for retirement, what would be the incentive to choose B.C. as a place to practise?
I took on a practice of about 1,500 patients from a retiring GP in September 2016. I regularly sit up most or all of the night trying to stay caught up with my chart notes, lab results and paperwork. As I write this at 1:42 a.m., I still have not finished my notes from today’s clinic. I will be lucky if I get two hours’ sleep before heading back to the office.
Am I earning any money for these “overtime” hours, in the wee hours of the night? Not a penny. I earn an income only when I am in direct patient contact. The fee I earn for an office consult does not take into account the number of medical issues we might address in that visit, nor does it account for the 10 to 30 minutes I will spend after hours arranging referrals, doing chart reviews or planning investigations for that patient.
Multiply that by the 20 to 40 patients I might see in a day, and the math simply doesn’t add up. I get paid for seeing patients for four to eight hours in my day, but make nothing for the minimum four to eight hours of additional work I will do before and after my clinic hours. Out of what I do earn I have to pay my staff and office overhead, plus put aside money for retirement planning, potential disability leave and medical expenses.
Doctors don’t earn pensions or have benefit plans provided to them, things much of the workforce in B.C. takes for granted. Family doctors are continuously being expected to keep more detailed notes for medico-legal reasons, and complete extensive insurance forms, all while maintaining the same number of patients seen.
Unlike private-sector businesses, which can pass on rising costs to the consumer, physicians are publicly funded by a set fee structure, and it would be considered unethical and against the Canada Health Act to try to recoup increased costs from our patients. Yet the government turns a blind eye as family physicians’ income is steadily eroded by such expenses, not increasing physicians’ fee structure or subsidizing the costs of running a medical practice to compensate.
Please listen to the family physicians of B.C. now, before it is too late. The Society of General Practitioners is a subset of a much larger group of primary-care physicians in this province, but I assure you, they speak for all of us.
I urge the government to heed their recommendations and make changes to family medicine in B.C., so that the entire population can continue to benefit from the excellent standard of medical care we have all come to enjoy. I fear for the future of B.C. residents if family medicine continues to disintegrate. When its underpinning crumbles, the entire health-care system can be expected to follow.
Dr. Jennifer Lush is a family physician in Victoria.
