I’ve written recently about the crisis in family practice: 1 in 5 British Columbians are not able to get a family doctor.
In a recent poll of British Columbians over 18 conducted on behalf of the BC College of Family Physicians, 40 percent of those who have a family doctor feared they would lose that doctor due to retirement or practice closures. Sixteen percent of respondents did not have a family doctor, two-thirds of whom reported they couldn’t find one and 19 percent said that their former family doctor had closed their practice.
This has significant implications for the well-being of all British Columbians.
As family physicians, we are advocates for our patients. Without a personal family doctor on your side, your healthcare is fractured. No single professional takes responsibility for helping you navigate the medical system to access the care you need when you need it.
Barbara Starfield’s international research demonstrated that patients provided with good primary care have lower care costs, improved access to appropriate healthcare and improved health outcomes.
Why is there a crisis in family practice?
A major factor is physician burnout.
Burnout is not a psychiatric diagnosis like depression. It is a syndrome of emotional exhaustion, depersonalization and reduced personal accomplishment resulting from chronic workplace stress.
Preliminary data from the Canadian Medical Association's National Physician Health Survey conducted in November 2021 shows more than half of physicians and medical learners (53%) have experienced high levels of burnout, compared to 30% in a similar survey in 2017. Nearly half (46%) of the Canadian physicians who responded considered reducing their clinical work in the next 24 months.
In an ideal world, the challenge of our work is matched by our capacity (time, ability and support) to meet that challenge; we are in a state of flow and functioning optimally. When our capacity exceeds the challenge, we are bored. When the challenge of our work far exceeds our resources for long periods of time, the result is burnout.
Why has the challenge of traditional family practice reached this breaking point?
Family practice has always been both challenging and personally gratifying. Where else can we use our knowledge, ability and humanity to help so many people over lifetimes? That’s what most of us signed up for.
But over the last two decades, our calling has been hampered by escalating stressors coming from many directions. Beyond the professional and personal satisfaction of our face-to-face time with patients, our time and energy are increasingly sapped by escalating demands and tasks.
Third parties, including insurance companies, patients’ employers, ICBC and accident lawyers, demand numerous forms and letters that take over our evening hours and weekends at home.
Though wonderful for proactive patient care, our EMR (electronic medical records) are not physician-friendly. Twenty years ago, the review of paper reports took me 20 minutes at the end of each day. I never needed to take a chart home. I get an endless stream of partial reports requiring summarizing and filing, requiring two to three hours each day with the computer.
Some specialists download their work onto family physicians. An example is the Special Authority forms required for our patients to get drug coverage from Pharmacare. Often, the original prescribing physician leaves that work for us. Pharmacists often tell the patient to ask us to apply for Special Authority even if the patient does not meet the criteria for those particular drugs.
Traditional family physicians are required to maintain standards not enforced for other physicians. Specialists can leave a message on their answering machine for patients to go to the emergency, and when they are on call, they are paid for those shifts. Traditional family physicians are required to be on call every evening, weekend, and holiday personally or with a group of colleagues, and we are not paid to do so.
Commercial enterprises (you see advertised on TV) offer free telehealth, taking advantage of this option through MSP. When a family physician uses telehealth, we are required by the College to be available to examine the patient in person when required. That requirement has not been enforced with Babylon and other telehealth businesses.
These companies — and some walk-in clinics — are allowed to bill the same fee that your traditional family physician bills for providing proactive, preventive care and the management of the multiple concerns a patient brings to each visit. In contrast, they only assist patients with a single problem over the phone or via video.
May 19th is BC Family Doctor Day. It has been marked as a day to recognize the work of the over 6000 family physicians across the province.
All community members are welcome to celebrate our Burnaby family physicians at an event hosted by the Burnaby Division of Family Practice from 6:00 to 7:30 pm at the Neighbourhood Church parking lot (formally Southside Community Church) at 7135 Walker Avenue (across from the Tommy Douglas Library).
It’s an opportunity to reflect on the commitment of my colleagues to their patients and community and learn more about primary care in Burnaby. We have over 370 Family Physicians working in our community, such as Community longitudinal family practices and clinics, Walk-in Clinics, Long-term Care settings, hospital, and the Urgent and Primary Care Clinic in the Edmonds neighbourhood.
You will meet other Burnaby family physicians and me, learn about how the Division of Family Practice is working to improve health services for the Burnaby community, and yes, there will be food.
For Burnaby residents without a family physician, there will be a registration table where you can sign up to be matched with a family physician.
If you’d like to share your appreciation for your Burnaby family physician by video, here is a virtual card where you can leave your message of thanks for Burnaby’s Family Physicians! Use this link to record or upload a video.
Dr. Davidicus Wong is a family physician. For more on achieving your positive potential in health, read his blog at davidicuswong.wordpress.com.