I'm fed up, and I can't take it anymore!

I went to pick up my daughter post-operatively at the hospital last year. All of the nurses were getting extra Covid-19 pay. None of the doctors were. I can’t take a vacation for more than a few days because there is virtually no availability of Locums, or they want more money than my overhead costs. It used to be a fair split. Not any longer. The College of Physicians and Surgeons of B.C. want us to be available 24-hours-a-day, seven-days-a-week, and to not look after patients from outside our community without having arranged coverage in their communities—in case they need to be seen. Fair enough. But the reason I still look after them from afar is because they can’t get anyone else to look after them. So, like so many College expectations, this one is unrealistic. I have patients in Nanaimo, Port Alberni, Kamloops, Abbotsford, Chilliwack and Vancouver. I can fire them as patients and leave them without a doctor because most can’t even get on a waitlist in their communities. Or I can do the best I can virtually and have them come to my office for an assessment when and if they can. I recently had a call from a patient in Newfoundland for a prescription renewal. He couldn’t get in to see a doctor and the local pharmacy said it would accept my prescription, even though I’m not licensed there. The province and local health authorities expect us to not only see our ill patients, but put ourselves and our families at risk to look after patients with influenza, SARS, Covid-19, etc., even though many of us are at high risk due to age and potential underlying health conditions. And for what? A nominal fee at best. Read: How UPCC are trying—but failing—to solve Victoria’s FP shortage and what locals are doing about it I have a great deal of respect and admiration for many of my specialist colleagues. But there are still those who think of family doctors as their clerks. They suggest we arrange tests for what they recommend, that we advise our patients of appointments that their staff could (and should) be doing. Then there are those who grace us with a consult letter six to 18 months after they see our patient, and often only when we go through the extra inconvenience of having to call their office to request it. Patients have no idea, for the most part, of what we are paid and what services we supply for our income. They have no idea that we may have to see up to 20 patients per day just to cover our overhead. They ask for a second specialist opinion and all the paperwork that goes along with that even before they get their first opinion. This requires time to redo a referral letter, copy all the relevant reports, etc. But to them it’s free because they are entitled to see who they wish. Plus, there is no fee for our time in doing all this extra work. Insurance companies want forms for orthotics, CPAP machine renewals, etc., but don’t want to pay for them. And if we don’t provide these forms, the patient is caught in the middle. We can’t bill for special authority forms, form G regarding psychiatric conditions, etc. Social services have somehow set their own fees for if and what they’ll pay but won’t honour the BCMA guide to fees. The Coroner’s office wants us to stop what we’re doing to answer their questions but refuses to pay for our time. And the list goes on and on. When patients transfer to another doctor and request a record review and transfer of records, we charge a nominal fee which is rarely paid. But the records are transferred anyway so as not to compromise continuity of care. That’s more work for free coupled with disrespect. We have to store records for 16 years after last seeing the patient, and after they reach the age of majority, at our own cost. And even if we die, our estate is still liable. Storage is just another cost of doing business. Celebrities, WCB, military, RCMP, and the wealthy get priority treatment one way or another. Yet we, the family doctor, have to plead with specialists to get what we feel is an urgent referral and are often put off. This only leaves emergency care, which may not be appropriate for our patient. The College of Family Practice of Canada is a political organization that does nothing for family doctors that our own family practice sections can’t do better and cheaper. College fees, which we are obligated to pay, are exorbitant for what we get in return. And they were talking about adding a third year of residency, which will make the shortage of family doctors even worse. I’m not aware of any advantage, except to the College, of that extra year of training. A recent letter to the editor of the British Columbia Medical Journal was bang on but only addressed a small part of the problem. Our fee for looking after an ill patient or doing preventive medicine is less than a hairstylist gets for a haircut. Included in that fee is all of the paperwork, which entails reviewing lab reports and following up, recording chart entries, writing referral letters and summarizing relevant reports so tests aren’t unnecessarily duplicated, reviewing consultant letters (if and when we get them), etc. Seniority doesn’t exist as a family doctor. There is no extra consideration for extra training or teaching. I get the same fee for service as a doctor who just graduated. What other profession works like that? Read: Why is one of Canada's most beautiful places steadily losing doctors? A hospitalist gets $1,500 per shift with no overhead and no long-term care responsibility. No wonder they are leaving family practice in droves. We have overhead of 35% to 40% with no guaranteed minimum income. We have no sick days, no paid holidays, and no young physicians looking to take over our practice. Right now, I’m off work as I have Covid-19, but my overhead is ongoing and I have no income coming in. The section of family practice can refer to us as “Specialists in Family Practice,” but no one else, including our colleagues, consider us specialists. What’s in a name? We certainly aren’t paid as specialists. So if you’re wondering why there is a shortage of family doctors, these are but a few of the reasons. I’ll leave the solutions to those representing us and the politicians who do the negotiating. What I care about is my family, my patients, my staff, my colleagues. I get up every day knowing I still have the best job in the world. I get to help people and get paid for it. But unless many of the issues I’ve addressed aren’t rectified, good luck attracting more family doctors. I am 74-years-old. I’m old, I’m tired, but I love what I do. I work hard to maintain my credentials and keep up with new developments in medicine and provide quality care. I am targeted with regular audits by the College of Physicians and Surgeons of BC because of my age (isn’t that contrary to the constitution?), but I accept that. I really have no choice. To date they’ve been satisfied with my performance, including chart reviews, patient and colleague reviews, etc. I hopefully have a few more years to practise. But unless the powers that be get their act together, I will be leaving behind many orphan patients adding to the almost one million people in B.C. who don’t have a family doctor. That will be really sad—for them and for me. Dr. Steve Shore has been a family doctor in Langley, B.C., since 1975, and is a clinical associate professor at the University of British Columbia. Read: More training: Canadian family medicine residency to expand to three years

I'm fed up, and I can't take it anymore!

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