Is there a doctor nearby?

Anne Johnson always cherished the peace of mind that came with having an excellent family doctor. Over the years, the two had developed a mutually satisfactory relationship. Her doctor knew and understood Johnson’s health needs and she was comfortable with him, trusting his diagnoses and treatments. And whenever she needed medical attention, she didn’t have to queue up for an appointment.But this all changed when Johnson moved. What she thought would be an easy quest to find a new family doctor has become a series of false starts and dead ends, culminating in her resorting to emergency and walk-in clinics for basic care.

Her experience has brought her to a troubling conclusion, perplexing in a country as rich as ours: “There seems to be no family physicians willing to take on new patients,” she says.

Doctor shortage
Patients, doctors and government representatives will all agree there’s a very real shortage of family physicians in Canada. And though not yet at a crisis level, the doctor dearth is affecting many across the country.

A 1999 Angus Reid survey showed that 45 per cent of Canadians felt there were insufficient numbersf physicians in their community.

Even doctors are worried. A recent Canadian Medical Association survey showed that six out of 10 physicians feel there aren’t enough doctors to maintain high quality care.

More surprising, the shortage has now gone from a rural crisis to an urban phenomenon. Toronto, hitherto a mecca for physicians starting out, was recently identified as being an area under-serviced by family doctors.

Be persistent
Nowadays, you’ve got to be persistent and pushy to get what you need from our healthcare system. Make some noise and you’ll probably get that extra attention from your doctor. However, many older Canadians find this strategy distasteful and so, rather than making a scene, in many cases they’ll quietly avoid seeking medical attention until their conditions reach a stage where the doctor must be seen.
How did we into this alarming state? Many factors are involved.

  • Many doctors are getting to the age where they are hanging up their stethoscopes and calling it a day.
  • Many of the new generation of doctors are either limiting their workloads or focusing their practices on specialty services (sports medicine, gynecology) at the expense of comprehensive care.

Fewer trained
The shortage has been further exacerbated by a disastrous 1990’s policy that saw provinces eliminate 10 per cent of first-year positions in medical schools as a means of controlling health costs. Doing so, they refused to heed the obvious warnings from the healthcare community-continue this policy and you’ll soon have a doctor shortage on your hands.

Fast forward a decade to 2001 and here we are trying to cope with a doctor-to-population ratio that has been in steady decline for most of the ’90s.

To compound the problem, we’re all living longer. This means we’re contracting more diseases, with more complications requiring more primary and follow-up care. The medical attention these cases require is considerable and the responsibility falls on the shoulders of our family doctors, putting a tremendous strain on our limited physician resources.

No continuity
Canadians in Anne Johnson’s age group are worst hit by the shortage. When she finally settled on a family doctor, she found him so young and inexperienced that he wasn’t able to give her the full medical attention a woman in her 50s needs.

“He’s well skilled and enthusiastic but his caseload is so heavy,” she says. “He isn’t able to focus on my needs or those of his other older patients.”  And attempts to find another doctor who could give her more time have been fruitless. “Are you kidding?” she asks. “There aren’t any available.”

Even if you do have a family physician, your problems aren’t over. What happens if your doctor is nearing retirement age, you decide to move to a different area or you’re simply not getting along with your current physician?

Get ready to put in some legwork. Finding a replacement won’t be as simple as opening up the Yellow Pages. Beyond the inconvenience a prolonged search poses, there’s also the threat to your health. We’ll never go without care-hospital emergency and walk-in clinics will treat those who can’t find a doctor. But without the benefit of a doctor who knows our health histories and can provide some continuity to our treatment, we’re settling for sub-par health care.

Worse hit
Anne Johnson’s case is made more noteworthy by the fact she lives in a large and prosperous community near a large urban centre. Small towns and rural areas in Canada are in much worse shape according to Dr. Galt Wilson, a 46-year-old family doctor in Prince George, British Columbia, a town of 80,000 in the northern interior.

“We’re constantly recruiting family physicians up here,” he says, noting that even an attractive package of financial incentives isn’t enough to encourage younger doctors to shift their sights toward small-town Canada.

“Climate and isolation are the two major factors that work against smaller or remote communities here,” claims Dr. Wilson. “Doctors prefer the weather in Vancouver or Victoria plus they feel they’ll miss out on opportunities for continuing education when they practice outside major centres.”

Local training
Realizing the local doctor shortage wasn’t going to right itself, Dr. Wilson developed a local family practice training program affiliated with University of British Columbia. The program trains medical students in Prince George-the theory is they’ll stay there after graduation to practice.

Over the years the program has graduated 30 family doctors, ten who practice in the Prince George region and the rest in small towns scattered throughout the B.C. interior. Still, it’s not enough.

Like many doctors across the country, Dr. Wilson’s practice is so packed and he’s worried he doesn’t have the necessary time to spend with his older patients. On top of his casework, there’s an office to manage, endless paperwork, conferences to attend, credentials to update not to mention the family time he would like to devote to his wife and three girls.

Overworked doctors
“A stressed-out and overworked physician workforce doesn’t benefit anyone,” says Dr. Claude Renaud, Director of Professional Affairs of the College of Family Physicians of Canada.

“Especially older Canadians, who have more complex medical needs that require more primary and follow-up care,” he says, noting that they’re the ones whose medical needs suffer the most because of the thinly stretched workforce.

Dr. Renaud feels the immediate problem is being addressed by once again increasing enrolment at medical schools, as well as upping the number of positions for foreign-trained doctors. But these quick-fix measures don’t go far enough.

Part of the problem is how doctors get paid, a fee-for-service model, which rewards them on the number of patients they see. Hence the short visits-more patients per day means an increased bottom line.

Some alternatives
“Fee-for-service works in certain settings,” says Dr. Renaud but admits it puts limits the amount of time physicians can give older patients. “We’re looking at alternatives to the current payment scheme that would encourage family practitioners to deliver specific care (for older patients) without sacrificing their earning potential.”

The College is also advocating the concept of the Family Practice Network. This is a multi-disciplinary clinic where doctors could share their current workload with other healthcare providers, including nurse practitioners, therapists, palliative care specialists and social workers.

But change isn’t always fast coming and, according to Dr. Renaud, it will take a number of years before the doctor shortage is rectified. Until then, those affected must get used to less than satisfactory health care and cross our fingers that, in the long run, it doesn’t have too pronounced an effect on our health.