Work conditions have pushed us to brink: MDs

family doctor says he and his peers can no longer do double duty at ERs

A Montreal family physician says his health is suffering because of impossible work conditions.

He said he can no longer do double duty staffing an emergency room twice a week while also looking after his own patients adequately.

Increasing demands to staff the ER has left him about three days a week to look after 1,500 patients registered at his practice, said the veteran family physician, who asked that his name and the facilities where he works not be published for fear of reprisals.

The physician said he has reached a breaking point: It’s not possible to work more days and longer hours in his clinic because of his increasing ER shifts. “Now I’m burning out,” he said. “It’s with a heavy heart that I’ve decided to leave emergency room medicine,” said the doctor, who has 25 years of ER experience.

“I am not obliged to work the ER, I do it because I love it. But it’s a lot of pressure. I end up working late because I don’t want to turn people away.”

His predicament is not unique. At least five other family physicians have left his ER within the last 18 months, and some of them are going to staff the super clinics that Health Minister Gaétan Barrette has promised will relieve pressure on overburdened emergency rooms.

“It’s crazy,” the physician said. Nearly half of the physicians staffing Quebec’s emergency rooms also have duties as family physicians in public health clinics — family medicine group (GMF) clinics, network and super clinics — which have hours dedicated for walk-in patients.

Faced with ERs that are over capacity by up to 200 per cent, hospital administrators are looking for solutions — like adding more doctors for weekend and evening shifts. But employment is capped by the government, which issues a certain number of physician permits to a particular area and hospital. So the extra shifts are distributed among the same pool of doctors — the existing medical staff.

“Instead of five doctors per day, we are now seven. The problem is that we all have to work more as the health ministry will not allow the hospital to hire more doctors to staff the ER and our team is burning out,” said physician of working overnight shifts and weekends. At least half the people coming to the ER are vulnerable patients with complex, chronic health issues, including diabetes, lung and heart diseases, depression and autoimmune diseases, he said.

It’s not clear that the Barrette reform of turning existing clinics into super clinics has had the desired effect on the ERs. On Tuesday, several Montreal hospitals were reporting overcrowded conditions: Centre hospitalier de l’Université de Montréal (CHUM) was at 131 per cent capacity, St. Mary’s Hospital was at 155 per cent, the Lakeshore General Hospital was at 139 per cent, and the Jewish General Hospital was at 153 per cent.

Wait times in the province’s emergency rooms are the longest in the country and among the worst in the western world, according to a report made public in June showing that one in 10 patients leaves in frustration without seeing a doctor.

Critics have said Barrette is simply reshuffling the deck, adding resources in one area by cutting resources to another, said Paul Brunet, head of the Conseil pour la protection des malades, a provincial patients’ rights organization.

The physician said he feels as if he is being pulled in two directions. “If I don’t see my patients, they’ll be waiting somewhere (else) for God knows how long,” he said. Also, according to the Barrette reform, physicians must guarantee their own patients an attendance rate (“taux d’assiduité”) of at least 80 per cent, or face financial penalties.

Physician staffing in Montreal and Montérégie-area ERs is more problematic than ever, said Dr. Bernard Mathieu, president of the Montreal group of emergency room chiefs, La table des chefs d’urgence de Montréal. The average ER occupation rate swings between 120 and 150 per cent with spikes over 200 per cent, he said, whereas the norms call for an 80 per cent rate.

Imagine a plane with 60 extra passengers, or an elevator with triple the safe number of occupants, Mathieu said. That would never be tolerated, but that’s the situation in our hospitals, he added.

Under Bill 130, hospitals are not allowed to keep patients in ERs for longer than 24 hours; Bill 20 called on family doctors to take on more patients in their clinics or risk having their pay docked by up to 30 per cent. Doctors now must adhere to the “taux d’assiduité,” but that’s near impossible for those who cannot attend to their patients at their own clinics because they are staffing the short-staffed ERs, Mathieu said.

“We are short about 100 emergency room doctors in Quebec, and the worst shortage is in Montreal,” said Mathieu, whose group informed Barrette on March 21 that “the situation has reached dangerous levels.”

In the ER, if the wait is interminably long, Mathieu said, “it’s because there aren’t enough doctors on the floor.”