Doctor shortage in B.C. is ‘going to get worse’
Demographic shift signals a wave of retirements, new study shows
Patients having trouble finding doctors or waiting too long to see specialists and get treatment haven’t seen anything yet, a study by B.C. researchers that was published Monday suggests.
About 40 per cent of B.C. doctors are at or near the average age that doctors retire: 65.1 years. The study in the Canadian Medical Association Journal shows 40 per cent of doctors reduce their workload at least 10 per cent in the three years before they retire.
The problem is particularly acute for patients who prefer female doctors or live in rural areas. Female physicians tend to retire four years before male doctors, and on average, rural doctors retire just over two years earlier.
“Early retirement in these communities is of particular concern, given that many rural areas are known to have substantial difficulties recruiting and retaining physicians,” says the team of authors from the University of B.C., Simon Fraser University and the Vancouver Coastal Health Research Institute.
Lead author Lindsay Hedden, a UBC researcher, said governments rely on College of Physicians and Surgeons licensing “head counts” but that may not be the most accurate method because many doctors keep their licences active as they wind down their practices.
“Our findings (based on billing data) indicate that current forecasts likely overestimate the supply of physicians that will be practising in the future and the amount of service they will provide,” she said.
The federally funded research shows since many doctors reduce workloads leading up to retirement and many retire slightly earlier, “it could make it more difficult for people to access care in the future, particularly in rural areas where the physician shortage already poses a significant challenge,” Hedden said.
Dr. Trina Larsen Soles, president of Doctors of B.C., said while it’s helpful to have fact-based data for workforce planning, she has reservations about the “implication” that female doctors aren’t “working our butts off.”
She said rural doctors in underserviced areas become exhausted because they frequently have to work nights and weekends on call.
“As well, while retiring doctors may curtail seeing patients, many still teach, take administrative jobs in health authorities, and work for the College of Physicians and Surgeons. They reinvent themselves in roles that still help the health system,” Larsen Soles said.
“Having said that, we do have a shortage of physicians and it’s going to get worse because of population demographics, and that means that we need to find ways of working differently so that doctors are freed up from clerical work so they can spend more time with patients.”
She added that she believes the government is “sincere” about its plans for team-based health care, making better use of people like nurse practitioners and social workers.
Hedden said while most doctors operate their practices as “business owners” within a fee-for-service model that sees them paid for each patient interaction, different models of payment may encourage more doctors to work longer.
“Having the option of more flexible models of practice, including (group or shared practices) and team-based models, may help retain physicians and reduce burnout,” she said.
“These options may also be more attractive to younger physicians.”
The study of physicians aged 50 and older in B.C. included data spanning six years and showed there were 4,572 physicians who were at least 50 as of March 2006 and had worked at least one year between 2006 and 2012. Retirement was defined as a permanent drop in taxpayer-funded payments to less than $20,000 a year.
The average age of retirement was 65.1 years. Women retired 4.1 years earlier on average and those working in rural areas retired 2.3 years early on average. There was no difference in retirement age by medical specialty.
Susan Prins, a spokeswoman for the College of Physicians and Surgeons of B.C., agreed there’s a critical problem because of retirements.
The college reports on the number of physicians who hold a licence, not how many are providing full services to patients. It requires registrants to self-report the total number of clinical hours they worked in the previous year on their annual licence renewal form to remain current.
According to college bylaws, a registrant must have practised clinically in his or her field for a minimum of 960 hours over a three-year period to be considered current.
Prins said the college has no jurisdiction over the supply and distribution of doctors — that’s the responsibility of government.
“It is true that many doctors are going to retire in the coming years, and that has been identified as a serious problem,” Prins said.
Prins said the college supports initiatives that help internationally trained family physicians obtain registration in B.C. if they meet criteria. She agreed with Larsen Soles that a more integrated health model including paramedics, nurses, nurse practitioners, midwives, physician assistants and others would help buffer the shortage of doctors.
“There are solutions,” she said, “but funding models need to change, and there needs to be a co-ordinated health human resources strategy to ensure appropriate distribution of physicians, nurses, nurse practitioners and other primary care providers to support an equitable, accessible health system.”