Doctor shortage creating care crisis

Without a family physician, the health of almost a million B.C. residents is at risk

British Columbians who have family doctors make good use of them, but those who don't avoid even trying to see physicians at walk-in clinics, a survey by the firm Leger shows.

The survey, exclusive to Postmedia, has troubling implications.

It found that 30 per cent of respondents didn't have a family physician. Almost half of those avoided seeking treatment at walkin clinics because of long waits.

By contrast, 81 per cent of those with family doctors see their physicians at least once a year, which “speaks to the divide between the haves and have-nots,” in B.C. health care, said Leger pollster Jason Allsopp. “That was the thing that really stood out to me.”

It's an alarming indicator for family physician Ramneek Dosanjh, who is keenly aware of B.C.'s shortage of primary care physicians.

“If we've got people that are now almost despondent and not seeking health care, even preventive health or maintenance care, that's concerning,” said Dosanjh, who is president of Doctors of B.C.

If people wait until they feel sick, they show up in hospital with more acute illness and diseases that have gone undetected, even cancer and heart disease, which has implications for the broader health system.

“And we know that people that are attached to a family doctor have better outcomes,” added Dosanjh. “That's worldwide data.”

Almost one million British Columbians are without a family doctor, and the Leger survey found many who do have a doctor fear they'll end up without one.

Some 43 per cent reported they're worried their doctor will leave their practice, while another 40 per cent fear their doctor will retire.

“That shortage is going to become even greater,” Allsopp said.

Leger did the survey online between May 6-8 with a panel of 1,000 British Columbians, weighted according to age, gender and region to obtain a representative sample.

Family medicine is still rewarding work, Dosanjh said, but comes with an increasing burden of administrative tasks and a feefor-service pay structure that hasn't kept up with increasingly complex conditions of aging patients, which leads to high levels of burnout.

Davidicus Wong, a general practitioner in Burnaby, said there has been a “huge explosion” in the amount of paperwork doctors are expected to do on top of the usual review of test results and renewal of prescriptions.

Insurance and WorkSafeBC forms have become lengthier and more complex. Even electronic health records, which work well for patients, are far from user friendly and take more time to navigate than a paper copy of test results, Wong said.

That adds hours to a Wong's work week, on top of seeing patients from 8:30 a.m. to 6 p.m.

“It's that administrative burden that's separate from running the practice that creates a really long week, like a 60- to 70-hour week,” Wong said.

“So, the amount of work is overwhelming and it's the alternatives for the (doctors) who are graduating,” Wong said, such as hospitalist work where doctors put in their shift and don't take any paperwork home. “They don't have to go into family practice.”

It would be helpful if the Health Ministry would work with family doctors to co-operate on building a sustainable team-care approach to primary care, according to Kelowna general practitioner Toye Oyeles. Instead, he said, the province is using scarce resources to build its own primary care centres, which he characterized as “glorified walk-in clinics.”

“Here's the Catch-22 point,” said Oyeles, president of B.C. Family Doctors. “If they don't change the circumstances under which we're practising, it doesn't matter who they're trying to replace us with, they're going to burn out.”

Subscriber exclusive: Vancouver Sun and Province subscribers and registered users of our websites are invited to attend an online Q&A session where columnist Daphne Bramham will interview Doctors of B.C. president Dr. Ramneek Dosanjh and president-elect Dr. Josh Greggai.

Watch your inbox for an invitation ahead of the event, which is scheduled for this Wednesday at noon.