CHARBONNEAU – The shortage is of family practitioners, not doctors
CANADA HAS MORE doctors than ever before but fewer of us (including me) have a family doctor.
How can that be? What are they doing if not treating the 6.5 million Canadians without a doctor?
A recent study published in the Annals of Family Medicine journal confirms the trend. Even though the study is based on Ontario Health Insurance Plan billing, the results are the same across Canada.
Nationally, 40 per cent of doctors don’t treat those who are in of need medical attention.
It’s also true in Ontario where about 40 per cent of the 6,310 doctors who entered the physician work force since 1993 would rather do something else.
For them, family medicine is such a drag.
Family doctors work hard and earn less than the optional choices. They have staff and rent to pay; incur heavy business overhead and administrative costs.
Family doctors suffer from burnout with increasing paperwork and a heavier caseload that erodes work-life balance.
Medical students often view the specialties as more prestigious. Who wants to be “just” a family doctor?
Many doctors would rather have it easy with regular hours, paid vacation, and benefits.
They would rather be a hospitalist. That’s what my doctor did after he “retired.” I’ve seen him a few times in the ER at Royal Inland Hospital where he now works.
In addition to working in emergency departments, they chose addiction medicine clinics, palliative care and geriatrics.
Or they go in to cosmetic medicine, Botox, and Dermatology where there is no government billing but the profit margins are higher.
Others prefer Telemedicine and Virtual-Only Clinics which avoids physical overhead.
You would think that they would feel some sense of obligation, especially when their education is publically subsidised. To get some idea how much, compare what it costs for a student to graduate as a doctor in Canada compared to America.
After the cost of tuition, books, supplies and living expenses, it costs a Canadian doctor $120,000 to $200,000 CAD, depending on the medical school.
The total debt for an American doctor is $250,000 to $350,000 USD. And if you include the currency exchange, U.S. medical training can cost up to 2.5 times more than Canadian training.
Some provinces subsidize medical training more than others in order to retain doctors,
The tuition at McGill University in Quebec is less than one-half that of UBC.
In return for the lower tuition, Quebec obliges doctors to work where they are needed for two to four years. If they don’t, they can’t bill the province’s health insurer.
There must be a better way to attract doctors into to treating everyone.
The non-profit Kamloops society called STEPS is a promising model. They take care of the business of running a clinic and doctors do what they do best –practice medicine.
STEPS now has clinics in Valleyview, Nicola Avenue in downtown Kamloops, and another in Sun Peaks. They recently opened a new clinic in North Kamloops in the Cooper building where they expect 30,000 patient visits each year.
The difference is that the new North Kamloops clinic is funded by the B.C. government.
After years of being without a family doctor, maybe I’ll have one who is happy to treat me.
David Charbonneau is a retired TRU electronics instructor who hosts a blog at http://www.eyeviewkamloops.wordpress.com.
ArmchairMayor.ca 
For the layperson this seems like such an easy problem to solve in urban areas. I have long since wondered why doesn’t the gov’t set up and staff sites which would house multiple doctors as independent contractors who would run their own practices whilst sharing resources which would allow Drs. to spend more time with patients, where their expertise is, rather than with the daily minutiae of the business side, where they do not have the same expertise. To me, this just seems intuitively obvious, maybe this North Kamloops site is at the forefront of this change.
Additionally with the gov’t setting up “clinic like” GP sites this would significantly reduce the financial barriers young Drs. have when opening up a practice.
As far as the tuition, I don’t think we should be reducing the front end costs (tuition fees) but certainly the backend costs could be reduced. For example, matching loan payments post graduation for those who become GP’s and other likeminded incentives which we presently do a little of.
Lastly, it just seems stupid to me that the taxpayer spends hundreds of millions each yr on medical schools, subsidizing medical school students well in excess of $100,000 per student and then expect these graduates to payback student loans on average of $150,000 along with incurring greater debt opening up or purchasing an existing medical practice all whilst paying them less than we pay firefighters. No wonder we have so many of our best and brightest skipping medical school and opting for MBA’s with much more lucrative careers in finance.
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For years, Canadians didn’t need to debate user fees, extra-billing, or privatization, but recent challenges have forced discussions about health care sustainability. Privatization is often proposed as a fix, yet it’s a major problem. In 1995, federal cuts of $30 billion to provincial health care, combined with B.C.’s tax cuts, privatization, and outsourcing, doubled provincial debt, reducing funds for health care. Instead of reforming governance, budgeting, or care delivery, B.C. opted for user fees, privatization, and hospital closures, blaming an aging population and lack of privatization. However, aging adds only about 1% annually to costs, manageable in European systems that prioritize prevention and non-hospital care. Privatization increases costs, with private health expenses in Canada (over 30% of total costs) growing faster (e.g., medications at 7.5%, capital at 14%) than public costs (4.9% annually). Countries with less privatization deliver sustainable, high-quality care, showing public systems are more cost-effective. Health care sustainability depends on collective, non-partisan choices prioritizing human values over profit.
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