B.C.’s family doctor shortage exacerbated by pandemic exhaustion, cost of living

After years of pandemic stress and a major exodus of retirement-age physicians, many in B.C.’s primary care sector are sounding the alarm over what they call a growing shortage of family doctors.

Dr. Rita McCracken, a family doctor and policy researcher in Vancouver, says the cracks in the system are now showing.

“The pressure of the pandemic came and what we’re seeing is that the people who were providing that primary care are retiring, or they’re going to do other work,” McCracken said.

She admits this isn’t a new issue for B.C.

“What’s different right now is that exhaustion … Family doctors have been saying for years, ‘We need a different system, we can’t keep working like this,'” she said.

McCracken has conducted several studies through UBC and the Centre for Health Evaluation & Outcome Sciences (CHÉOS) and spoken with doctors about what they need in order to stay in family medicine.

“Family physicians are still working very hard and they are choosing to work in environments that are sustainable, where they are also able to be human beings, oftentimes parents or providing care for elders just like anybody else in our society, and they want a job where they’re going to be able to work in a team, have a predictable source of income,” she said.

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Overwhelmingly, she says family physicians are saying they don’t want to run their own businesses.

“We are only paid in the fee-for-service system for the time that you spend literally in front of patients,” she said. “I think that family doctors get paid enough but what I think is a real problem, and we certainly see the literature supporting this, is that disconnect between the work that you have to do and the work that you get paid for. And so if somebody needs to work 60 or 70 hours a week and is only getting paid for 37 and a half hours a week. You can see very quickly that that can become frustrating and not very gratifying.”

She says to supplement their income, doctors are often turning to other avenues in medicine, like a focus practice or a subspecialty such as working in the E.R., palliative care, sports medicine, or addictions care, which also takes away from primary care hours.

McCracken says those who are close to retirement age — a demographic that makes up the bulk of family doctors in the province — are making the tough decision to leave their practice.

“There’s a story that millennial family doctors don’t work as hard or that they prioritize lifestyle and that is frankly not true … There was a study that my team did that showed that doctors who fall into that millennial category actually worked four more hours a week than any other category,” she said.

Doctors of BC President Dr. Ramneek Dosanjh says the association is working with the province to ensure recent changes, like telehealth, are embedded in family medicine and that there are more long-term solutions to address the current issues.

New payment talks initiated 

This is all coming as renegotiations are underway for the Physician Master Agreement, which expires on March 31. The agreement outlines the fees and services set by the government of B.C. and the Doctors of BC, which represents doctors’ interests in the public healthcare system.

The previous agreement stated the province would fund community-based offices to help doctors pay for lease or overhead costs. A Vancouver physician operating their own practice, for example, was allocated an additional maximum of $60 a day, and many say that the overhead costs are rising steadily.

“I also am a family doctor by training and one of the hardships of running your own practice is the amount of paperwork and the challenges of the infrastructure as it currently exists in this system,” Dosanjh said.

At least four clinics have been forced to close in recent months and many doctors across the province are also saying they may have to follow.

“This has been a crisis in Victoria and the South Island and other parts of the province and it’s something that has been exacerbated by the pandemic of course,” she said.

Province reevaluating primary care

The province has been working to help by creating dozens of primary care networks in the coming years, promising team-based care in several communities, primarily those in rural areas. Plus, the province also says it would create more choices for those who want to move away from the commonly used fee-for-service model and into other avenues.

But McCracken says unless the model moves away from doctors running their own business, people will choose other avenues.

“There’s very few of those and expansion of that model would be an excellent idea,” she said. “You can’t just put up a big box and say ‘this is our clinic and we’re going to be a community health center.’ There needs to be an appropriate consultation and inclusion of community members. But again, it is a very attractive employment model for family doctors. And we have good evidence that particularly for people with more complicated health needs, that they are able to get those health needs met and overall reduce costs to the system.”