Ah, the good ol’ days. Nary an orphan in sight.

Many hospitals in BC are looking for ways to deal with unattached, or orphan, patients. These admitted patients fall into three categories: those who have a family physician who has privileges at another facility, those who have a family physician in the local community who doesn’t have any hospital affiliation, and those who just don’t have a family doctor. Years ago orphans were quite rare and fell almost exclusively into the first category. However, as walk-in clinics proliferated and general practitioners gave up their hospital privileges for a number of reasons—round/call obligations, committee work, etc.—the number of orphans in the other two categories blossomed.

Initially most hospitals relied on the good nature of those who remained by adopting some form of Doctor of the Day strategy where orphans were assigned to a privileged hospital family physician. I remember administrators in our hospital being very reluctant to remunerate those family physicians for their extra workload. It seemed expected that we would pony up and take all comers regardless of time and expense. I believe that family physicians should take care of our own, but should not take care of Dr X’s hospital patients while he works away in his clinic just down the road. Many overtures were made toward increasing payments for this added service but little was done. Therefore, the system eventually imploded due to the sheer numbers of unattached patients. This might have been avoided if more was offered to the gradually shrinking hospital-based GP workforce.

At this point well-funded hospitalist programs became the norm. Nothing against my hardworking hospitalist colleagues, but as time progressed the metrics (no idea what this is but always wanted to use the word) began to show that patients who were cared for by their own GP had shorter hospital stays. I guess there is value in knowing your patients’ intimate details and intricacies. I would like to congratulate you GPs for a job well done over the years.

There is a current move in our health region away from hospitalists, and the GPs have been approached to take over hospital care for orphan patients. I guess we proved our worth. A lot of resources have been offered to fund this initiative, such as money for nurse practitioners, administrative help, and even paid call. I think it is unlikely that busy GPs will leap at this chance even with the extra resources. We have enough of a challenge managing our own hospital and office patients; there is no capacity to do more. Another troubling issue is that with all these resources being directed toward caring for orphan patients, those patients who are cared for by their capable GPs are relegated to being second-class citizens.

I’m not sure what solution will be found to this challenging problem, but I can’t help but long for the good ol’ days. If every family physician worked in a solo or group practice, took care of their own patients, and had an affiliation with their community hospital, most of the population would have a GP, and orphans would again be a rarity.
—DRR