Stop, collaborate, and listen

I was going to write this editorial as a rant, Rick Mercer style, regarding the woes of family medicine, but I think we are all aware of the ongoing crisis facing us by now. Then I considered writing a Kumbaya piece instead, but that would have been disingenuous. I settled on looking at how 2023 was a year of positive change for family medicine.

The Longitudinal Family Physician Payment Model[1] was introduced in early 2023. It promotes good medicine while providing some improved compensation, and it values the time we spend outside the clinic completing forms, tasks, charting, and administrative work. In 2024, the model is expanding to facility-based care, including inpatient, maternity, palliative, and long-term care. The model does not, however, change the intense workload and 24/7 obligations we face, and there are still not enough family physicians to do the work at hand. An estimated 1 million people in BC do not have a family physician. An article in the Vancouver Sun from 20 May 2023[2] discusses this shortage and informs us there are many family medicine residency spots in Canada that go unfilled every year.

There are also unoccupied long-term care beds in the province because there are not enough family physicians providing this type of care. While some of my family physician colleagues feel pressure to maintain the care of their patients when they are transferred to long-term care beds and short-term subacute care beds, transitioning from hospital to home, they feel overworked and undercompensated and do not have the capacity to provide this care. Perhaps the new incentives will revive some interest in long-term care and subacute care.

On a positive note, some family physicians who were on the verge of retiring have stayed in practice thanks to the new payment model, and this shift has been beneficial for family medicine.

Speaking with newer family physicians has revealed that many of them want flexibility and diversity without the burden of fiscal and administrative obligations attached to having a family practice. They also fear not being able to find coverage when they are away from their practices for some well-deserved rest and relaxation. Currently, most locums have a 70/30 or 80/20 split, which means they are financially compensated equally with longitudinal family physicians, and the split barely covers the cost of keeping the doors open. Why would newer family physicians take on that extra burden?

Despite these barriers, there are new graduates who are considering joining practices or taking over retiring physicians’ practices, and this newfound interest is largely due to the payment model. We are starting to see this trend in Kamloops.[3]

The terms general practitioner and just a GP are fading, and newer physicians want to be experts in family medicine and feel more valued. Many newer family physicians are pursuing this expertise in areas such as emergency medicine, rural medicine, maternity care, or hospitalist training.

I could go on regarding the issues facing family physicians, but we also need to discuss solutions. Many of the solutions need to come from the physicians entrenched in this predicament. To that end, what would make my life as a family physician easier is a common platform where family physicians, specialists, hospitalists, and long-term care physicians could communicate. It would be incredible if we all used the same EMR. The amount of time currently spent retrieving and communicating information is wasteful and inefficient for physicians and patients. Occasionally it will take a patient multiple visits involving several physicians in different locations to resolve one issue. This redundancy of services could be eliminated if we had one common, easily accessible, secure platform. I realize this is a multifaceted undertaking, and hopefully it is already in the works.

Let’s stop and reassess how we practise family medicine. Perhaps it’s time to collaborate and communicate with each other, with our divisions, and with our health authorities, rather than trying to carry the burden individually. The BCMJ is here to listen to your concerns, your successes, and your solutions and to advocate on your behalf by sharing your stories.
—Jeevyn K. Chahal, MD

hidden

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Government of British Columbia. Longitudinal Family Physician (LFP) Payment Model. Accessed 2 January 2024. www2.gov.bc.ca www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/msp/physicians/longitudinal-family-physician-lfp-payment-model.

2.    Culbert L. How UBC filled all of its family-medicine training spots to help B.C.’s doctor shortage. Vancouver Sun. Updated 21 May 2023. Accessed 2 January 2024. https://vancouversun.com/health/bc-training-186-new-family-doctors-in-effort-to-address-shortage.

3.    Kneeshaw D. One year after it was announced, new pay model for B.C. family physicians showing signs of success. CFJC Today. 1 November 2023. Accessed 2 January 2024. https://cfjctoday.com/2023/11/01/one-year-after-it-was-announced-new-pay-model-for-b-c-family-physicians-showing-signs-of-success.