My husband and I are getting ready to move back down south to the Regina/Moose Jaw area later this summer, which means I’ll have to find a family doctor again.
I haven’t really had a family doctor for 10 years. Up north, where I live now, in the Pierceland, Saskatchewan area, I’ve had a nurse practitioner for the past five years.
While living in Winnipeg, I went to a learning clinic for four years, seeing a variety of medical residents for my routine care.
But my sister and parents, who have remained in Regina over the same period, have also found themselves looking every several years for a new doctor, ever since our family doctor, which we saw for decades, retired.
Last summer, I was in the car with my mom, when she got a phone call from her latest doctor, saying she was closing her practice.
Having a long-term family doctor seems harder to come by and finding a family doctor in general is a problem across Canada.
Part of the problem is that family medicine doesn’t seem to be a popular choice amongst recent medical graduates.
For instance, in 2017, thirty-four of the 113 graduates at the University of Manitoba decided to go into family medicine. Six of those 34 went to northern and remote comminutes, while 12 went to rural areas.
Going into family medicine comes with the “burden of administration — hiring, billing, budgeting and reporting,” wrote Ken Fyke, former Saskatchewan deputy minister of Health, in an op-ed in the Victoria Times-Columnist last year.
He described the business side of family medicine a distraction from a doctor’s true calling, which is helping patients.
Furthermore, doctors receive a flat fee per patient, which encourages “volume rather than in-depth patient care.”
Recently, in Regina, Dr. Tomi Mitchell made headlines for deciding to quit her practice at the Pasqua South Medical Centre to focus more on consulting and her raising her two children.
She said the $30 per patient she receives isn’t adequate to cover her clinic costs, such as supplies and paying her administrative staff, in addition to paying herself a fair wage for her expertise. Some days she worked for less than minimum wage.
Tristin Hopper, a writer at the National Post, described the family doctor pay situation like this:
If a family doctor “spends five minutes telling a nine-year-old to stop picking his nose in order to stop the nosebleeds, she gets paid $30. If that same doctor has to spend a difficult 45 minutes with an elderly patient suffering from heart arrythmia and thoughts of suicide, she gets paid $30.”
Hopper said no other business would tolerate this sort of pay arrangement, writing that a mechanic wouldn’t except a flat $30 fee for a diagnostic check.
“Cracked windscreen? $30. A weird rattling sound where you have to dismantle the entire crankcase to figure out what’s wrong? $30.”
It wouldn’t work for a mechanic, so why should it work for a doctor, Hopper says.
Fyke wrote in his op-ed that trying to fit in as many patients into the workday to cover the bills isn’t ideal, especially as baby boomers age and face chronic diseases, like dementia, diabetes and mental-health disorders, which merit much more than five minutes of a doctor’s time.
“A physician visit of only a few minutes for the typical patient with complex needs is not acceptable for most physicians, and inadequate for people with multiple ailments,” Fyke wrote.
Technically, Canada currently has more doctors than ever, but as Hopper notes, they’re getting jobs at hospitals or as specialists so they can work normal hours, and not be buried in paperwork.
“They aren’t trying to pay down their student loans at $30 a pop minus expenses,” writes Hopper.
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Family doctors frustrated with the situation are starting to leave for better opportunities, in part to protect themselves from burnout.
Even before the pandemic, a 2019 survey conducted by the Saskatchewan Medical Association showed that 62 per cent of Saskatchewan doctors said they are at risk of burning out.
The reported level of burnout among Saskatchewan doctors was more than double what was reported nationally
Data from Saskatchewan’s Medical Services Branch shows that at the end of last March, there were 454 family doctors practising in Regina and Saskatoon — a decrease of 43 physicians, or 8.7 per cent, from the previous year.
The number of family doctors in rural areas was 235, a decrease of eight physicians, or 3.3 per cent.
During 2018-19, there were 982 active family doctors in Saskatchewan, but in 2020-21 that dropped to 900.
In Manitoba, back in 2017, the Interlake-Eastern Regional Health Authority, had 31 vacant family physician positions.
With 84 positions in the region, that was a vacancy rate of about 37 per cent.
Last fall, the area picked up nine new doctors.
Four of the nine are graduates of the University of Manitoba’s medical licensure program for international medical graduates. They have made a four-year commitment to the region and are centred in Ashern and Pine Falls, Manitoba.
Two other doctors completed their two-year residency program in the Interlake health region, while the other three did their residencies in rural and northern Manitoba through residency programs.
Some think the best way to increase the number of doctors in rural areas is to boost the training spots in these communities.
For instance, in Prince Albert, the hospital became a rural division of the University of Saskatchewan’s family medicine program. Students complete 16 months of a four-year program in Prince Albert.
I personally wouldn’t describe Prince Albert as rural, as it’s Saskatchewan’s third largest city… but the program has been successful.
Since it started in 1997, more than 80 per cent of its graduates have stayed in rural Saskatchewan.
In Manitoba, the University of Manitoba operates satellite programs for family medicine students in several communities, including Brandon and Dauphin in western Manitoba.
Even so, more than 90 per cent of Manitoba municipalities are reporting doctor shortages, according to the Association of Manitoba Municipalities. Each of these municipalities spend more than a million dollars annually on family doctor recruitment and retention, but, when it comes to recruiting, the solution may not just be about throwing money at the problem.
In a 2016 study, doctors didn’t list compensation as the reason they were working in a particular region. They chose their locations based on if it was close to family or if they liked the community. They also cited a job that allowed for work-life balance as important.
A 2019 Canadian Institute of Health Information report found that younger physicians of both genders are not working the same hours as previous generations of doctors because they want that work-life balance, and some female physicians leave the profession temporarily to raise children.
Even 20 years ago, one study I looked at found, at the turn of the century, family doctors aged 30 to 49 did 20 per cent fewer patient visits than doctors their same age did in 1991.
It’s been suggested that increasing the seats in Canadian medical schools could help increase the number of family doctors, but the universities would have to be able to have the teaching capacity, which is another challenge.
According to Fyke, short-term solutions could include increasing the fee per patient.
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