Ask any random group of senior citizens about what’s on their minds and you’re sure to get an earful about the GP shortage.
“Many of our seniors at the centre, they speak about that a lot,” said Brenda Prevost, executive director of the Kamloops Centre for Seniors Information.
Thousands of residents in the southern Interior are without a family physician. While it can be a concern for anyone with health care needs, those needs almost invariably increase with age.
Even as the Thompson Division of Family Practice works to match more residents with general practitioners, many GPs are reaching retirement age. In some cases, seniors who have had the same family doctor for most of their lives find themselves high and dry at their time of greatest need.
“Doctors are retiring,” Prevost said. “Doctors are so specialized now. Most doctors at one time were family doctors and they could do a little bit of everything. To get your medical needs met, you now have to see five or six doctors. It’s very stressful.”
Starla White, a Brocklehurst senior, said she can’t imagine what it would be like to lose her family doctor after 30 years.
“That would be devastating,” she said.
Joyce Chuhaniuk didn’t have a family doctor for 22 years before she found one last year. Now that doctor has sold his clinic and she has yet to find another.
“I tried all over the place,” she said. “It’s not that I needed a doctor. I was told by my kids, ‘Get a check-up, Mom.’ They’re worried. I’m going to try to do that just in case.”
Larry Reynolds, a cancer survivor with diabetes, had only just received a call confirming he now has a family doctor after his previous GP retired. It was his GP, recognizing Reynolds has serious health issues, who found a replacement.
“I’d been checking online with the College of Physicians and Surgeons and there’s none,” Reynolds said. “Vernon had six (new doctors) and we had none.”
Giulio Leone has been without a GP since his doctor retired. He’d like to have a family doctor again but hasn’t been actively searching because he knows they’re in short supply.
“I’ve been going to a walk-in clinic but I’d rather have a family doctor. It’s pretty hard right now to find one.”
MEDICAL GRAD FORCED TO LEAVE
Brandon Mitchell, a medical graduate raised in Kamloops, would like nothing more than to fill a residency in his home town and eventually settle into a practice here.
Seniors’ health risk tends to be increased when they do not have a primary care physician, he said. He pointed to “polypharmacy,” where seniors seeing multiple specialists are placed on a variety of medications with no one managing overall care. GPs, obviously, gain a firmer handle on their patients’ medical history.
“It’s a mess,” Mitchell said. “If you have one doctor, they’re better able to co-ordinate care.”
Mitchell, 29, obtained his medical doctorate in Poland last year. He’s working as a server at a retirement home because he is unable to obtain a residency in Canada. His next best hope is to accepted into a residency in the U.S. And he knows of several peers who have had to take the same route.
“The problem is primarily about the very limited openings in Canada for post-graduate training,” he said. “You have to get a residency to carry on. Every doctor, no matter where you come from.
“In the U.S., everything is not tethered only to medical schools,” he said. “In Canada, everything is tied to medical schools. They have only so much capacity, money and resources available.”
Although many graduates prefer to go into specialist practices — they may have a specialty of interest — Mitchell is not one of them. He wants to become a general practitioner although hours can be longer. Many graduates face significant student debt, another reason they may opt for a specialty because there is more money to be earned.
“For me, I like to know a little bit about everything and I can feel very useful,” he said.
There are specialist as well as GP shortages. As a result of retirement, the Kamloops area is down to a single oncologist, he noted.
It’s difficult to understand why this state of affairs continues since exhaustive Royal Commission on the Future of Health Care in Canada was completed in 2002 and specifically addressed human resource shortages in health care.
The problem stems in part from a decision to reduce residencies by provincial health ministers in the 1990s based on a report that the system would lead to a surplus of doctors. As it turned out, the opposite occurred with significant shortages of doctors and the system trying to play catch-up ever since. The aging demographics, with many senior doctors approaching retirement, exacerbated the shortage.
As well, they erected “very tough” barriers for foreign-trained doctors wanting to set up practice in Canada, which has further compounded the problem. Mitchell has no problem with those barriers themselves.
“I’ve written the exams I need to write if you’re going to practice in Canada and I’ve done quite well with them.”
In this country, there are only about 400 residencies available for between 10,000 and 13,000 applicants. That total includes about 1,500-2,000 international medical graduates a year.
While he doesn’t think standards should be diluted to allow more international graduates to practice, he does point to one requirement that seems excessive. In order to remain in the running, he has to re-take an English as a second language exam every two years at a cost of $700 even though English is his principal language and has been for all of his 29 years.
“It is, actually, quite absurd,” he said. “It’s all the monopoly of the medical schools.”
There is another area where authorities could act but haven’t. While Canadian taxpayers subsidize their medical students to the tune of about $200,000 each, foreign students are sponsored by their home governments. But this ties up infrastructure that could be used for Canadian graduates, Mitchell said. Once foreign medical students graduate, they are free to return to their country of origin to practice if they so choose. Mitchell believes they should be required to stay in Canada for a period of practice and give back.
If the med school spaces provided to foreign students were allocated instead to Canadian students, it would similarly help ease the physician shortage.
“I am Canadian and therefore not qualified for this program.”
“Money is tight all around … There is money out there and if it could be used in a particular way to some advantage, then that’s an asset.”
WAY AND MEANS
In response to the persistent GP shortage, the Division of Family Practice established its GP For Me program in partnership with the B.C. Ministry of Health. Prominent among its goals is to ensure that every patient who wants a GP finds one.
A year into the program, it has found family doctors for almost 3,000 residents, but the gap will take a lot longer to fill, said Dr. Peter Loland.
“We’ve also been able to attract eight new doctors to the area, though not all are family doctors,” Loland said. Two took over family practices and one started a new family practice. Others are doing locum work or serving at RIH as hospitalists.
One of the seven focus areas of GP for Me is a residential care project, so there isn’t a specific program for seniors without family physicians.
“Certainly there are programs in place to work towards improving that.”
Other initiatives include succession planning, so that doctors nearing retirement can do so gradually while ensuring their patients continuity of care. The Family Practice Incubator is designed to allow recent medical school graduates to transition to full-time practice with the mentorship of experienced GPs.
Another remedy to the problem is in the test stage. It offers a dual advantage of assisting doctors confronted with overwhelming case loads, spreading out the workload to a degree.
“We’re piloting a nurse as practitioner, using nurses as extenders to help us see more people in a day.”
Some Thompson Division doctors have integrated nurses into their practices. They hope to expand this model. Nurses can provide counselling and support to patients who are dealing with chronic health issues.
Then there are the UBC medical graduates serving in the residency program at RIH. There is no assurance those grads will remain in Kamloops once ready to set up practice, though.
“We try to make it attractive,” Loland said. “That’s going to be a huge potential over the years. That’s probably our biggest hope. It’s all a work in progress, but it all takes time.”
And time may be limited. The GP For Me program officially ends less than a year from now and a number of projects are in the assessment phase.
“It’s still up in the air as to whether any of the programs will continue.
“For me and most of the division behind this, we’re less worried about the now. We want to make things better for our community in the long term.
The division is conducting an ongoing electronic survey on the family doctor issue and encourages feedback. Here’s the web address: https://surveys.divisionsbc.ca/AGPforMe.aspx.
There remain, however, qualified graduates who can answer the need yet remain sidelined by a system unable to fulfill demand for more GPs. There are no precise figures, but the number of people in Kamloops alone without family doctors has been estimated to be somewhere between 15,000 and 30,000. Many have tried in vain, using resources including the online registry at https://www.cpsbc.ca/physician_search, to find a GP.
“I just feel the playing field is not fair,” Mitchell said. “I’m not looking for government to spend tons more money, but to make better use of the money we have.
With his training, Mitchell is a reluctant critic of the system but feels changes are needed in the interest of patients.
“As a physician, I’m only supposed to advocate for patients. For me, this is advocating for my patients.”
Mel Rothenburger says:
August 8, 2015 08:54am
Thanks, Brandon, I've made a correction on subsidization.
roxanne Taylor says:
August 7, 2015 08:36pm
the local CBC news reported, One walk-in clinic in Surrey, Hilltop Medical, has posted signs after a story about the changes appeared in The Vancouver Sun two weeks ago. One of them states: “Due to new regulations with the College of Physicians and Surgeons we will no longer be able to see patients who are not registered with one of our family physicians. Our walk-in clinic will only see our own patients.” posted May 8 2015 by the Vancouver sun, "So we may not make the 2015 mark, but the work we've put in place as part of the GP For Me program is certainly having positive dividends. I do see us making good strides." However, the shortage of family doctors is growing. A backlog of 176,000 British Columbians looking for a family physician in 2010 has grown to more than 200,000. "It has actually got worse," said Dr. Martin Dawes, head of the department of family practice at the University of B.C. "But in that time, obviously, the population of the province has increased by a couple hundred thousand. This has to be a critical priority, yet it appears it's not! Who are we voting in the next election. Do you know what you are voting for?
Brandon Mitchell says:
August 7, 2015 11:58am
Mike, I just need to clarify something that was misunderstood in our interview! Above it is mentioned that international medical graduates are subsidized by the taxpayer to the tune of some $200,000, it is actually Canadian medical graduates who receive this subsidy, not international graduates! Those international graduates who are sponsored are sponsored via their home governments (example, Saudi Arabia, Kuwait etc). This program is tying up the infrastructure that could be used on graduates who are from Canada, and wish to remain in Canada. If communities could raise the funds to sponsor a qualified doctor (passing exams) through this program, that would be infrastructure better spent. My point was the subsidization of Canadian medical graduates by the taxpayers is a cost with no guarantee on return (having a Canadian medical graduate work where he/she is actually needed). That could be fixed, with the graduate working where they are needed for a period of time, or facing the entire burden and cost of their education by themselves. Thank-you for the chance to help get the message out to those in need of a physician! Brandon Mitchell