A Fond Farewell
By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.
A modified version of this article was printed in the June 4
The Mississauga News under the feature: Health & Wellness, Doctor's Corner.
It probably is not worthy of headline news, but April was a month that thousands of Mississauga residents were sent searching for a new doctor as four more primary care physicians quietly closed their practices and went on to do something else. I ran out of fingers trying to calculate how many Peel doctors have burned out or retired in the last year alone. What is really of concern is the paucity of reliable up to date data that looks at the trends. Most bean counters divide doctors into two groups, primary care and specialist. No one has any idea of how many primary care doctors vs. walk-in clinics, full-service vs. part-time, etc there exist in our region. The picture gets very confusing. A full-time primary care physician is difficult to define, but a loose definition would include someone who does prenatal care, well-baby care, full physicals, PAP-tests arranges consults and tests, keeps detailed records and fills out those growing piles of forms and whose patients are seen in the office on a regular basis. These creatures are disappearing from our landscape without leaving many tracks or skeletons.
The impersonal nature of living in a city hides the evidence. I contacted some of these docs to gain some insight. Not one was going to the U.S. and no one was retiring either. The underlying theme is a loss of self-esteem and satisfaction in performing their calling. They simply feel that their training is under-utilized. All cite extreme dissatisfaction with how their local hospitals are run and administered. Government bureaucracy is another touchy point. Most interestingly was a feeling of helplessness and gridlock within the system when dealing with patients’ medical problems. Being talented and highly trained physicians they all found rewarding endeavors outside the realms of OHIP.
This worries me a great deal. In the early 1990’s it was a common sight to encounter several dozen family doctors every morning busily at work in local hospitals. They would be looking after their own admitted patients, delivering babies, assisting at surgery, staffing emergency departments, sitting on committees, doing minor surgeries, reviewing results and lending support. A decade later, they have largely disappeared from the hospital scene. This has occurred in large numbers. To get an idea of how many have left, I tried to use an old staff directory from a local hospital and lost count at 70. Some functions have been taken over by salaried part-timers, while other things just do without. The interesting thing is that warning bells have never really been sounded. Administrators never saw it as a problem in need of addressing, or felt it was due to circumstances beyond their control. Local health departments are not mandated with tracking and dealing with physician service shortages either. The District Health Council did look at it briefly and confirmed a shortage, but used it as a rallying point to blindly pour money into “regional” healthcare. Calling for more graduates and foreign doctors is like trying to fill a pail full of holes with water. Not one person asked any of these departing physicians “why”?
The primary health-care system is under reform of sorts. It is so well reformed that no one can explain how it functions anymore. It is full of many different well-intentioned but beaurocratic models of care in different stages of destruction and re-structure. I am part of one, and as an example recently got a generic note from OHIP asking me to take more time out my day to explain all the rules and benefits to patients? Now that’s a no-brainer. I have intelligent patients. If they truly noticed any benefits that I may have missed, surely I don’t need to rub it in. It also reminded me that mounds of paperwork have yet to be completed. I should be less cynical since a “newer and better” model of primary health care that comes with money has been granted to the local hospital. However, it excludes and alienates any remaining affiliated family doctors. In the meantime, I can continue to expect my patients to continue to make due with bare necessities. There is little accountability in this system.
I attended a large conference of several thousand Canadian Physicians. There were numerous recruiters from communities all around Ontario. Even though it was held in Peel, incredibly, no local recruitment of any sort was evident. It seems that most health care players in Peel do not have an organized strategy or plan to retain or recruit. Retainment of full-service physicians is probably the true hidden crisis in Peel. It is a domino effect. When the top of the pyramid begins to topple, it puts such strain on the base and collapse is imminent. The cracks have turned into large gaps. A little prodding reveals that many remaining full-service physicians in Peel have second jobs and other part-time positions outside of their offices and OHIP. There is a mad dash for exit strategies, and no local efforts are in place to reverse the trend.
I could fill a whole new practice every 3 months by the number of phone calls and requests I receive. For the most part, family doctors enjoy the interactions with their patients. But they also increasingly bear the frustrations of a system that sometimes functions smoothly like clockwork, yet most other times bogs down to a crawl. Being on the frontlines, they tend to become the repository for complaints about wait times, wasted spending, hospital inefficiencies and lack of service. From the other end, consuming paperwork and demands that attempt to apply square rules into round practices multiplies the frustration. The cavalry is on its way. With as little as three months training, throngs of “new wave” health care workers called physician extenders are on the way into the system. Regulations are about to change, and you will no longer need to have qualified physicians with those petty M.D. degrees assisting at operations, supervising radiation treatments, performing endoscopy, or assessing the not so sick. The only role left for physicians will be to assume the risk. Seven years of medical training can be circumvented by a three month course, and with all these micro-trainees around, it should free up the full-service physicians for really important stuff, like pushing pencils and trying to figure out and explain rationales behind new policies. Oh joy, how simple life is becoming!