New doctors need to give up sense of entitlement

There are more doctors than ever before; yet two million Canadians can’t find one.

  image: davegranlund.com

An estimated 30,000 Kamloopsians don’t have a family doctor, although only about one-half of them are looking if national averages apply.

Something doesn’t add up. Why can’t Canadians find a doctor if there is a surplus? It’s complicated.

First, recent graduates of medical schools can’t find the residency they want. Without a residency, they will never become doctors.

This year, 2,980 will graduate from Canada’s 17 medical schools. They will compete for 3,308 residency spots. That would seem like every graduate should get a spot. However, 917 of those spots are in Quebec which means that there is a shortage for English-speaking graduates.

Then there is the arcane process of matching graduates to residencies which leaves some out. Health reporter André Picard says:

“But matching a graduate to a residency spot is a complex process, overseen by the Canadian Resident Matching Service (CaRMS). Medical students apply to CaRMS in one or more specialties; committees select who they wish to interview and rank them; graduates rank the programs and, finally, an algorithm spits out a match, and the student is legally bound to take that residency spot (Globe and Mail, May 1, 2018).”

Graduates have become pickier. They get assigned in residency specialties where they don’t want to work. As a result of preferences and the complexities of CaRMS, 115 graduates are unmatched this year. Jobs are waiting for them -there are 78 unfilled positions, 65 of them in family medicine.

The unmatched graduates have invested a lot. They have accumulated an average debt of $100,000 during four years of training. Taxpayers have invested a lot. We are on the hook for their subsidized education. The cost of training a medical student is $250,000.

Also, some graduates want a regular job where they work only 40 hours a week as in a hospital in a so-called “hospitalist” position. At $150 an hour, a hospitalist makes $300,000 a year with no overhead. Compare that with a doctor in his own private practice. After paying staff and rent, a doctor would have to earn $400,000 a year to take home that much -and they’d work longer hours with less medical equipment and fewer support staff such as nurses. But there are only so many hospitalist positions.

One-half of Canada’s physicians focus on sports medicine or palliative care says Dr. Danielle Martin on CBC’s the Current:

“. . .they’re not practicing what we would think of as full scope full service cradle-to-grave primary care family medicine, and that is what those people who are lining up at Dr. Pengilly’s clinic and asking [for a primary caregiver].”

Doctors need to abandon their sense of entitlement says Picard. We need more general practitioners, especially in small cities and rural Canada. Enrolling in medical school doesn’t entitle graduates to jobs wherever they want, in the speciality of their choice.

“Becoming a doctor is hard,” says Picard, “It’s also a privilege. We need a system that ensures the right doctors are working in the right places, not on where personal desires can trump societal needs.”

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B.C.’s failed health-care experiment

Other provinces have opted for the team approach to solve the growing problem of patient access to doctors. Not in B.C. The team approach is not new. Roy Romanow recommended it in his 2002 report:

NorKam Medical Clinic (Google street view)

NorKam Medical Clinic (Google street view)

“in view of …changing trends, corresponding changes must be made in the way health care providers are educated and trained. If health care providers are expected to work together and share expertise in a team environment, it makes sense that their education and training should prepare them for this type of working arrangement.”

B.C. decided to keep doctors in their silos and try monetary reward.

B.C.’s experiment has failed, according to a report published in the Canadian Medical Association Journal. The report’s authors, Kimberlyn McGrail and Ruth Lavergne, professors at UBC and Simon Fraser University, respectively, wrote of their results in the Globe and Mail (August 17, 2016). Taxpayers have paid $397 million on the plan without much to show for it. Here’s how it was supposed to work.

The plan, called the Complex Care Initiative, was negotiated between the government of B.C. and doctors a decade ago. It gave doctors who treated patients with complex health problems an extra $315 each year per patient.

The rational was that if doctors cared for patients who were really sick, rather than those with minor complaints, the rest would go to a walk-in clinic. Dr, Shelley Ross, co-chair of the General Practice Services Committee, says that a doctor’s time is sometimes taken up with minor complaints, sometimes more serious. It could be a runny nose and sore throat or it could be case of diabetes, stroke, high blood pressure, and memory loss.

“So you can see the difference,” said Dr. Ross, “It is basically a time issue, it is not a knowledge issue. It’s not that we don’t know what to do, it’s just a matter of being able to spend the time to do the quality of care (Globe and Mail, August 15, 2016).”

While doctors understandably want to direct more attention to those in dire need, more walk-in clinics haven’t happened.

The failure of planning for clinics has left patients out on the street. I know, because last year I was one of them. Last year when my doctor was on vacation and I had an eye infection, I only got into the clinic on Tranquille with great persistence and intervention from the pharmacist next door.

Kamloopsians are expressing their concerns on social media. On Tuesday of this week, Megs (‏@PirateMeghan) tweeted “The walk in clinic doesn’t open til 8am and I’m waiting in a line up of 28 people outside. The need for doctors in #Kamloops is intense.”

I’m lucky to have a doctor. Tens of thousands of Kamloopsians don’t according to former city councillor Nancy Bepple: “Which is why it is no surprise that studies have reported between 15,000 and 30,000 people in Kamloops don’t have a family doctor. That is, between one in three and one in six people don’t have a doctor.”

The B.C. Liberal plan has left us with a shortage of doctors, overcrowded clinics, and no improvement in health care. Some plan.