Addressing family physician shortages

Francine Lemire

doi:10.46747/cfp.6805392

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RE: Addressing family physician shortages
Dara Behroozi

Published on: 16 June 2022

Published on: (16 June 2022)
Page navigation anchor for RE: Addressing family physician shortages
RE: Addressing family physician shortages
Dara Behroozi, Clinical Professor Department of Family Practice UBC, Department of Family Practice UBC
In the May 2022 issue of CFP (1), Dr Lemire listed the 5 key areas the CFPC has outlined to keep FP engaged and prevent burn-out in our younger colleagues.

There is one area that was missed and that is the huge burden that 'we' have put on the shoulders of these doctors. By 'we', I am referring to the baby-boomer generation who populated and set policy for the Colleges and Regulatory Organisations, Medical Associations, Academia, Divisions and of course the CFPC.

When I point the finger, I am pointing it directly at myself, as I occupied all these roles. We may not still be there, but we set the impossible to attain standards for our younger colleagues. They were unrealistic for us and even more so now as complexity and demands of practice increase.

We have asked - actually expected - FPs, to be Counselors, Friends, Social workers, Advocates, to stand up and fight for Universal Health Care, always be available, never consider remuneration and of course be clinically beyond reproach. In short FPs should be everything to everyone.

To be fair we came on this with good intentions. Having seen the calamity of physician-centred medicine that our predecessors often practiced and having learned that much of disease and lack of health had social and economic roots, we sought to address it all.

However, how can anyone live up to those expectations? They cannot. We did not look at the other side of the ledger. What would be...
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In the May 2022 issue of CFP (1), Dr Lemire listed the 5 key areas the CFPC has outlined to keep FP engaged and prevent burn-out in our younger colleagues.

There is one area that was missed and that is the huge burden that 'we' have put on the shoulders of these doctors. By 'we', I am referring to the baby-boomer generation who populated and set policy for the Colleges and Regulatory Organisations, Medical Associations, Academia, Divisions and of course the CFPC.

When I point the finger, I am pointing it directly at myself, as I occupied all these roles. We may not still be there, but we set the impossible to attain standards for our younger colleagues. They were unrealistic for us and even more so now as complexity and demands of practice increase.

We have asked - actually expected - FPs, to be Counselors, Friends, Social workers, Advocates, to stand up and fight for Universal Health Care, always be available, never consider remuneration and of course be clinically beyond reproach. In short FPs should be everything to everyone.

To be fair we came on this with good intentions. Having seen the calamity of physician-centred medicine that our predecessors often practiced and having learned that much of disease and lack of health had social and economic roots, we sought to address it all.

However, how can anyone live up to those expectations? They cannot. We did not look at the other side of the ledger. What would be the cost of trying to fulfill all this on the health and well-being of the FP? What would be the time commitment, the emotional drain, the limitless demands, the cancelled holidays for lack of coverage, the missed family events? We told our patients to aim for a reasonable balance of work and life while unable to attain it ourselves.

The problem is everyone noticed the self-flagellatory and messianic stance we had taken. Governments had, and so have let remuneration drop behind or refuse to pay for on-call, but still expect it. Our specialist colleagues downloaded menial tasks like completing forms for time off after surgery, as our time was more dispensable. Insurance companies, specialized Government funded clinics from Cancer to Aging expect us to provide whatever they ask for, go through any hoops for them, or the patient will not receive what they need, be it their mortgage payments or life saving treatments. And if anything is not to the patients standards, standards which we set out and disseminated, we hear the refrain " but Doctor you are supposed to be my advocate, or be there for me when I need you". Do you think any FP in 1980 and 1990's was reproached for not being an advocate? Where did that come from...us!

When we propagated these lofty goals, we forgot to set expectations for the other side, whether that meant adequate remuneration and respect of our time and expertise from Governments, Specialist colleagues and patients! We should not be co-opted by insurance companies. When the policy was signed, did we sign it as well? They can of course hire their own doctors and nurses but prefer to obtain our free services.

I am saddened to see the residents I have had the honor to train over 20 years, burnt out by the pressures of trying to meet these goals. With the lack of psychiatric services, they may have several severely depressed patients to deal with a day, in the midst of all the many other problems, with no time to debrief and just have to move on to the next issue. Unfortunately if anyone feels they did not get what they wanted, they can anonymously attack the physician on-line. Then they are spending hours completing forms in the evening for no remuneration. They cannot say no to any of those, so instead they are walking away mid-career. (2)

We have to accept our role in this error and make our goals for FP more attainable, and also set some clear expectations for other stakeholders as well.

Dr Dara Behroozi MBBS LMCC CCFP FCFP
Clinical Professor
Department of Family Practice
UBC
(1) https://www.cfp.ca/content/68/5/392
(2) https://www.cbc.ca/radio/whitecoat/q-a-two-family-doctors-on-why-they-ne...
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Competing Interests: None declared.