It is Grim Out There.

Recently, I had another acquaintance inquire if I was taking on patients for family medicine. It sparked memories of my own scramble last year to find a family doctor. Asking former colleagues revealed that those close enough to retirement are choosing retirement and the younger doctors are choosing focuses of practices outside of traditional family practices. Those staying in family practice are already overextended. As the costs of rent and support staff wages go up against fixed revenue, a lot of practices are simply not economically viable.

I spoke recently to one family doctor who is winding down her practice of 20 years because rent now costs more than her revenue. It made no sense to renew her lease and the same for the other nine family doctors in the office. Medical students see this reality and gloss over family medicine as a career choice. A record number of family medicine residency spots went unmatched this year. Residency spots are the training programs for medical school graduates to become fully trained doctors.

Nobody wants to hear doctors whine about asking for more money. This government and the last government have both taken advantage of that fact and bled practices dry. They may point to recent increases in payments, but those are just returning concessions of the past eight years. Specialists are not immune either. Combined with the hostility faced by the physicians during the middle of a pandemic by the government, it is no surprise that a quarter of the specialists left the province last year. A quarter!

Look Into My Crystal Ball

So what is going to happen? Someone else is going to have to pay the rent. Already we are seeing an explosion of new clinics with alternate funding models. One can also foresee larger corporations such as pharmacies or supermarket chains subsidize the practitioners in a way that aligns with their own businesses. You can already hear the screams of protest about private healthcare in Canada. But those protests detracts from thoughtful discussions we should be having in how we redesign our healthcare system. The underlying system was built for a 1960s agrarian society. Something this complex deserves deeper analysis beyond the typical Canada vs the USA tripe that ignores the other OECD countries or the other 155 countries in the world.

Beyond that, there is the increasing reliance on nurse practitioners and integration of other allied health professionals, which is a good thing as team based care is a pillar of quality primary care. However, there is not enough of them either. The typical response is to train more doctors, nurses etc. However my experience on the hospital wards tells me we train a lot of nurses already. In 2021, there were 12 780 new registered nurses in Canada. But then many of them leave after two years. So they are not finding healthcare palatable either. Clearly there needs to be a restructuring of the system to satisfy both users as well as providers. I am skeptical that either of the parties contending the current election are going to bring about any meaningful change, despite the rhetoric.