- cross-posted to:
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- cross-posted to:
- [email protected]
The number of Canadians who visit emergency departments across the country only to give up and leave before they receive any care has increased more than fivefold, according to new data collected by CTV News.
This is a symptom of a twofold problem. First, additional staffing and resources for ERs would help to reduce wait times, but I think the more important issue is lack of primary care, which would help patients avoid needing to go to the ER in the first place.
I’m not much of a fan of the way the article is written. Of course there are going to be some cases where a LWBS has serious complications, but locally (and anecdotally), our ER seems to operate more as a walk in clinic at times, and doctors will often see more patients there than they would in a typical clinic day. I feel like the non-emergent visits are likely a considerable part of the 6.8% LWBS rate, and could be offset by a better supply of family physicians. Unfortunately, at least in Saskatchewan, that would require a government willing to do anything whatsoever to help the healthcare system.
What action(s) would the government take to help the supply of family physicians? (disclaimer: I’m asking out of ignorance and curiosity. I solemnly swear I am not a conservative sea lion or provocateur).
It’s unfortunate you have to make that distinction, but thank you.
It’s definitely a complex issue, but I think a few things could help in my experience as the spouse of a physician in rural SK with an engineering background.
Pay parity - rural family physicians provide many of the same services as urban ER docs would, but are paid considerably less, while having worse work-life balance. Family docs can also do just one year of ER residency add-on and work solely in emergency medicine. This makes family practice much less attractive and incentivizes many family docs to pursue subspecialties. One of Regina’s hospitals’ ERs are staffed fully by family doctors, and we’ve had 2 of our 14 doctors leave recently to work in non-primary care specialties, with another also pondering leaving, effectively saying, “I can make more money, see less patients in a day, and have better work-life balance just an hour down the road, why should I stay here?” With this, family physicians have considerably higher overhead compared to really any other specialty. Clinic rent, clinic staff, clinic equipment, an EMR subscription, IT equipment all adds up. Work in a hospital and you have none of that. We also just had a health authority administrator ask the doctors here, who practice privately, to pay for scheduling software for the hospital. It’s insulting, really.
Support and scrutinize education - there is med student and residency education opportunities throughout many rural sites in our province, but there’s become a lack of supports around those positions. Lack of housing for electives, stagnant med school intake and family residency spots. If you want more doctors, you need to educate more doctors and provide the adequate support in order to do so. Less on the government side and more towards education, but there are also some residency programs and/or preceptors whose residents are consistently behind standards, yet there seems to be no oversight or corrective measures taken. This is more on substandard self-governance and entitlement of certain individuals, though.
If I had to boil it down, I’d say those who make decisions in government have a complete lack of understanding of the day to day operations and expenses of rural physicians. A government rep was flabbergasted when she heard that family physicians often have several hours of non-patient facing time in a day when she asked why clinics can’t be open 8-5 in a recent meeting. A 6-hour clinic day would often produce 2 hours of paperwork, or you’d need to leave 1 weekday for paperwork if you worked the other 4 seeing patients. Yet, given this lack of understanding, they still refuse to pay doctors for their time to meet to discuss these issues.
Thanks for the response. If I’m understanding correctly, I too am completely flabbergasted that family physicians have worse work life balance than ER docs. That seems like the opposite of everything I’ve heard about practicing medicine (although I’m in the States, and get 90% of my info from Scrubs).
Urban and rural can be quite different. Urban family docs can do mostly clinic, so a fairly regular 8-5 with maybe some evenings, because other people provide the other medical services.
A typical week for a rural family doc in my experience would be clinic about 3 days, maybe 9-3 seeing patients, but actually 8-6 because you have to round on your hospital inpatients first and have paperwork after seeing patients.
Another day would be a 24 hour ER shift, where you’re seeing 60 patients because there aren’t enough resources for a walk-in, some with a stubbed toe, some trying their best to die. You might get an hour or two to sleep if you’re lucky. You’d often take the day after to recover, but it’s not uncommon to get phone calls during the day from consults and such, so not really a great sleep.
On top of this, you can be on obstetrics call on your clinic days (or weekends) so if there’s a baby to deliver, you’re up, either delaying your clinic or keeping you working into the night. There’s a fair bit of communication needed even when the doc isn’t needed in the hospital, so your sleep is shit again.
Essentially, rural family docs do nearly everything in their service area and only the most serious stuff gets sent out. With an antiquated part of the bylaws of the College of Family Physicians saying family physicians must always be available for their patients, rural physicians get fucked around, while urban docs have the luxury of dedicated 24-7 ER to take care of that.
ER docs on the other hand, at least from the ones I know in Regina, have usually a rotating 8 hour (sometimes 10 or 12) shift over a few days. So you’d work an afternoon, evening, then night shift three days in a row, then have a day or two off. Patients seen can be less because of better family physician and minor ER access, but the main thing is that when you’re done your shift, you’re done. You aren’t going to get a call from a consult, or lab, or a request to do or assist in a procedure like a c-section. You can turn your brain off of work mode and not dread the sound of your phone’s ringtone.