To the editorial board of the Times Colonist.
I have struggled with an article you posted: “New light on doctor shortage”. I have struggled to understand how you could harbour such animosity towards family physicians, in particular female family physicians. I would like to take you out for a cup of tea and talk this over with you. I would like to understand why it is you feel this way. Unfortunately, I don’t know you and you don’t know me, so that likely won’t happen. So, let’s do it here. Let’s get to know each other. Because, you know what, we are on the same team. We want the same thing. I may be a physician, but I’m also a mom, sister, wife, daughter, grandchild, and human. I get sick, my family gets sick. We all need care.
So let me tell you about me. I’m 40 years old. I did 11 years of school and training to become appropriately qualified and safe to work as a family doctor, which I began to do in 2010. I work about 50 – 60 hours a week with somewhere between 12 – 36 of those hours being either overnight or on the weekend or both. I take home approximately $13,000 dollars a month. That works out to about 55 – 65 $/hr, assuming an hour of work at 3am on Saturday is equal to an hour of work at 3pm on Wednesday. This is the full sum of my income. There is no vacation or sick pay, no extended health coverage, no pension. If you look me up in the MSC Financial Statement (i.e. the “Blue Book”), you will find my income to be much higher, approximately $23,300 dollars a month or 100 – 115$/hr. This 56% discrepancy is due to the costs I incur to practice family medicine in my own community office, to mention a few: staffing, equipment, rent, hydro, electronics, five different insurances, two different licensing fees, fees to lawyers and accountants and bookkeepers. I am very similar to most family physicians I know.
My income makes up over 80% of our household income as it is difficult to find regular childcare between the hours of 5pm and 8am and also we need my husband to be able to be at home if our children are sick or have days off of school because I cannot change my schedule. It was a very difficult decision for us to make to structure our lives this way. My husband is university educated and previously worked in the financial sector. However, the stress of my hours in parallel with him working just a regular 9-5 job was significantly impacting our family so we made that decision. My husband now makes about $2000 dollars a month doing all the bookkeeping, IT support, human resources and some purchasing for our 8 room, 12 doctor, 4 nurse, 3 allied health, 5 medical office assistant clinic. It occupies most of his day outside of childcare.
We have a wonderful life. We are happy, our children are happy and I love my job and feel privileged to be a part of all my patients’ lives. They teach me so much and enrich my life in ways that many of them will never know. I couldn’t imagine doing anything else.
I found your article hurtful and disrespectful. Over our cup of tea I would now try to understand how your experience has lead you to be able to feel such a way and I would provide some insight into why I feel so strongly against much of what you wrote. I know that many of my colleagues have written your paper with their own concerns about the inaccuracy of your article and its inflammatory tone, so I would focus on what is most concerning to me in our conversation.
“In practice, we are paying physicians to work less. This effect is particularly noticeable in female physicians, who, on average, see almost 40 per cent fewer patients than their male colleagues. Of course, there are legitimate reasons for some portion of this difference. Much of the burden of child-rearing falls on women.”
You wrote this. I would like to understand what the goal of you writing this was. Should I feel guilty? Should I endeavour to find another career that I can do a better job pulling my weight at? Should I encourage my two girls to avoid medicine as a career as their breasts and uteruses will prevent them from serving society as is adequate? Surely, no, this is not what you meant to imply. I would love for you to clarify though, in fact 50% of the population would love for you to clarify. Also, consider that perhaps it may be a good thing that women see 40% less patients then men. As a patient, would you like me to rush you through the office or would you prefer me spend a little extra time with you when your marriage is falling apart or when your father was just diagnosed metastatic cancer? As your wife or your mother, would you like me to increase my hours to 80 per week?
Although not forgivable, it is easy to see how one could be hurtful when they are at arms length or simply don’t know the population they speak of. However, it is more challenging to understand a journalist misrepresenting facts. I would encourage the paper to publish the letters that it has received that provide a rebuttal to the bulk of your article’s insinuation that the fees paid to family physicians have escalated while the doctors have sat back and done less. Also, to remind you how the fee schedule works, if I choose to spend more time with a patient as they are seriously unwell, physically or emotionally, I do not get paid more. I only receive a payment if I see a patient. If a patient does not show up for their appointment, I do not receive any income and I pay the expenses for that time. If I go on vacation, I do not receive any income and I pay the expenses for those weeks still. If I “man up” and work 40% more hours, then yes, I will earn 40% more I suppose. And yes, I do “consider myself self employed” and yes, I do have to be “entrepreneurial” to be sure I generate an income while doing so. I consider my 55-65$/hr to be appropriate to my level of training. I would positively love not to have to give flu shots as it adds 5 unpaid minutes to the routine appointment the patient is otherwise in for. Multiply that by the 6 patients I see every hour and you can see the math doesn’t work in my favour. I could alternatively have people just book an appointment for their flu shot, then I can bill $5.17. And please, please do train more family physicians as I think it is the most important and rewarding job in the world. However, if I’m being a fiscally responsible Canadian, I would caution you to do that math first too. Because simple supply and demand rules apply. The very unfortunate truth is is that we currently train enough family physicians but they choose not to go into community family practice. They choose to work in hospitals or emergency rooms or in academia or any where else except the community family doctor’s office. Why? Because they can earn appropriate to their level of training and expertise in those other settings and not suffer the public back lash from articles such as yours.
“If GPs, in balancing their personal lives with their professional responsibilities, place too much weight on the former, no amount of government support will suffice.”
And then you said this. This is where the tea becomes really important. Because I really need to understand how you feel you have the right to say this to me? I would 100% expect your personal life to be your priority, our health and our families and our dreams should be everyone’s priority, why shouldn’t it be allowed to be mine? If I choose to start my clinic 30 minutes later in the morning so I can exercise or take 2 weeks to go on vacation with my children, to reiterate, I do not get paid, the government is not involved. If I go to work vomiting with morning sickness and have to ask my resident to give me an injection of Gravol in-between patients so they all get seen, the government is not involved. Again, what is the goal of this statement? I am, in fact, not asking for more “support”. I am actually just asking to be respected.
“It is a disgrace that in the second decade of the 21st century, tens of thousands of British Columbians are denied the most basic medical service — reliable access to a family doctor. While there are two sides to this issue, we must ask physicians to bear more of the burden.”
And then this is how you left it. You lead the public to believe that it is family physicians themselves who are denying them of a family physician. You spent a whole article insulting the practice of family medicine and then stated that, indeed, it was an essential service that every British Columbian should have the right to have and found it abhorrent that they didn’t have it. Yes, it is abhorrent. Yes, the population would be healthier and the health care expenditures would be lower if every British Columbian had a family physician. But, after reading this article, and the 10 others that preceded it, and the 10 others that will follow it, 10 more educated young minds just decided to do something else. 10 more women just decided to stay home with their families. You can not guilt us into thinking that we are not doing our part to bear this burden. I encourage you to take me up on my tea offer. I also encourage you to talk to my patients. I think they will tell you that family physicians are doing their part. I think they will tell you that we care.