Reasons for Family Doctor Shortage in BC
It’s not because there aren’t enough family doctors in the province
In BC we have the most Family Doctors per capita in Canada. In BC we have approximately 6,200 licensed family physicians (FPs), but only 4,122 of them are actively working as a family practitioner, according to 2021-22 data. The new payment model which went into effect on February 1st, 2023 has seen 2,142 of these active FPs choose that option versus other payment options.
The Ministry of Health is hoping all 4,122 will eventually have a patient load of approximately 1,250 each, which would be more than enough physicians for all our citizens. Unfortunately, there are no public statistics on how many of these doctors work full time, part time or even just one day a week as a family practitioner, while also working in other areas of medicine. We still need more doctors to replace those that are retiring, and to supplement part time hours, but the lack of trained individuals isn’t the cause of this crisis.
It’s not because we don’t train enough Family Doctors
In Canada, we have a higher ratio of doctors to the population than ever before. In BC we are graduating more family doctors than ever before. Nevertheless, new graduates are choosing to specialize or practice as hospitalists (hospital doctors) because they see how discouraging and financially draining it is to be in private practice as a family doctor. A hospitalist job doesn’t entail overhead costs, has a set schedule and fewer unpaid tasks, making it an attractive alternative for family doctors.
Family Doctors in BC are the lowest paid in all of Canada.
Family Doctors in BC who are paid under the Fee for Service model have been the lowest paid in all of Canada.
Family doctors in BC have the lowest gross earnings in all of Canada. Figures provided by the Ministry of Health showed the average salary for a full-time family physician in BC in 2020-21 was $250,000. This number might look good but it represents the gross earnings in a year before expenses are deducted. The family practitioner has to pay all the expenses involved in setting up and running an office: rent, utilities, internet, furniture, equipment, supplies, staff wages and accounting fees. Other expenses we should mention: liability insurance (expensive), professional license fees, continuing education expenses and of course, income tax.
Meetings with government officials, vacations and continuing education take time away from work which means no income during that period. While on holiday they must hire a locum (difficult) and usually break even or lose money after paying them. Two more things we must mention: paying back their education loans which are in the hundreds of thousands of dollars and saving for retirement, because there is no dedicated pension, nor can they sell their practices, unlike other businesses.
Again, why would they stay to work here especially when living costs are so much higher?
Retiring family doctors can’t find anyone to take over their practice.
Patients are being abandoned when their family doctor retires as no new family doctors are coming to practice in BC. We need solutions to encourage new graduates to enter the field, and to encourage new doctors to come to our province.
Family doctors are only paid 100% of their fee for service rate for the first 50 patients of the day.
For patients 50-65 they get paid 50% of $31, for patients over 66 they get paid $0.
Family doctors don’t get paid enough under the fee for service model.
Fee for service pays BC doctors an average of $31 per patient visit. In Alberta, family doctors can bill $41 per patient visit plus extras. (2022)
BC family doctors on fee for service don’t get paid for many tasks they have to complete
In BC family doctors get paid for a 15-minute visit and nothing much beyond that. They do all the following tasks for FREE, they can’t bill MSP for other tasks – writing a referral letter, charting, reviewing charts, reviewing lab results, talking with and examining the patient beyond 15 minutes, anything else the doctor does in relation to the patient’s care.
Yet, Alberta doctors can bill for all those tasks. They receive compensation for a large portion of their jobs that BC doctors do not. Why would the BC doctors stay here then?
30-40% of their gross billing total goes to paying for their business expenses
Doctors pay for – rent/mortgage, taxes, insurance, all staff salaries, all medical equipment, and supplies (needles, catheters, etc.)
No standardized electronic records system between all the health authorities. Care Connect is supposed to be the province wide system but click here to read about doctors experiences with program.
Among the 6 health authorities, there are numerous electronic patient record systems. The systems aren’t even compatible with each other. Doctors in different health authorities can not share patient files or data with any ease. It also creates an extra workload burden on MOAs and doctors due to inefficiencies of the systems. In Contrast, Alberta uses one electronic system called NETCARE in their community offices and private practices which allows all doctors in the province to pull up information on any patient in the province.