For those of us who live in Canada we're used to the concept of physician wait times. 6 months to see a specialist is far from uncommon but wait times to see your own family doctor?
I saw a patient yesterday who kindly gave me permission to anonymously discuss her story.
Over the weekend she developed acute pancreatitis. She's not a drinker (most common cause) and really the docs in the ER were stumped as to what was going on and concerned about whether or not things were going to get worse.
In terms of my patient, she was in a great deal of pain but not so much that she would require admission to hospital and therefore she was instructed to follow up with her family doctor within 2 days for further blood tests and to see how she was doing.
My patient, a health professional herself, called her doctor's office to make an appointment and explained the situation.
She was told that the earliest available appointment was 3 weeks away.
I don't understand that.
When I was training to be a family physician I was taught always to leave some emergency slots in my schedule to accommodate the unexpected. When I was a practicing family physician I had those slots and frankly even if they were full if there was a true emergency, I'd see the patient regardless. Even now in my specialized practice if a patient calls for a non-weight related emergency I'm happy to find time for them.
Why?
Not because I'm an exceptional doctor or human being, but rather simply because that's what doctors are supposed to do.
Shockingly the story I've recounted above is far from an isolated one.
What's happening to health care in Canada? Have you had similar experiences?
Posts
I have had the same experience with my family doctor numerous times. I have rarely been able to get an appointment in less than 2 weeks. So now I rarely see my family doctor and instead choose to wait in a 2 hour lineup at the walk-in clinic as opposed to a 2 week lineup at my family docs practice. It's terribly frustrating!
ReplyDeleteI'd say it depends on the doctor and the practice. My PCP has two days appointments each week and one or two half-days as walk-ins; she works in a walk-in clinic with about a dozen other physicians. It usually takes a month or so to get an appointment with her -- and she's been less and less available for emergency walk-ins -- but there is always a doctor on premises who will have access to my medical records.
ReplyDeleteI don't know about Canada, but I think the issue with physicians in the US is that the insurance companies and Medicaid/Medicare pay them so little and expect them to become revolving-doors rather than true healthcare providers that they are forced to run these packed, or overpacked, schedules.
Sadly, physicians are underpaid in Canada.
ReplyDeleteI know a specialist who explained that the pay system is not adequate. This specialist has 40 years of experience, and he's making roughly the same amount as a new specialist in the same field in their first year. With no option or ability to increase his revenue.
Honestly, I don't see that Canada is doing much to retain physicians of any sort. I can't blame doctors wanting to pursue more lucrative positions in other countries.
I've seen in the last 2 - 3 years a significant growth in the number of people who tell me they don't have a family doctor.
And the level of care varies from doctor to doctor. There are still many excellent doctors out there, but there are equally really awful ones.
We're still fortunate to live in a country that has a health care system... but when things aren't working, it's time to get out the toolbox, not the bandaids.
I'm in Ottawa & this happens all the time. If I call my dr early enough when they just open, I might get an emergency appointment. Otherwise it's off to Appletree or some other clinic. At least if you have an ear infection or something you can get antibiotics to tide you over until you can get in to see your family dr. My husband once picked up pinkeye from one of those clinics too, they're not the cleanest.
ReplyDeleteIt's usually a two-week wait. I haven't been to my family doctor in years; I go to the walk-in clinic instead.
ReplyDeletefrom what i understand, you are talking about a family doctor. what about when your child has a fever, you have national health insurance, you phone the service for free-of-charge treatment, and are told that the next available free-of-charge appointment is two weeks away? this is happening in greece where i live.
ReplyDeleteof course, i dont wait for two weeks to see the free-of-charge doctor. i go to his surgery when he's accepting paying patients, and see the SAME doctor i would have seen through the free-of-charge appointment service, but i pay him the private fee, because i could not wait for two weeks...
My family doctor is "out of the office" on Mondays and Fridays. Wednesday is "Baby day" in which he sees only OBGYN related cases. That leaves Tuesday and Thursday to see all of his patients. I haven't seen him in over 5 years - instead I go to the walk-in clinic at my University.
ReplyDeleteIf you are lucky enough to be born to parents who already have a family physician then you're in luck. If you move away from home, or your doctor moves, your best bet is the walk in clinic or worse, the ER, where you have to take a day off work to wait to get in. There is a HUGE shortage of family doctors! When I mention to someone that I have a family doctor, its like a won the lottery "your so lucky" everyone says.
ReplyDeletePeople complain about wait times, but frankly I have never not seen a doctor when I needed one. I may have to go to a walk in clinic or I may have to go to the emergency ward, but I have always managed to get care. Really, a family doctor is best for chronic conditions, not emergencies like an ear infection or a cut. Any doctor at any hospital will do for a situation like that. People like to rant about how it is so much better in the USA and there are no wait times. This is simply wrong. First of all, there are the same numbers of doctors per capita in the USA as there are in Canada. If it is easy to get in to see a US doctor it is because you are lucky enough to have the insurance that pays for this type of service. Other people sit ant home dressing their own wounds or die. The people that belong to HMOs have a difficult time as well. For example, I have a friend who told me about waiting at the hospital for 12 hours and then only saw sometone she referred to as an assistant doctor. This is someone who is ranked slightly above a nurse, but still below a doctor. Incidently, this friend is a professor at a major American university. Few of us have jobs as grandiose as that and would fare far worse in an American system than we currently do in Canada.
ReplyDeleteA two-tier system is worrysome as well. As the person from Greece suggests, those with money will pay for service, those who need to wait for the free service will have to ...wait.
I also like to shy away from the idea that Canadian doctors are underpaid. They are paid many more times the national average. Few people earn as much as doctors. It is not valid to say that a new specialist should be paid less than a specialist of 40 years. They each have the same qualifications and the new specialist may have better, up to date training. If there are doctors in Canada that can not live on their earnings, they need to see a financial counselor.
Some years ago I used to visit a doctor in BC. It was his office policy to tend to only one medical concern per visit. For example, if you had a bladder infection plus a funny rash on your leg, you had to CHOOSE which of these you wanted help with and make another appointment for the issue at a later date. This was to ensure the doctor could get paid twice. Once for treating your bladder infection and again for treating your rash. It was near impossible to get into his office.
ReplyDeleteHi dr. Freedhoff,
ReplyDeleteI live in montreal for 6 years and in all that time I tried several times to find a family doctor and I wasn't able to find a single one.
I even went to the clsc several times and they always said to comeback in six months that maybe they will have a new doctor.
Once I went to a private clinic and the prescription that the doctor gave me the pharmacist couldn't read and despite the fact that he call and send a fax to the clinic, they never answer back.
Then I had to go to the hospital to wait for 5 hours, that's is the real public health that canadians have.
I live in rural BC. It usually takes 1-2 weeks to see my PCP. I've never had to ask for an emergency appointment.
ReplyDeleteAs for referrals to specialists, I've had three this year. One to an internist (2 weeks). One to a endocrine surgeon (3 weeks). One to an orthopedic surgeon (3 weeks).I had parathyroid surgery in June and I'm having a foot reconstruction in October. (I could have had the latter done sooner but it's been postponed to October because of my work schedule.)
I've been very pleased with the health care I received here. I have to travel further for my surgery (2 hrs each way) but I can cope with that for the privilege of living in Canada.
I also received good care when I lived in Northern California but the wait times were no shorter.
And in California our very basic health insurance cost $900 per month in 2004.
I am very very grateful to live here.
I've lived in Ottawa most of my life. My family has been with the same family doctor since 1988 (I was two years old), and when my son was born in 2006, he became a patient of our doctor as well.
ReplyDeleteI have a very special family doctor. He's always busy, but he makes it a point to see every patient as soon as possible (usually within 72 hours - and those are NON-emergencies). He has a lot of patients, and has shared with my father on a few occasions that he routinely spends 14 hour days at his office - seeing patients before and after hours to accommodate their schedules.
I've had nightmarish experiences in hospitals, and a serious decline in my health since the birth of my son, but I've got absolutely no complaints with my family doctor. Sometimes, the receptionist even calls me at home after receiving paperwork from the different specialists I've seen - just to make sure I'm doing well.
...And, yes. I consider myself very lucky.
I stand by my comment that doctors are underpaid in this country. If they weren't - we wouldn't have such an issue with retaining them. I realize they get paid a lot more than the national average - but they also earned it. Years and years in medical school, interning, and for the type of job that they have. Decisions they make are considering someone's life - and that is not a light subject.
ReplyDeleteAnd I disagree that a specialist who has been working 40 years deserves the same salary as one fresh out of school. 40 years of experience trumps, by far, any 'up to date training'. And working doctors keep up to date with research. So, it's not even, it's 40 years experience + being up to date. I bet any other person in the regular work force would be stunned and frustrated if they'd worked 40 years and some entry level kid made as much as they did.
Just because our system may be better than other countries, doesn't mean we need to settle for what we've got.
@middlevillage
ReplyDeleteUnderpaid? I have a friend that is a cardiologist and when he started to work as a doctor his first pay check for the first 15 days was 9.000 dollars!!! and the reason for that it was because he was visiting more his new hospital than seeing patients, as you know, doctors received according to the numbers of patients that they see.
So, probably now he is getting much more.
I'm 29 years old and have never had a family doctor. I have only ever gone to walk-in clinics and ERs. Approaching 30, this is a concern...never had a physical (walk-in clinics won't do it), I have to fight to get GYN appointments, vaccinations, or any sort of care beyond antibiotics for ear infections.
ReplyDeleteA patients bill of rights, and a College of Physicians with a drastically revised mandate (removing their conflict of interest) would go a long way towards helping this situation.
Today is July 20th - My doc is booking for Sept. Un fickin' believable.
ReplyDelete