Don't let patient loads weigh you down

With more and more patients, overworked Canadian docs need a break

More and more patients want your attention — but there are only so many hours in the day. This is a dilemma faced by an increasingly large number of Canadian doctors, according to NRM's 2006 Practice Management Survey.

Based on the more than 700 responses we received from across the country, 42% of you have seen your patient load rise since last year. Conversely, only a few of you — just 6% — had fewer patients this year than last.

"I've been in practice about 15 years and every year it gets a little bit worse," says Dr Dan Ezekiel, a Vancouver GP. For every extra patient you take on, there is more paperwork to do. Even a small increase in your number of patients can lead to a huge rise in paperwork, test ordering, referrals, scripts and refills, and, ultimately, the many additional hours you must work to do all those things.

MDs SPREAD THIN
Canada's doctor to patient ratio ranks us 24th out of 27 countries with universal healthcare; we have just 2.3 doctors per 1,000 people, compared to world leader Iceland's 4.2. Here, where the doctor dearth is worsening by the day, it should come as no surprise that many GPs saw huge volumes of patients in 2006 (see "Patients seen per day" chart).

Dr Ezekiel was among the vast majority of GPs seeing between 26 and 50 patients per day, a number that has increased over the last 12 months and has risen continuously over the years. "As soon as I wake up I hit the ground running," he explains. "You are always behind and it just kind of taxes on your brain to be late for everything.

"During the day there is a crush of time — I'm often multitasking. As I talk to patients on the phone, I am reading other patients' charts or checking the mail," Dr Ezekiel adds. "If I didn't do that my days would be longer still."

DESPAIR FOR THE ORPHANS
Besides the extra hours, excessive patient loads make many doctors guilty for having to turn away 'orphan' patients. "Not being able to accommodate new patients" was one Winnipeg-area GP's most pressing practice concern. He's not alone — fully 5% of our survey respondents cited the same woe. "Trying to meet the increased demand to see more patients!" wrote another physician, this one from booming Alberta. "Requests to take on new patients by my own patients," was one Ottawa FP's complaint. Turning away needy patients is a reality many Canadian doctors deal with constantly, and it seems to weigh on many of you despite the fact that the problem is a systemic one and not your fault.

RUNNING ON EMPTY
The problem of having too many patients was not limited to GPs. While fewer specialists saw more than 25 patients in an average day — 31% compared to GPs' 90%-plus — according to Montreal psychiatrist Dr Raouf Dimitry, measuring patient loads in absolute terms doesn't do justice to the difficulty of dealing with some specialists' cases, like his own psychiatric patients.

"Seeing 10 or 15 during a day can sometimes feel like seeing hundreds of non-psychiatric patients," says Dr Dimitry. "By the end of the day, you don't want to talk to your wife, your kids, anybody."

The resulting lack of family time is a common problem for overworked doctors — a particularly draining day at the office can be a real impediment to your ability to relax when you get home. When you find your workload is starting to interfere with your family life or your overall happiness, then it may be time to consider some changes.

FIND A WAY TO COPE
For Dr Ezekiel, striking a balance between seeing patients and setting aside personal or family time has been a difficult — and often frustrating — task. "I like what I do but I find that, since I am conscientious, I want to take care of everybody," he says, and that often means he finds himself working extra hours at the office.

"I have to find more time to make myself happy, but I also have to make money," he adds. There are some ways, however, to combat the too-many-patients blues without sacrificing much income.

For instance, take a short break. Yes, it's often next to impossible to have a few minutes to yourself during the day, but it's worth the trouble, says Dr Dimitry. The reprieve can take any form you like. "I go outdoors," Dr Dimitry says, "or I sit quietly in my office and read a magazine or something. Otherwise I would be swamped." Even something as simple as leaving the office for lunch can be a life-saver. Dr Dimitry tries to combine his lunch with a short walk and sometimes even an errand or two, to give his mind a rest.

Another way to rescue yourself from the endless flow of patients is to step back and try to determine the correct balance of work and personal time. Of course, cutting back your hours will affect your income. But for some it's worth the sacrifice. "When I was young I used to take extra calls to pay off my debts," Dr Ezekiel says. "Now I realize that an afternoon off is worth way more than the 500 bucks I could make in the office: it's priceless."