Family doctor outlook mostly grim: survey

Access to care uneven across country as more MDs reducing hours

By Gillian Woodford

New province-by-province results from the National Physician Survey 2007 released late last month confirm that access to family physicians is getting worse. Fully 45% of Quebec specialists rated access to FPs as "poor," up from 25% in the last survey from 2004.

That trend isn't surprising, but it is worrying, says Dr Ruth Wilson, president of the College of Family Physicians of Canada, which partly funded the survey. "Quebec in particular is a concern," she says, noting it's the province with the highest number of patients living without a family doctor.

The best access was seen in Nova Scotia. Only 6% of specialists deem access "poor" while 55% of NS specialists classed FP access "good to excellent." (That number is an abysmal 26% in Quebec, and an even worse 24% in Alberta).

WINDING DOWN
Far more physicians reduced their work hours in the 2007 survey than 2004 — 27% versus 16%. Province-by-province numbers are fairly uniform, with BC reporting the highest proportion of MDs who reduced their hours (29%) and PEI the lowest (21%).

"This is a major worry," says Dr Wilson. "We've been working so hard to increase the number of medical school places only to see doctors planning to reduce their hours. My impression is this is older doctors winding down," she adds.

There is one bright patch: the number of physicians nationwide with closed or partly closed practices has dropped from 60% in 2004 to 40% in 2007. Ontario saw the greatest change, from 69% in 2004 to an improved, though still high, 42% in 2007. Saskatchewan has the lowest proportion of closed practices at 23%, the same as it had in 2004.

TAKE THIS JOB AND....
Physician satisfaction with their jobs is tepid, with most doctors reporting being "somewhat satisfied" (46%). Thirteen percent are "somewhat or very dissatisfied" with their work, but when it comes to work-life balance 27% reported dissatisfaction. For rural docs, this is probably because they're forced to work so much on-call. There were no big increases in on-call hours from 2004 — thankfully, since 10% of doctors are already doing more than 240 hours on-call per month (more than one in three nights). Compounding the problem is the fact that fully 30% of doctors couldn't use a locum last year to take time off because none were available.

Dr Wilson, who works in Ontario, says that province's new nurse-staffed telehealth lines have made a big difference in the number of calls doctors have to respond to when they're on-call.