Black Press Media article 91裸聊视频淭oo few doctors working too few hours91裸聊视频� raises many interesting points about access to our general practitioners and family physicians.

91裸聊视频淎dding more doctors is the only way.91裸聊视频� This would certainly help, but you rightly acknowledge that it takes so many years to train them. 

At present, a high school graduate who wants to enter the field, is obliged to enrol in a four year undergraduate university program before applying for the four year medical school course (eight years of expenses out of their own pockets).

Then there is the three year general practice residency program to complete.

That's 11 years, and they will be around age 30 before starting to practise and to get returns to pay off their loans. 

But this assumes entry to medical school in the fifth year of university.

A lot of would-be medics are obliged to do masters programs before finally being accepted into medicine, another two to three years of treading water; and reducing their eventual active practice involvement to only 30 years, before retirement at age 65.

Given that running the small business of family practice has become horrendously expensive, the length of training and the fact that the costs have to be met either from a salary/capitation fee system, or a fee-for-service charge, with a fee that cannot be raised to cover inevitable increase in those costs; entering general practice is no longer as desirable a proposition as it used to be.

As a stop gap measure, should students be able to enter medical studies directly from school? Countries such as the UK do this. 

It would more quickly boost the supply of GPs if those entering such an 91裸聊视频渆mergency" program had their licences restricted to family medicine for a certain number of years.

The recruits entering medicine have changed. They put an emphasis on quality of life rather than following the style of their somewhat workaholic forebears.

They prefer a 9-5 existence. This has reduced physician numbers available to cover shifts. 

GPs are also limited by regulations as to the number of patients they can be paid for seeing each day; this renders overtime impossible, except by working free of charge.

Also, up to a third of GPs have become tired of working to pay ever increasing office expenses out of a relatively low fixed fee.

So, they have avoided office practice (getting rid of that expense) to take work in GP-related areas that are less demanding and involve much-reduced paperwork; such as functioning as hospitalists, operating room assistants, emergency room physicians and so on.  

Availability of GP time to see regular patient problems in offices has also been reduced by the FP's search for activities that can be billed outside MSP, in order to help defray the burden of overhead costs;  Botox injections, vasectomies, etc.

Although, from the emotional and intellectual basis general practice can be a very satisfying field to work in, a lot of doctors have left the field because of the crushing amounts of paperwork, the administrative loads, demoralization, and the ever rising overhead and labour costs that far exceed the meagre fee increases. 

The fee for an office visit in 1967 was $6 per new problem, but has only risen to the $30 range six decades later. 

Compare that to any other cost changes that come to mind for that interval; a full hour of labour on one91裸聊视频檚 car in 1967 was obtainable for $5.

There seems to be an impression that some GPs express a dissatisfaction with the fee-for-service set up of general practice and may wish to simply work for a salary, leaving administration and costs to someone else. 

However, reading available data, it seems that physicians who commit to work on salary in proposed government primary care facilities will not have perks like a pension, and will have to pay for their work space by expenses being deducted from their salaries.

Surely the were expecting to be civil servants with all the perks and pensions, and like them not to have to pay the expenses of their work places?

The real dissatisfaction with fee-for-service system is with the level of fees for general practice, rather than the set-up.

After all, fee-for-service gets far less criticism when specialist stipends and surgical fees are being discussed, and one does not hear a desire to change those to a salary.

Why do we have a primary care crisis at present? 

A recent journal article compares our medical primary care system to several European countries.

These do not permit walk-in clinics, because it has been found that they are the death knell of desirable conventional 91裸聊视频渓ongitudinal91裸聊视频� general practice.

So, it would seem that the phenomenon of walk-in medicine has contributed adversely to the current status of primary care in our country.  Strange revelation.

However, going back further, in the 1960s GP's fees for service were covered by MSA, an insurance scheme set up by the medical profession which adequately covered patients91裸聊视频� needs, and whose premiums could be adjusted according to cost requirements. 

Those without this insurance were often handled on a charitable basis. 

That decade the B.C. provincial government decided to take over this scheme. 

Thus, to change premiums acquired a political aspect and a political  dimension was incurred if they were raised. 

Needless to say, they were kept low and finally disappeared, a real electorate pleaser but removing funds for the payment side of the equation; while GP fees were gradually reduced relative to the cost of practising.

In the 1990s, the Harcourt government received the Seaton report which suggested that a program be developed in B.C. to limit the number of physicians in the province. 

The rationale was that the more doctors you have, the more billings will be made to the provincial health plan. This idea was felt logical. 

It implied that that the care patients were seeking from GPs was unnecessary. 

So, in order to control medical costs, a 10 per cent reduction in medical school places was initiated. 

This is a major reason why we have our present GP shortage; the average GP age reached 50 years by 2010.

Our system allows for practitioner costs for the care of certain parts of the body to be passed on to the patient91裸聊视频�if you are a dentist (teeth); an orofacial surgeon (jaws); a physiotherapist (bones and joints); a massage therapist (muscles); an optometrist (eyes); psychologists (mental health). 

They are all allowed to bill the patient directly or to add a top-up to their bill directly to the patient. 

But if you are an MD, there is to be no personal billing to recover your costs. And working outside the system is not permitted.

There was parliamentary jubilation last year when the country91裸聊视频檚 Supreme Court made a decision that confirmed this.

However, a different decision was made with regards to the provision of private health care in Quebec by the same Supreme Court, several years ago, the Chaoulli decision. 

There, a patient can use private facilities when the public system fails them.

Why is this so? Surely B.C. residents deserve the same consideration? 

There are now more than 500 GPs working outside the Quebec equivalent of MSP; and a couple of hundred specialists. But they have to work completely outside 91裸聊视频淩AMQ91裸聊视频�.

As an octogenarian, whose GP is into his 60s, it is very worrying to see the difficulties primary care is having here at home.

Surely, we need to be logical and less dogmatic, when it comes to the situation that primary care has fallen into. 

General practice could be helped by the type of top-up fee that one pays to the other health professionals listed above. 

And permitting some private overtime (but still being able to remain in the system) would seem logical under present circumstances and go a long way to helping manage our present access difficulties.

Some form of changes are needed. 

General practice has to be made attractive again to recruits, less onerous in paperwork and administrative duties, and more survivable as a business. 

Unless government wants to take over coverage of all office expenses and employ GPs as civil servants with all the perks, general practice will remain a small business, with all the exposures to a market place that can only be countered by having the ability to control costs, by raising fees. 

This is exactly what  all other businesses and all levels of government do all the time.

Should the business of general practice not have the same courtesy?

Anthony Walter,
Coldstream