by Carolyn Thomas ♥ @HeartSisters
“Dear Valued Patient. . .”
I opened the envelope, unfolded the letter inside – and stopped breathing. I’ve known this day would come ever since my family doctor had to start working part-time a few years ago for family reasons. But still, I could barely comprehend the blur of words on the page:
“Dear Valued Patient. . .retiring from active practice. . .my last day will be . . .”
It had finally happened to me. Just like that, I’d joined the endless line-up of almost one million people here in British Columbia who do not have a family doctor.
I was upset to learn that in five short months, my family doctor will no longer be my family doctor, but I was especially upset when I got to the part of her letter where she announced she hasn’t been able to find a replacement physician for her clinic. This is the worst possible news if you’re living with any chronic illness.
In our Canadian system of publicly funded health care, as reported by CBC News:
“Family doctors play a crucial gatekeeper role by coordinating care and ensuring access to preventive medicines, drugs, diagnostics and specialists. And unlike in the U.S. — where some insured people can go directly to specialists and clinics — we Canadians must go through family doctors or Walk-In Clinics if we need a particular kind of care.
“In Canada, having a family doctor isn’t a perk. It’s a necessity!”
In the U.S., by the way, over 30 per cent of Americans don’t have a family doctor. And as U.S. Senator Bernie Sanders, who chairs a Senate committee on American health care issues, explained to Politico interviewers:
“You’re not going to go back to the old days. The goal is not to restore the reign of independent practices where a town doctor served a community for a lifetime. That day is largely gone.”
That “Dear Valued Patient” letter suggested I should sign up with the Health Connect Registry, an official online waiting list for people like me who need a family doctor. I registered immediately, but my heart sank when I saw the health questions on the registration form. These asked me to list the medical conditions I’d been diagnosed with during the past three months. THE PAST THREE MONTHS?!? What about heart patients like me who were diagnosed 16 years ago? I haven’t been diagnosed with any new condition in the past three months. I live with two painfully life-altering chronic conditions (refractory angina and osteoarthritis) yet I have as much chance of moving up this wait list as a person with no pain.
Nobody knows where I am on this wait list, or how long I’ll be on the list. In Nova Scotia, reports on a comparable wait list for a family doctor in that province found that over 15,000 Nova Scotians were still on their wait list for more than three years.
So let’s do the math: primary care physicians who are retiring or leaving the field now outnumber medical school graduates choosing a family medicine career, according to a report from the non-profit Primary Care Collaborative. This means we’re in trouble now, and the trouble will likely worsen for my children’s generation.
The National Post explained this reality in detail:
“Family practice has become unsustainable.
“Family doctors are retiring, exiting early or moving into other areas of medicine. Many are abandoning the “cradle to grave,” comprehensive approach to family medicine and are focusing on one specific issue, such as chronic pain or sports medicine.
“Crushing amounts of paperwork and administrative loads, pre- and post-pandemic burnout and demoralization, physician fees not keeping pace with inflation, rising overhead and labour costs, inefficient referral systems — the pressures are many and making things worse on the ground.”
Here’s an example: my soon-to-be former family doc referred me last year to an impressive new Skin Cancer Screening Clinic to have some suspicious-looking moles checked out. I learned there that the four young physicians running this clinic used to practice as family doctors. They now work in this ultra-high-tech specialty clinic (funded by our provincial health service).
Unlike the average family doctor in Canada who works 60-100 hours a week (with hours of unpaid paperwork), these four docs work regular hours that provide better work-life balance. What they’re now doing is offering a much-needed skin cancer screening service during what one local dermatologist calls a “critical shortage of dermatologists at a time when cases of skin cancer are increasing, and early detection can be key to survival.”
Most of us grow up expecting to have a longterm relationship with a family doctor. Since my childhood, I’ve had three of them:
1. Dr. Zaritsky was our family doctor until I was an adult. He had delivered each of my mother’s five babies, and made regular house calls when any of us got sick. That kind of true patient-centered care is truly ancient history in this country.
2. My second family doctor ran a “New Patients Welcomed” ad in the paper announcing the opening of her family practice after we’d moved out west as newlyweds in the 1970s. If ever I woke up with a severe sore throat or any other troubling symptom, I knew I could call her office and she’d check it out that morning. I liked her a lot – until the day she decided to open an all-cash Botox Clinic within her family practice clinic. Overnight, she was solidly booked two weeks in advance. She told me that this new clinic was her “retirement plan”. As my daughter (who had been her patient too since infancy) told me: “Dr. R. hasn’t yet put up a sign saying “I am no longer interested in the practice of medicine” – but that’s what she’s telling us. . .”
3. My current – but sadly, soon-to-be-retired family doc – rescued me from the Botox doc. I was whining one day to my friend Dan about the Botox marketing videos on continuous loop in my doctor’s exam rooms. Each video showed sad women with wrinkly faces before Botox and then happy wrinkle-free faces after Botox. Dan had a friend in his meditation group who was a family physician, recently returned to Canada after 14 years working overseas for Doctors Without Borders. That sounded like a far more noble profession than poking needles into women’s faces. Dan asked his friend if she could accept one more patient – and that’s how she became my family doctor!
For the past 15 years, we’ve had an exceptionally positive doctor-patient connection. But our healthcare system is very different now than it was then. The “Dear Valued Patient” letter suggested I should ask my family and friends to see if their doctors can take me on – just as Dan had done for me. The trouble with that suggestion is that now there are no family doctors in Victoria taking on new patients anymore. *
So this past week, I’ve been feeling dreadfully worried by the news of my doctor’s upcoming retirement. That doesn’t mean I don’t fully understand her need to retire. She deserves to be happy and to retire well.
A 2023 study published in the British Medical Journal (BMJ) found that more than one quarter of patients were no longer even seeing a physician during medical visits – but instead are seeing pharmacists, nurse practitioners (NPs) or physician assistants (PAs) for our care.(1) In fact, the study reported that the percentage of clinical visits handled by non-physicians has nearly doubled in recent years.
I agree with Tony Keller, who lobbied in his highly-recommended Globe and Mail column last summer for Canada to sharply increase the number of our nurse practitioners. He describes NPs as “the one group of healthcare professionals who can compete with family physicians” because (unlike PAs) NPs are legally allowed to open and run patient clinics independently.
This may seem outrageous to some family physicians, but desperate times call for desperate measures. People who have been to medical school are understandably prickly about this notion of NPs daring to “compete” with them. Many see this competition as clearly inferior in every way. But patients who have lost hope in every finding a family physician anywhere on the horizon don’t have the luxury of waiting around until governments start expanding medical schools that will one day churn out the physicians we need.
What we need is accessible care for people who right now are seeking care in impossibly over-booked Emergency Departments because they believe they have nowhere else to go. And I have to steel myself for lining up from now on at Walk-In Clinics (if I can get in) and Emergency Departments (if I can get in).
At this point, I’d sign on to almost any care provider with a detectable pulse. I’m still reeling from the profound shock of knowing that – unless new family physicians move to Victoria between now and December – and then generously invite me to join their family practice – I will be on my own.
“Dear Valued Patient . . .”
Funny, that. I do not feel valued at all.
.
1. Patel SY et al. “Provision of evaluation and management visits by nurse practitioners and physician assistants in the USA from 2013 to 2019. BMJ. 2023 Sep 14;382:e073933.
♥
Envelope image: Geralt, Pixabay
* BUT WAIT – THERE’S MORE! ! !
* UPDATE: August 6, 2024:
Dear readers, I have such happy news! Today, I met the Nurse Practitioner who will be my new primary care provider! A million thanks to my friend, Peggy – who somehow pulled off a miracle for me. She must have done a stellar sales pitch while convincing her NP to accept me as a new patient. Exactly 29 days ago, I started feverishly begging everyone I know to please-please-please ask their own family practice clinics to take on just one more new patient – despite every clinic having a policy of “Not Accepting Any New Patients” .
But today, something shocking and surreal happened. This morning, I found myself in a nice bright family practice clinic, while a charming receptionist measured my blood pressure, weight and height details for my new medical chart!
“For my new medical chart. . .” This was really happening to me!
My retiring family doctor could not help me. Getting my name on an endless government waiting list does not help me when there are one million people here in B.C. ahead of me on that list. Calling, emailing and sending letters in the mail to every family practice office in town did not help me.
But knowing Peggy, who went to bat for me, is what helped.
I cannot possibly thank you enough, dear Peggy! ♥
The last question my new practitioner asked me at the end of our scheduled “meet & greet” appointment this morning was:
“Do you have any other concerns before you go?”
Concerns?! I may have some minor concerns some day. But today is not that day.
Because today is the day I have a new family practice clinic again.
❤️ ❤️ ❤️
Q: Have you ever received a “Dear Valued Patient” letter from your own doctor?
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NOTE FROM CAROLYN: I wrote more about the medical provider-patient relationship in my book, “A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University Press). Find it at your favourite locally-owned bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from Johns Hopkins University Press (and use their code HTWN to save 30% off the list price when you order)
Heart Sisters 
About 10 years ago, I was shocked to find out that my family doctor of 30 years was semi-retiring by cutting out her most complicated patients – and that included me! No referral.
I decided to go to walk-in clinics for minor problems as a way of assessing physicians. To my horror, they were terrible! One never even approached me. He stayed at a desk, LOOKING AT A COMPUTER the whole time he talked to me.
However, I kept at it and at one walk-in clinic where they also had patients with appointments, I found the female doctor direct, personable, not in a hurry, even with a sense of humor. I told her that I needed a new family doctor and asked if she would take me on. Yes!! She does well for me.
I’m in Alberta, not B.C., but I hope you can do the same with the same good luck.
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I really like the happy ending of your story! I too am hoping I’ll have the same good luck you did.
That is so awful about the “most complicated patients” being cut by your former doctor – they’re the ones who really need a dependable family doctor the most! When my soon-to-be-former doc had to start working part-time for family reasons, she told me that she’d decided just the opposite of your experience. I made the cut specifically BECAUSE my chronic conditions were deemed more problematic, while she let go of the “young, healthy” patients – assuming that statistically, they’re less likely to need that level of care that we do.
I like the idea of basically previewing MDs at Walk-In Clinics (hoping to find one that’s as good as your female doctor – although I do NOT look forward to having to book an appointment at Walk-Ins. Few Walk-Ins if any in Victoria are truly WALK-IN – all require booking appointments by phoning the minute the clinic opens in the morning, getting a busy signal (of course) then redialing/redialing/redialing for half an hour until finally you hear a dial tone, and then a recorded message saying “I’m sorry, but all available appointments are now fully booked for today!!!” – a really frustrating scenario that many people I know have told me about.
Or worse, encountering “terrible” doctors in person and feeling even more discouraged!
Thanks for telling me that sometimes, things work out pretty well!! ❤️
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Hello Carolyn,
I do sympathize with the imminent loss of your family doctor. When our GP retired a few years ago, he was very lucky to find a replacement. We don’t have the same rapport with our “new” GP, but at least we have somewhere to go! And West Coast General Hospital here in Port Alberni has also been a lifeline.
I remember when we lived in Ontario for a while and did not have a family doctor – going to the Walk-in Clinic was very impersonal and you just don’t feel that the doctor of the day is invested in your care.
Might I suggest that you talk to the receptionist at your current doctor’s clinic? If she/he is moving to another clinic, they may be able to fit you in – especially as she knows your current health problems.
Good luck!
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Hello Sue – having any GP or NP now – anybody at all! – seems to be a luxury worth celebrating!
As you say, at least you have somewhere to go! I have rarely had to go to a Walk-in Clinic in all the years I had a regular family doctor – but the stories I now hear from my friends sound grim: in most cases, it seems you can’t just “walk in” (despite the name!) You must start phoning the minute the clinic opens in the morning to get an appointment, either in person or a phone appointment(by then, the lines will all be busy so you’ll keep re-dialing and re-dialing until at last you hear the dial tone – but the recorded voice that finally answers merely says: “Sorry, all available appointments for today are already booked!”
Thanks for your suggestion to talk to the receptionist at my current doctor’s office – but the reality is that for the past year or so, there is no receptionist answering the phone – all appointments are booked by clicking on an online calendar on the screen that shows the next available date and time. There basically isn’t a real live receptionist to talk to. To make an appointment, we’d have to go to the clinic website, click on the “Make An Appointment” tab, either show up on the day of the confirmed appointment – or more and more often be given a phone appointment only, and the doctor would call us on that date & time to chat about the reason for the call. All of these changes happened gradually over the years – until they all just seemed “normal”.
It’s a pretty bleak prognosis for our doctor-patient relationships!
Take care. . . ❤️
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I’m so sorry to read this; it’s awful. I got a similar letter five months before my MI in May 2021, and it was a scary time.
I’m also in Victoria. I don’t know if Nurse Practitioner clinics are still maintaining individual wait lists here, but that might be an option. After 14 months (back in 2021/22) on the NP clinic’s wait list, I got the call on Valentine’s Day 2022 letting me know I’d been accepted into the clinic and was assigned an NP. It might be a shorter wait now (she says hopefully and possibly somewhat naively).
Having an NP has been the best experience as NPs have more time with patients which is important for those of us with chronic disease(s) and complex needs.
I have both CAD and MVD, as well as chronic vestibular and sensory migraines. The two categories of diseases make medication a challenge as most heart meds are contra-indicated with most migraine meds. It’s this type of complexity that makes having a primary care provider so critical.
I wish you the very best and am keeping my fingers and toes crossed you find someone in the next five months.
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Hello Simona – thanks for crossing your fingers and toes on my behalf! I would be happy to have a Nurse Practitioner for all the good reasons you list! I’ve found one NP Clinic in James Bay which sounds lovely – but it requires a monthly subscription fee which I just cannot afford. I’m going to call the 811 Nurse Line to talk to a real live person for info on how to get on the NP waitlist. You’re so right – complexity of chronic illness makes a primary care provider compulsory (MD or NP, both are fine!)
Thanks for that big vote of confidence about your NP experience! ❤️
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Oh wow. I am sorry to hear this has happened to you. It is very scary, as someone with a medical condition.
It is amazing how fast things have deteriorated in BC – during COVID, my partner’s GP of 25 years retired. He put himself on the wait list and had a GP in 5 months. Shortly afterwards, my GP retired and I put myself on the list 14 months ago – and have heard nothing.
I was very willing to accept a nurse practitioner but none of them have appeared out of the woodwork. The local walk-in clinic has stopped seeing walk in patients and now I have to drive 15km away to some sort of emergency triage walk-in clinic. And I live next door to Vancouver!
I desperately wish Canada would allow private health care. It’s funny how our American neighbours always say, ‘But you have free health care!’ And I point out to them 25% of British Columbians – and Canadians – have NO Health care because with no GP, you don’t have access to prescriptions and referrals to specialists.
Then my American friend might scoff, and go surely not – even your PM? And the answer is yes, unless they can afford to cross the US border and pay out of pocket, they too would be restricted to ER’s and too few walk-in clinics and put on a long wait list.
The provinces don’t help either with their ridiculously high barriers to letting in foreign-trained medical professionals. Why would they come to Canada when they can practice in the US, UK, NZ or Australia within a month or so as their colleges have systems to get physicians practicing ASAP without having to do 2 years of additional education before being able to practice (which is absurd if you have been practicing elsewhere for 5 or more years).
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Hello travelblips – the wait lists are unmanageable in our broken system. My 9 year old granddaughter, for example, had two trips to the Emergency Department with her parents last month after alarming and mysterious symptoms were worsening every day. (They do have a family doctor, who happened to be away on vacation – with no locum doctor to fill in while she was gone). During the family’s first trip to Emerg, she and her parents had to wait 8 hours before being triaged by an Emergency nurse. The second trip took 10 hours of waiting. Even before my family doc announced her upcoming retirement and I had regular follow-up appointments with her to discuss my lab results every three months, our appointments were by phone only. And even last fall, when I had a nasty case of bacterial conjunctivitis (pink eye), I was unable to speak to a live receptionist at my doctor’s office or even leave a message – their outgoing message directed me to the office website where I could book an appointment online – but their first available spot was two weeks away. if I’m having an urgent problem, I should go immediately to the Emergency Department.
It seems clear that the problems (including the points you make about jump-starting foreign-trained doctors certifications) are catastrophic ones that were predictable decades ago as our huge Baby Boom cohort of citizens became seniors. THAT’S when our Health Ministries could see the writing on the wall. Any systemic improvement they implement today will take YEARS to trickle down to the patient’s bedside!
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Hello Carolyn,
I am so sorry for your situation. I grew up watching Marcus Welby MD and other TV shows representing the quintessential family doctor yet I don’t remember ever really having one!
Maybe because we moved several times when I was young. The Health Maintenance Organization ( HMO) I belong to here in the USA serves as an organization of Internists and specialists where my Primary Care Physician (PCP) is the captain of my “team” of Specialists.
I have an OB-GYN. Cardiologist, Endocrinologist, Hematologist, Dermatologist, Spine Specialist, GI specialist,Optician and Nephrologist all of which I see at varying intervals for preventative Care and ongoing management of chronic conditions.
In the 13 years I have been in this HMO, I have received Dear Valued Patient letters from 4 PCPs and 1 cardiologist.
My closest relationships are with my specialists rather than my PCP.
I think the increase in knowledge in the fields of health and medicine has caused the growth in specialization over generalization. How do General Practice physicians, GPs, keep current in so many areas?
That, along with the fact that the number of physicians willing to give up a work-life balance for 40 or 50 years has also caused a decrease in those choosing to be GPs.
There is an ongoing program being sponsored by a guru in Southern India where intelligent youth, in very rural communities, are being recruited for totally free, upper level education and medical school in exchange for returning to their rural communities as doctors.
I believe that in New York they are also experimenting with free medical school to try to meet the increasing needs for general physicians.
Does Canada have a plan to increase the number of Family Doctors?
Wishing you good fortune in finding that new doc!
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Hello Jill – thanks for your good wishes in searching for a new family doc! That HMO description of yours sounds pretty spiffy (all those specialists when you need them?!) – yet you too have received FIVE of the dreaded “Dear Valued Patient” letters so far. I agree, family medicine can seem far less attractive to med students who are considering other more lucrative medical specialties. I love watching this video of the Albert Einstein School of Medicine in NYC where the med students learn that from now on their tuition will be free, thanks to a $1 billion donor. It’s fantastic!
Here in my province of B.C. we unfortunately have no such generous donors. There are of course scholarships and government student loans – but no financial incentives to actually produce what we need: more doctors. Our federal government does however have a program to forgive student loans – up to $60,000 for physicians and $30,000 for nurses – if they agree to practice in rural areas for a specific period of time. Over 90% of our graduating medical students work in cities – so a big gap in care for all under-served small towns/rural regions – as in most other countries.
The government claims this rural incentive is working (over 18,000 doctors have apparently moved to rural areas since 2012).
There has also been some discussion about fast-tracking foreign-trained med school grads to be able to have their credentials acknowledged here (these grads often find it difficult/impossible to land residency positions once they return to Canada). Our province claims that, thanks to some big doctor compensation improvements here in B.C., “we now have 700 more family doctors”. I have no clue where those 700 family docs are – they are NOT here in Victoria!
Another obstacle in attracting more med students into a family practice career here in Canada is just medical school itself: we should have seen the writing on the wall decades ago so that we’d have more than only 2,800 first-year openings at Canada’s 17 medical schools each year – so (not even counting drop outs over the years) that’s simply not enough for the 6 million Canadians who do not have a family doctor. And they need a doctor NOW, not a decade or more from now when these students finally graduate. It’s a hot mess out there. * SIGH! *
Take care, Jill. Let’s all enjoy our fond memories of watching Marcus Welby MD. . . ❤️
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Hello Carolyn,
I’m grateful to have so many doctors to call on here in upstate NY, but I wanted to say that I understand this, for the growing doctor shortage is a terrible reality in the US too.
I am especially concerned in these days when I read that the number of OB/GYNs in America is dwindling due to the whole abortion debate and the threat of lawsuits.
Imagine being of childbirth age and having no doctor in your community (or even state! — this seems to be becoming a reality in some places!) to give you care and deliver your baby! Actually gives you one thing to be thankful for at age 67 — to be way beyond that time of life.
But what I really wanted to say was that (in my experience anyway) nurse practitioners are great. My primary care is a NP who is fantastic and in many ways better than any doctor I’ve had. She takes the time to listen, talk, ask questions, care, etc, and sometimes I have to remember that she is not my counselor or friend but my healthcare professional.
She can do referrals and prescribe medications and do most of the things a family doctor can do. I also see NPs at my cardiologist’s office for routine periodical visits, and they have been fantastic too.
I hope the number of NPs in Canada increases, because this seems to me to be a good solution to the shortage of doctors, although here they have to work under the supervision of a doctor. In any case, I hope you can find a good primary care person very soon.
(By the way, I also am developing arthritis so I sympathize with you on that. Exercise is very helpful — try to keep your joints moving!)
Side note: I’m grateful that there are still some doctors here who are accepting new patients, especially since I was just handed the diagnosis of breast cancer, something I never dreamed would happen to me (ha! just like the diagnosis of heart disease!).
Just starting that health journey with my first visit to an oncologist this week. I’m told we are catching it very early and it should be okay, but we shall see.
God bless!
Meghan McComb
“The two most important days in your life are the day you are born, and the day you find out why” * Mark Twain *
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Hello Meghan – first of all, I’m so sorry about this new breast cancer diagnosis. I’m keeping fingers and toes crossed for you that the docs have caught it early enough and that your treatment will be uneventful and successful!
I agree with you completely about the shocking change in American women’s freedom to make their own healthcare decisions (along with their doctors’ guidance) without being dictated to by a bunch of old white men in government! WTF?!?!?
I agree with you about the value of Nurse Practitioners, for sure. I’ll continue to search like mad hoping against hope that somebody somewhere will be able to help me.
Take care – good luck at your oncology appointment! ❤️
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My husband and I actually got that very same letter in the mail yesterday!
Fortunately for us we still have great options, but I chose our primary care physician after researching, calling, and questioning the front desk staff.
I was in dentistry for 45 years and when our patients told us they were moving away and worried about finding a new office like ours, I advised: ask the local Dental Society, ask your new neighbors. But most importantly, call the office you are thinking about going to and quiz the front desk person who answers the phone. They should be well versed in that doctors qualifications and be able to explain their education, like a live talking billboard.
I would ask what specialist they refer to when procedures are outside their scope,. I found that if the front desk was well informed, the doctors quality of care was almost always exeptional.
Luckily for us my primary care clinic has a new physician and I met her a month ago when I needed urgent care and I really liked her. I think she will be a good choice.
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Hello Jennifer – you are indeed fortunate. But your experience reflects a reality that is completely unavailable to people like me (and to over one million of other patients in my province who have no family doctor, and as this post explains: WITH NO REPLACEMENT PHYSICIAN in place).
The thought of calling local family practice clinics to “quiz” the front desk person about the quality of the medical team is simply a fantasy here. It used to be, years ago, that even in family medicine clinics that had posted signs saying “WE ARE NOT ACCEPTING NEW PATIENTS”, we might still get accepted IF one of their longtime patients put in a very enthusiastic good word for us. But a severe family doctor shortage means those days are gone.
Here, there is no “interviewing” of medical desk staff working at “the office you are thinking about going to”. This is a crisis in our healthcare system.
This reality is very different than looking for dentists here, by the way. There are lots of dentists, and all dentists openly advertise their services to recruit new patients.
Take care – be grateful for your new physician ❤️
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