Ontario docs are leaving – patients have trouble finding good doctors











{November 16, 2012}   Family Practice no longer worth Docs’ Effort and Investment

 

 

The breaking point: ‘I hate being a doctor’

 
Written by Dr. John Crosby on November 15, 2012 for CanadianHealthcareNetwork.ca
 

Photo

The Kindly Country Quack
 

by Dr. John Crosby

 

I recently had a doctor from northern Canada email me saying he had lost the joy of being a doctor. He was 10 years post-graduation and used to love his job as a family physician in a mid-sized city, working with 30 colleagues. Now he is just going through the motions. He can barely pull himself out of bed every morning and dreads the hospital and, worse, his office.

 

He said that when he got his acceptance letter to medical school he was the happiest he had ever been; he looked forward to an exciting life helping people get well, preventing disease, making brilliant diagnoses, saving lives and relieving pain. Now he is hours behind all day, with a standing-room-only waiting room, phones ringing and staff interrupting.

 

“I CAN’T EVEN GO TO THE BATHROOM”!! He shouted with capital letters in his email. “I munch a sandwich between patients because my lunch hour is full of sick people spilling over from the morning. I don’t see drug reps except to sign their receipts to get samples for my working-poor patients who can’t afford medications. They could be putting a (blank) cheque in front of me for all I know. Thank god I am overdrawn at the bank so the cheque would bounce.

 

“I am crabby with my staff, the hospital and nursing home staff, patients, family and the few friends I have left.

 

“My last patient limps out at 6 p.m., while I catch up on paperwork and e-mails until 8 p.m., sitting alone in my office with the light on over my desk, my shoulders slumped in pain and exhaustion. I look up at my medical school diploma and wonder where it all went so wrong.

 

“I get home to a supper sitting in the microwave ready for me to hit the nuke button. My kids are doing their homework, I say hi and my wife looks mad. She is watching Dancing With the Stars. I grab a beer and watch sports or sitcom reruns on our other TV until I fall asleep in front of it at 10 p.m. I toss and turn all night to wake exhausted, only to start again the next morning.

 

“Weekends are no better. My wife and I do chores all day Saturday and Sunday, and watch DVDs at night.

 

“By Sunday night that hollow, dreaded feeling in my stomach returns. When I’m on call, which is one in four, I am really crabby and tired and can’t sleep at all. I watch the phone, dreading a ring, as even a few calls throughout the night disrupt my sleep for the entire interval. I yell at patients if I think their problem is trivial.

 

“I am angry with the government and media for wanting more and more from doctors for less and less pay.

 

“Financially I am making a ton of money but it is all going into income tax, overhead and paying back my student debts. My mortgage, two cars and saving for my kids’ university and our retirement eat up the rest.

 

“I just read how, with 2% interest rates, I will need to have $2 million in my retirement fund just to make $40,000 a year (plus $12,000 in Canadian Pension plan) in retirement.

 

“I hate medicine. If I could afford it, and could do anything else, I would quit.”

 

Wow, how did I handle this one? Comment below or e-mail me at drjohncrosby@rogers.com. I will give you my solution in my next blog.

 

Dr. John Crosby is a family physician in Cambridge, Ont.

 

 

 

Below are Dr. Crosby’s solutions:

Some solutions for the MD who ‘hates being a doctor’

 

 
Written by Dr. John Crosby on November 21, 2012 for CanadianHealthcareNetwork.ca
 
 
In my last blog I spoke of a doctor who hated medicine. Working long hours and constantly running late were making him stressed and unhappy.For starters, I asked him to phone me at a time when he and I had an hour to talk. I gave him eight possible times that I was free, at breakfast or lunch.When he called I asked if he had a family doctor and like half of Canadian physicians, he did not. I made sure he was not suicidal and told him to get a respected family physician who was not a friend, which he did.I told him to get a full physical and lab workup and to be screened for depression. 

I advised him to get counselling. I told him the hotline number for distressed physicians was 1-877-CMA-4YOU.

 

Over a number of lunchtime phone interviews he squeezed me in and we went through the reasons that doctors late. He saw how he could time manage away a lot of his stress.

 

Too many patients

 

This doctor had more than 3,000 patients and practised in a medium-sized city with 30 family physicians. There were no doctors taking on new patients and he felt guilty about saying no to anyone without a doctor.

 

I advised him to advertise for an associate. He said that wouldn’t work and he couldn’t afford a pay cut. I said he was headed for burnout and would not be able to sustain this pace and give good care.

 

He advertised in the journals and with his local hospital’s medical staff secretary. He received an application from a local young doctor starting a family who signed on for one day a week.

 

His income dipped initially but then returned to the previous level because he was much more efficient and rested, and was seeing more of the easy cases that had been going to the ER and walk-ins because he had been too slow to see them.

 

He also hired a semi-retired nurse for a half-day a week for all his shots, well-baby exams, physicals and prenatal exams. He paid her $35 an hour, which came to $5,880 per year. This expense is 50% tax-deductible. The resulting cost is $8 a day. These two actions took a huge load off his shoulders.

 

Improper delegation

 

I advised the doctor to let his secretary do her job and for him to do just the things that require an MD. He had been filling in all forms.

 

He found that pharmacists were calling him about prescriptions a lot so I advised that he fax them instead and to return the fax stat so they wouldn’t call him.

 

He was on the phone a lot with patients so I advised him to have his secretary handle this, with his supervision.

 

Paperwork and emails

 

He was doing them while exhausted, from 6 to 8 p.m., and missing dinner with his wife and children. I suggested he do these tasks from 7 to 8 a.m. every weekday morning.

 

He was getting up at 8 a.m. so I suggested he get up at 6 a.m. and go to the gym or pool for a workout and exercise. This made him feel much better and sleep better at night. He could go to bed at 10 p.m. and get eight solid hours of sleep and wake up refreshed. He found he could get two hours of paperwork done in one hour because he was fresh and focused.

 

Now he is getting home for supper with his wife and kids and has time and energy to spend with them. He still watches sports while his wife watches Dancing with the Stars (you can’t change everything in life), but they meet at 9 p.m. to watch TV or read together.

 

In my next blog we will see how he handled office interruptions, patients with lists, and seniors.

 

 

 

Dr. Crosby continues with a follow up, promising to teach the poor doc how to make time for his wife.  On that note I’ve decided not to post any further installments of this kindly Country Quack who has appointed himself the well-meaning but unqualified “Dear Abby” of Ontario physicians.

 

 

 

 
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