Three years after starting his family’s practice, Dr. Christopher Ablahite says he regularly considers quitting smoking.
Applewhite practices on Salt Spring Island, British Columbia – the largest of the province’s Gulf Islands – where, he says, half the population is without a family doctor. This number is significantly higher than the estimated figure for one in five British-Colombians without a doctor.
Despite the rising number of people without a GP, Applewhite says he’s not the only physician reconsidering a career in the county.
Canada is facing a shortage of doctors due to an increasing workload and declining wages.
On average, approx 15 percent of all Canadians aged 12 and over report not having a regular health care provideraccording to Statistics Canada’s 2019 report. A survey published this month by The Angus Reed Institute suggests that the number is now close to 20 percent.
Talk to Applewhaite White coat, black art He hosts Dr. Brian Goldman in his office on Salt Spring Island about what he has experienced in his practice – and what systemic problems might mean for the islanders.
Here is part of that conversation.
And now, more than three years later, what is the mood for you and your colleagues?
So I think people talk with their feet. Practices are closing across British Columbia at an alarming rate. I don’t know where the doctors go, but they disappear. I think some of them leave medicine altogether. They are retiring.
I once assumed they would work as hospital doctors. But when speaking to one of my colleagues in the hospital program, they also struggle to find people. So people quit training altogether.
Including here in the practice.
Including here in the practice, yes. We have left a few times in the past year or so. Only one of these doctors was able to find a replacement. Because of this, this island community’s bonding rate is only about 50 percent, currently. So the majority of people don’t have a family doctor on the island now.
I called this area the swamp. Why do you call it the swamp?
So this is the room where paperwork is done and family doctors everywhere have a great deal of paperwork to do. The burden of that has been increasing even while I’ve been working it out, which isn’t very long.
I don’t know why, but, you know, insurance forms and notes … etc., multiply at an amazing rate. And unfortunately, we only get paid for the visits, which is really, you know, probably half of our work that we do.
Such as physically seeing the patient, making a diagnosis, and suggesting treatment.
Right. So I think my point is that this is the room where unpaid work happens. And I spoke to my teacher and former supervisor in residence about the way he practices in the city, which is five days a week in the office.
He estimates that when done full-time, it performs 20 to 30 weeks of unpaid full-time work per year, consisting mostly of paperwork and forms.
For the time you get paid, for the work you get, do you pay well?
My opinion is that I am not. $33, which is kind of the base price to visit in BC, seems pretty much insufficient. It certainly hasn’t kept pace with inflation, and every time it has been negotiated, it has essentially meant a wage cut because it’s far from inflation.
I don’t spend less time with my patients because I don’t want to [spend time with them]. I spend less time with my patients because of the funding model, because I simply can’t keep the lights on if I spend the amount of time I actually want to spend with my patients.
Just this week I had a mental health visit where a patient was revealing to me a very horrific trauma history, and I wasn’t about to tell that patient, listen, 10 minutes are up. it’s time to go. As a result, I let her tell me everything she wanted to say, which is so important for building the relationship that we hope will help her recover.
And I actually canceled some of my appointments for that day, and rescheduled them, so she could have time. And that’s what we all want to do, is give the required time. Of course, at the end of the day, I get $30 for that hour I spent with that patient.
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All that and then came COVID. What has COVID done to your practice in the office?
On the plus side, the government has been able to show a remarkable ability to make timely changes when it comes to the pandemic. More importantly, they allowed us to bill for virtual care at the same rate as we billed for personal care.
Most GPs liked to deal with simple things, like refilling a prescription, maybe checking blood sugar, that kind of thing, over the phone in the past.
But unfortunately the pay rate was so low that we always asked people to come. Telehealth is now a huge part of our practice and still probably has half or more visits per day… It’s great for patients and it’s great for clinicians. It could be more efficient and save everyone a little bit of time.
You’ve talked about moral damage… I’ve recently been through a couple of situations that have taken it to a different level. Can you talk about those?
I had a very unfortunate patient who was diagnosed with a brain tumor on imaging. She consulted a neurosurgeon who suggested she urgently get an MRI of the brain to fully describe what was going on, so she could have a real conversation about diagnosis and prognosis with the neurosurgeon and/or oncologist.
Unfortunately, the MRI scan, which the neurosurgeon ordered, took three to four weeks. The patient was deteriorating rapidly and eventually decided to seek medical help in dying.
Of course, many people choose medical help when they are dying, but I think every patient deserves to have a full range of information before they decide to go this route. More and more, this is not happening. People kind of raise their hands high, and I know it’s a bad thing and I don’t know when I’m going to see the cancer doctors, so I’m going this route.
How does such stories affect you?
It’s sad because it’s not the way it’s supposed to work. It is not the best patient care. And I know because I talked to them over and over in those six to eight weeks how much they struggle with waiting, not knowing, and unanswered questions.
And this extends to their families, their children, their parents, all these people are waiting and waiting and waiting and not knowing. And it causes a great deal of distress which, in my opinion, should not happen.
I’ve been here a little less than three years or about three years ago. Have you thought about quitting smoking?
I’ll be honest, I think about it on a regular basis. The only reason why I am [still] It does, and I think most of us do it [still] Doing that… now, in this environment, because we really care about our patients. And abandoning another group of people feels really sad and feels like a failure.
But as I mentioned, many, many people though have reached the point where they just decided they couldn’t continue and shut down their practices. So yeah, I’m thinking about it.
I hope that this county can change course and start making the meaningful changes needed to reverse this spiral of deterioration and have more family physicians in this county who offer a longitudinal family practice.