These med students want to become family doctors. B.C.'s compensation model is making them think twice

Some medical students in B.C. are rethinking their career paths as they near graduation amid a critical shortage of family doctors in the province. 

Nearly one million British Columbians don't have a family doctor.

Although the University of British Columbia has the largest family practice program in the country, with about 170 spots that are consistently filled by future physicians, that isn't translating into more family doctors in B.C. Some medical students say they are concerned about having to run a business on top of caring for patients, and say the financial viability of the current fee-for-service model doesn't make sense.

Jordyn Heal, 23, is about to enter her third year in medicine at UBC, and says although she's passionate about family medicine, her mentors are advising her to rethink it.

She said the fee-for-service model isn't "feasible" when it comes to making ends meet. 

"I need to think about myself in the practical aspects of being able to finance my own future," she said. 

"I feel a little bit guilty about that because I didn't go into medicine for the money. I went into it … to care about patients."

Most family doctors in B.C. are paid anywhere from $30 to $50 per patient visit, depending on age, whether they're treating a common cold or a complex chronic health problem.

They do receive higher payments for consultations, complete medical exams and minor procedures, according to the Ministry of Health. They also get annual per-patient payments of $125 for treating patients with chronic illnesses.

Physicians run their practice as a business, paying out overhead costs like staff and office space at an average rate of about $60 per hour or more.

Ivy Deavy, 34, went into medical school at age 32, with the intention of becoming a family physician. While she still intends to go that route, she says she's not as excited about it as she once was. 

"New grads and students like myself are thinking, why would I go into longitudinal care when it's not financially sustainable, when there's so much burnout, when the workload is overwhelming?" she told The Early Edition host Stephen Quinn.

She often hears of family physicians leaving their practices to work in telehealth, retire early or just pack it in altogether because the workload is too much and they can't afford to stay afloat.

"It's incredibly discouraging."

Deavy says the thought of having to run a business as well as provide care to patients is "incredibly daunting."

"We get no training in that," she said. 

"I get tons of training in identifying different diseases, training in medication, training in communication. I get no training in business. That is not what I am specializing in. It is not what I want to do." 

Deavy says people who are looking to practice family medicine have other options: they can work in hospitals, specialise in palliative care or find salaried positions in youth or sexual health clinics. 

If the current business model for longitudinal care — family physicians providing long-term care — doesn't change, Deavy says she'll consider those other options.

Health Minister Adrian Dix has said he recognizes that young doctors don't like the current business model for family physicians. 

"We have to do a better job recruiting new family practice doctors," Dix said. 

When he spoke with CBC last week, Dix said he'd be meeting with Doctors of B.C., an association that advocates for physicians, to discuss short-term and long-term measures to ensure British Columbians have access to family physicians.

For now, he points to urgent primary care centres and primary care networks, although critics say those models are not fixing the problem as they too remain under-staffed and overused.