Why young doctors aren't taking over from retiring physicians

Dr. Graeme Bethune's examining table has been with him for nearly four decades.

There's now a 'free' sign on the vintage turquoise table that has hand-knit socks covering the stirrups.

But Bethune hasn't been able to find someone to take his old office equipment, let alone his practice.

The former Halifax family physician is one of a number who are leaving their practices this year with no replacement. He says finances and support are huge deterrents to recruiting young doctors to take over private practices, and the patients are suffering as a result.

"Patients would come to me and say, 'What am I going to do, what am I going to do? Find me a doctor. Please help,'" Bethune said. "It was difficult."

Many deal with guilt, but Bethune says he retired in May knowing he did everything he could to help his patients. Bethune gave one year's notice that he was retiring. In that time, he only had interest from one resident to take the practice, but it didn't pan out.

Bethune then found himself advocating for his patients, and asked favours of his colleagues. In the end, he found a new physician for about 600 of them.

"There were some that I really specifically looked for who absolutely had to have someone to follow them. Those with cancer, and other chronic illnesses that just couldn't manage by themselves," he said.

More than 1,000 of Bethune's former patients are now without help. Their files are still in his old clinic, along with the free furniture.

His north-end office remains vacant despite the cheap rent and low operating fees.

"By nature I'm an optimist, but I'm not optimistic at all now. I think it's disgraceful that every Nova Scotian does not have a family doctor. And it's getting worse."

Options with no overhead costs

One of the problems, says Bethune, is that those who specialize in family medicine now have a number of options compared to when he graduated.

"You can go to work in the emergency room, you can become a hospitalist, who is a family practitioner who specializes in hospital care," he said.

Those other options come with built-in support systems and no costs of running a business. Bethune says for young doctors, the math around a private practice no longer adds up. Those who run private practices take home significantly less than those who work in hospitals.

He says the province could tempt more people to enter private practice by either increasing their pay so they can afford to hire support staff or paying for the staff directly.

"Help me hire a family practice nurse. That position can do a lot to help a family doctor in his or her office," he said.

Bethune says some in private practice do pay for family practice nurses.

"They have to pay for it by seeing more patients. I find that unfair when you compare it to the hospital setting where a lot of specialists and others have physician assistants, for a lack of a better words. They don't come out of the back pocket of the physician. They're supplied by the institution."

Bethune isn't the only family physician with these concerns. Last year, Dr. Timothy Matheson posted his financial information on his practice website to show how difficult it is for a doctor to make money while operating an office. 

No physician to follow up with

In Kentville, Sharon Kehoe knows all too well about young physicians who aren't happy with the current financial structure for private practice.

Her family has had countless doctors at the clinic they've gone to since 1985. That was, until a few months ago when she says her most recent physician left to work at the hospital.

Three generations of her family are now on the provincial wait-list.

"So we're out in the cold … without any primary medical care and we're at an age where it's starting to become even more important."

On Monday, Kehoe's husband went to Valley Regional Hospital to get fitted with a blood pressure monitor. They found themselves in a predicament.

"There's no one to report the results to. So I guess there was quite a conundrum at the hospital with what they're going to do with the results when they get them."

In the end, Kehoe says the hospital agreed to send the results directly to the family, so they can take them to a walk-in clinic or emergency room to be assessed.

Bethune says those types of situations are simply unacceptable.

"We're the gatekeepers into the medical system in Canada," he said. "Everyone needs a family doctor. It's simple to me. Walk-in clinics don't cut it. They need a consistent person."

Readers who wish to share their story about searching for a physician can contact [email protected].