Patients having trouble finding doctors — or waiting too long to see specialists and get treatment — haven’t seen anything yet, suggests a study by B.C. researchers that was published Monday.
That’s because about 40 per cent of B.C. doctors are at — or near — the average age that doctors retire, 65.1. And to exacerbate things, the study in the Canadian Medical Association Journal shows that 40 per cent of doctors reduce their workload at least 10 per cent in the three years before they retire.
The problem is particularly acute for patients preferring female doctors or living in rural areas. Female physicians tend to retire four years before male doctors, and on average, rural doctors retire just over two years earlier.
It is hypothesized that rural doctors may retire earlier because of burnout or because of lower cost of living but regardless, “early retirement in these communities is of particular concern, given that many rural areas are known to have substantial difficulties recruiting and retaining physicians,” says the team of authors from the University of B.C., Simon Fraser University and the Vancouver Coastal Health Research Institute.
Lindsay Hedden, lead author and UBC researcher, said governments rely on College of Physicians and Surgeons licensing “head counts” but that may not be the most accurate method of counting doctors because many keep their licences active even when they wind down their practices. “Our findings (based on billing data) indicate that current forecasts likely overestimate the supply of physicians that will be practising in the future and the amount of service they will provide.”
The federally funded research shows that since many doctors reduce clinical workloads leading up to retirement and many retire slightly earlier, “it could make it more difficult for people to access care in the future, particularly in rural areas where the physician shortage already poses a significant challenge,” said Hedden.
Dr. Trina Larsen Soles, president of Doctors of B.C., said that while it’s helpful to have fact-based data for workforce planning, she has reservations about the “implication” that female doctors aren’t “working our butts off.” And she said rural doctors in under-serviced areas become exhausted because they frequently have to work nights and weekends on call.
“As well, while retiring doctors may curtail seeing patients, many still teach, take administrative jobs in health authorities, and work for the College of Physicians and Surgeons. They reinvent themselves in roles that still help the health system.
“Having said that, we do have a shortage of physicians and it’s going to get worse because of population demographics and that means that we need to find ways of working differently so that doctors are freed up from clerical work so they can spend more time with patients,” said Larsen Soles. She added that she believes the government is “sincere” about establishing team-based practices utilizing allied health professionals like nurse practitioners and social workers.
Hedden said that while most doctors operate their practices as “business owners” within the fee-for-service model in which they are paid for each patient interaction, different models of payment may encourage more doctors to work longer.
“Having the option of more flexible models of practice, including (group or shared practices) and team-based models, may help retain physicians and reduce burnout. These options may also be more attractive to younger physicians,” she said.
The study of physicians aged 50 and older in B.C. included data spanning six years and showed there were 4,572 physicians who were at least 50 as of March 2006 and had worked at least one year between 2006 and 2012. Retirement was defined as a permanent drop in taxpayer-funded payments to less than $20,000 a year.
The average age of retirement was 65.1 years. Women retired four years earlier on average and doctors working in rural areas retired earlier 2.3 years early on average. There was no difference in retirement age by medical specialty. Researchers observed four patterns of pre-retirement activity: a slow decline in the number of patients seen, a rapid decline, holding steady and even increasing activity.
Susan Prins, spokeswoman for the College of Physicians and Surgeons of B.C., agrees there’s a critical problem because of retirements. The College reports on the number of physicians who hold a licence, not how many are providing full services to patients. It requires registrants to self-report the total number of clinical hours they worked in the previous year on their annual licence renewal form in order to remain current. According to College bylaws, a registrant must have practised clinically in his or her field for a minimum of 960 hours over the preceding three-year period to be considered current.
Prins said the College has no jurisdiction over the supply and distribution of doctors; that’s the responsibility of government.
“It is true that many doctors are going to retire in the coming years, and that has been identified as a serious problem.”
She said the College supports initiatives that help internationally trained family physicians to obtain registration in B.C. if they meet criteria. Prins agrees with Larsen Soles that a more integrated health model including paramedics, nurses, nurse practitioners, midwives, physician assistants, and others would help buffer the shortage of doctors.
“There are solutions, but funding models need to change, and there needs to be a coordinated health human resources strategy to ensure appropriate distribution of physicians, nurses, nurse practitioners, and other primary care providers to support an equitable, accessible health system,” she said.
B.C. doctor demographics and supply problems: 2017 snapshot
• There are about 11,600 physicians licensed to work in B.C. according to the Canadian Medical Association. The College of Physicians and Surgeons shows 12,187.
• The CMA says 1,900 active doctors are over the age of 65 and 3,010 are aged 55 to 64.
• HealthMatch B.C. shows there are 759 openings for doctors across B.C. It is not a complete list of all vacancies.
• The latest Canadian Institute of Health Information (CIHI) report shows that 15 per cent of B.C. residents don’t have, or can’t find, a primary care doctor.
Sources: Canadian Medical Association, Health Match B.C. and CIHI