The Slow Death of Primary Care: A Canadian Perspective

The Slow Death of Primary Care: A Canadian Perspective

Loss of autonomy, gaslighting, abuse, exploitation and hypocrisy are strong words. Just writing them reminds me of the harsh reality of my experience and the collective experience of others who have dared to speak out. These words come to mind when I think of primary care in Canada. I recognize that similar sentiments are being heralded by my American colleagues and those in the UK.

The system is faulty. It does not work. The people who are on the front line, caring for patients day in and day out, are being left behind by the system. We are overworked, underpaid and undervalued. Our opinions and expertise are often ignored. We are told to do more with less and given impossible deadlines. When we speak up, we are often met with gaslighting and denial.

It is not sustainable; something has to give.

Many of us have already given up. We have completely abandoned primary care or gone part-time. We got exhausted and frustrated. So the next question is what should a person do with these feelings. We can withdraw and isolate ourselves, be proactive and turn difficult situations into something positive. At the beginning, I chose to reflect, but now I act.

When I was younger people would say, “wow, you want to be a doctor”, or even as an adult, as I reluctantly admitted to my profession, there was usually a sense of admiration from the part of people. Then, the next question that people often asked was: “what is your specialty?” I would say “family medicine” and I could sense the palpable disappointment in their response. It was as if the family practice was somehow inferior to. It was not just strangers who expressed these sentiments, but also colleagues and those who knew me closely. So many years ago, a doctor’s wife remarked, “Oh, why do you choose family medicine? It’s not very glamorous. Even in medical school, students are often discouraged from applying for family medicine residencies for many reasons.

Contrary to what many assume, family medicine was my first choice. I felt this was a specialty area where I could use my vast knowledge base and help a patient. I also believed that the knowledge I had acquired could save someone’s life and potentially even that of my future family. I didn’t know that my understanding and persistent stubbornness saved my life and my family’s life when I became the patient.

However, the longer I stayed in the profession, the more I realized that medicine had been glorified to perhaps hide the truth – as doctors, we are essentially puppets in the healthcare system. Politicians may smile and pretend they are making changes and listening, but we on the front lines often don’t see those claims turn into measurable differences. After all, many people think of healthcare professionals as their “health care taxes in action.” I remember hearing comments that sounded like doctors were somehow indebted to taxpayers’ money. Accordingly, it is our duty to do whatever it takes to get the job done.

The system was failing, and it was failing us.

It took a lot of courage to decide that I could no longer be part of a system that was so broken and causing immense suffering – not only to patients but to those of us who swore no harm. So, I decided that I would no longer be an accomplishment because of inaction and lack of leadership in health care. I felt I was part of the problem by allowing those who should be the solution to avoid making real change because they know medical professionals will continue to be abused. And so, I left and took a break from family medicine.

It’s time for those on the front lines to speak up and demand change. The status quo is no longer acceptable. We cannot allow the slow death of primary care to continue. It’s time to revolutionize health care, and it starts with each of us taking a stand.

I now realize that the system will not change overnight, but you have to start somewhere. We must start by demanding better support and better working conditions for doctors. We must stand up for our patients and fight for the changes needed to save lives.

Before publicly announcing to my practice that I was stepping down as a clinic owner and having my own practice, I did a lot of soul-searching. I remember asking myself: “what am I doing with my life? “I felt like I was wasting my life in full-time medicine and not fully utilizing my talents. I knew I was missing so many things that life had to give, and that had to change. I loved being a doctor, but the business side of things, politics and, quite frankly, gaslighting, drained my energy and took away the enjoyment I used to practice.

The system is sick. And it makes us sick.

I am concerned about the slow death of primary care.

Primary care is the foundation of health care and must be addressed. Instead, it is strangled by a system that prioritizes quantity over quality and puts profits before people. In primary care, we are being asked to make the proverbial strawless bricks – with more and more expectations placed on one. In many parts of Canada, we are being asked to act as “the health care system” without the adequate financial and human resources to do the job. We are often blamed for system problems that have nothing to do with us.

You see, competent and knowledgeable health care providers do not manage health care. Health care is often run by people who know next to nothing about health care leadership. they know very little about health care and the short and long term consequences of their actions. When the solution to long ER wait times and long wait times to see health care providers is to hire more administrators, that, in my opinion, is a wake-up call. So you see, we don’t need more admins. We need people who know what they are doing and who listen to health care providers who unfairly shoulder the lion’s share of the workload. When you look at the structure of our health care system, there are far too many managers who know very little about health care, but who make decisions that affect us all.

In my view, the slow death of primary care is a direct result of the mismanagement of our healthcare system by individuals driven by power and greed rather than a genuine desire to improve people’s lives. We need to take back control of our health care system and put it back in the hands of those who know about health care.

It’s not sustainable. It is not suitable for our patients and not good for those who have dedicated their lives to caring for them.

We need to speak up, we need to demand better, and we need to fight for the future of primary care. Otherwise, we will all continue to suffer.

Primary care is slowly dying across the country, and everything that primary care supports is also failing. Emergency rooms are flooded, comprehensive care is lacking, millions of people don’t have a family doctor, surgery wait times are skyrocketing, and so on.

This is not the fault of the individual doctor. I repeat: it is not the fault of the individual doctor. They are excellent doctors practicing in an unsustainable model of care. Simply put, great documents in a bad system.

I believe that a better trained medical workforce will help rectify the current system. The relationship between physicians and health organizations must be strengthened, the trust between them must be renewed, their visions reassessed and their mutual expectations must be clarified. And it should be initiated by the doctors themselves. Institutions led by managers and their leaders will automatically see physician leaders as equal and important partners in the effective delivery of health care and the overall effectiveness of the organization.

As the organizational structure changes for the better, increased attention needs to be paid to identifying high potential physicians and training them through formal development programs. And that will only be the beginning of how physicians can more proactively shape the future of healthcare rather than passively being recipients, along with patients.

Tomi Mitchell is a family physician and founder, Dr. Tomi Mitchell Holistic Wellness Strategies. She can be reached on Twitter @DrTomiMitchellFacebook, Pinterest and Clubhouse.

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