Physician Burdens

The Physician Burdens engagement is now closed. Your input will be used to inform policy development at Doctors of BC. The results from this engagement have been included in a What we Heard report distributed to members.

Help us understand how we can advocate for you

We know physicians are frustrated by mounting demands. For many, the volume and pace of these demands has become burdensome, and this can have serious consequences for physicians and the health care system.

A dedicated, long-term approach that focuses on systemic change is needed. Doctors of BC is committed to advocating for this change.

A literature review and early member engagement revealed 10 key burden areas. We now need your input to understand if and how these impact you. Scroll down to the three blue tabs below to share your thoughts.

Your input will help inform policy recommendations specific to the BC context and enable Doctors of BC to advocate for solutions that reflect your experience and meet your needs.



Have your say

Take 10 to 15 minutes to share your input on this online engagement platform:

  • Go to Step 1 to help us Identify the burdens
  • Go to Step 2 to help us Understand their impacts
  • Go to Step 3 to Inform our solutions


Navigate through this online platform by clicking the three blue tabs below.

Help us understand how we can advocate for you

We know physicians are frustrated by mounting demands. For many, the volume and pace of these demands has become burdensome, and this can have serious consequences for physicians and the health care system.

A dedicated, long-term approach that focuses on systemic change is needed. Doctors of BC is committed to advocating for this change.

A literature review and early member engagement revealed 10 key burden areas. We now need your input to understand if and how these impact you. Scroll down to the three blue tabs below to share your thoughts.

Your input will help inform policy recommendations specific to the BC context and enable Doctors of BC to advocate for solutions that reflect your experience and meet your needs.



Have your say

Take 10 to 15 minutes to share your input on this online engagement platform:

  • Go to Step 1 to help us Identify the burdens
  • Go to Step 2 to help us Understand their impacts
  • Go to Step 3 to Inform our solutions


Navigate through this online platform by clicking the three blue tabs below.

Tell us what specific demands are burdening you or your practice.

Share as many specific examples as you'd like in the comment box below. Comments will be displayed below and can be viewed by other physicians.

Your input will provide further insight into if and how the burden areas identified in the literature and early member engagement impact physicians across BC.

Click the Submit button to publish your comment.

Firstly, thank you for forum. There are four major systemic problems with how family medicine is perceived and practiced in BC. 1) it is not appreciated for the speciality it is. With its own unique training, college oversight, rigorous examinations, continuing medical education, challenges and demands, it is one of the most onerous medical specialties. From an economic argument alone, the pivotal longitudinal role of caring, competent FP's to an efficient primary care stratum for the betterment of population health is indisputable. 2) it is shamefully underpaid in this publicly funded system. Simply put, no worker in the healing industry can accomplish their mandate without remuneration for the time required to actually do the job. A family doctor in BC who sees three complicated or needy patients per hour, paying typical overhead, will take home post-tax less than minimum wage in Alberta (less than $15.00 per hour.) MSP is NOT fee for service, but fee for ONE service per day. Patients and doctors are both losers in such an antiquated, stressful and unjust system. 3) Overhead costs are punitive. It is wholly inappropriate to continue to expect family physicians to subsidize the primary healthcare system out of paltry MSP income at their own expense. 4) Paperwork : Charting, letters, results, reports, referrals, prescriptions, requisitions, insurance claims, WCB, Pharmacare, benefit applications, parking badges, letters, sick notes, other notes etc are time consuming, soul destroying and unpaid or underpaid. If transformation does not occur imminently, FP workforce and morale will continue to plummet, recruitment could vanish, government costs will inexorably rise, and most importantly, population health will suffer. The choice is ultimately the government's. -- Posted on behalf of the user ttroughton

antony 3 months ago

- paperwork & transition to EHR in hospital setting- lack of appropriate admin support- increase complexity of health system: patients with multiple health & social issues, number of team members, privileging & credentialing, etc- excessive on-call hours & workload without appropriate remuneration- lack of recognition & remuneration for non-clinical duties- financial & retirement planning: tax changes, having to build own pension plan, etc- challenges to recruit & retain due to income gap & higher cost of living compared to other provinces

user55 3 months ago

Increased patient demands and volumes, rapid ministry changes in support without time to train/recruit.

Apuuli 3 months ago

I'm trying to improve a health system and run up against older colleagues woh are stagnant and unwilling to change/improve. They have negative attitudes about improving patient care if it isn't primarily aimed at improving their lifestyle and they use bullying and intimidation to push back.Many physicians I try to work with are more focused on their income than patient care.In general when I'm treating patients I often feel great!

Apuuli 3 months ago

From a medical student perspective, one incredibly important demand/burden is the CaRMS match - students from the first day of medical school (and for some students, even before starting medical school) are concerned about potentially not matching in their fourth year. This leads to students trying to engage in numerous extracurricular activities to make themselves a more "competitive applicant" throughout medical school, causing an increased workload and stress. For students that do not match, that results in incredibly high stress levels, continued debt, and much uncertainty. Work is being done to improve match rates (both on the student application side and systemically) and to provide more options and support for students that go unmatched, however this is still a considerable stressor for students throughout their years of medical school.

user427 3 months ago

1. GROWING ADMINISTRATIVE BURDEN: In my first 5 years of practice, I was done with referrals, reviewing consult letters and reports in under 20 minutes each day. Today, with a good EMR, it takes a minimum of 2 extra hours each day to complete my tasks (even though I do all my charting with each patient throughout the workday).Part of this is the increase in the number of requested forms and their complexity. Part is from the increase in medical legal reports requested. In some months this past year, I have had up to 6 new requests at a time. Each takes a minimum of two and a maximum of 6 hours to complete. There is no clinical time to complete these tasks so they consume my personal time on evenings and weekends.2. PATIENTS BRING IN MORE PROBLEMS THAN CAN BE REASONABLY MANAGED IN A FAMILY PRACTICE VISIT. I can handle 3 to 5 problems in one visit. Patients don't realize that we have to take a thorough history, complete a physical exam, think through a differential diagnosis and propose some investigation and treatment with informed consent FOR EVERY PROBLEM. We make mistakes and put ourselves at medical legal risk by being nice and doing a quick check of a lump, lesion or injury that patients add on at the end of a visit.3. NEEDING TO SPEND MANY HOURS EACH WEEK COUNSELLING PATIENTS because for many of them, psychologists are not funded. 4. NOT BEING ABLE TO GET MY PATIENTS TIMELY CARE FOR NECESSARY INVESTIGATIONS SUCH AS MRIs or SPECIFIC SPECIALIST CONSULTATIONS (e.g. neurosurgery, orthopaedics, psychiatry) because of their lack of availability (i.e. long wait times).5. INCREASING DEMANDS (SOME UNREALISTIC, SOME VERY COSTLY) FROM THE COLLEGE OF PHYSICIANS AND SURGEONS OF BC with respect to POMDRA.

USER5891 3 months ago

Firstly, thank you for forum.There are four major systemic problems with how family medicine is perceived and practiced in BC.#1 it is not appreciated for the speciality it is. With its own unique training, college oversight, rigorous examinations, continuing medical education, challenges and demands, it is one of the most onerous medical specialties. From an economic argument alone, the pivotal longitudinal role of caring, competent FP's to an efficient primary care stratum for the betterment of population health is indisputable.#2 it is shamefully underpaid in this publicly funded system. Simply put, no worker in the healing industry can accomplish their mandate without remuneration for the time required to actually do the job. A family doctor in BC who sees three complicated or needy patients per hour, paying typical overhead, will take home post-tax less than minimum wage in Alberta (

ttroughton 3 months ago

Volume of patients needed to be seen in order to pay off cost of operations and have a salary large enough to then pay for CME, insurances, College fees, with the remaining being a small salary for the responsabilities that we have... not really worth it to my eyes but "stuck in the wheel" as school debt and getting old enough that having a family needs to be now or never. Also patient expectations are reasonable but the public health system structure doesn't allow a reasonable way to deliver quality care AND be respectful to oneself as a practitioner. Patients want continuity, availability and compassion just to name a few, and doctors need time to think/put care plan in place and address multiple issues at once (as everybody, patients include, tries to optimize there time). A clinic needs to run 85% capacity MAX to allow for proper service (like hotels etc), not 110%!!... When everybody is stretched 110%, staff included, stress prevails and unhappiness/conflicts ariseFinally, the public health facilities are deficient in IT support and with health authority stuctures not collaborating seamlessly together, the "broken communication burden" is offloaded to community based facilities which in turn increases considerably the administrative load, documentation and paper work of that practice at the expense of the shareholders, it's not fair!

Pinky 3 months ago

-limited resources for patients - we work in a rural area with no physiotherapy, pain clinics, limited mental health resources, etc. I have little to offer patients.-patient expectations - that we will always be in the office, not have a life outside, expecting phone calls, immediate rx renewals, etc, etc. So many patients are entitled and I find it very difficult managing expectations.-finding locums - I split a practice with my husband so that we can cut down our need to find locums to 1 instead of 2 when we need time off. We are capable of working more, but it is such a barrier to us that we have found this the only solution. Even then, we struggle to find locums and take the time off we need.-paperwork is overwhelming. Given the expectations of the college/cmpa/etc, the extensive charting I am expected to complete is unrealistic. I spend almost as much time doing paperwork as I do seeing patients. When I look at increasing my patient load, I avoid it because I don't want to increase my paperwork.-Health Authority issues - there is a lack of engagement with MDs in our area, with our HA making sweeping changes that negatively affect us and patient care. -lack of time modifiers for billing - when I want to do a better job with a patient and take the time needed, I am discouraged from doing so because I lose money. I want to be paid for the work I do. -perception of MDs in the media - There is a lot of physician-bashing in the media and in popular culture. Our medical associations seem to be doing little or nothing to promote us and what we do, and address misconceptions (ex. that we get paid WAY more than we do, not knowing our overhead, lack of benefits, pension, mat leaves, etc).

dresnik 3 months ago

I'm sad to hear so many of my colleagues are feeling burnt out, but hopeful that we can come together with some good ideas and make some positive changes.New doctors should not be permitted to work only as walk-in clinic doctors and should be required to take on regular patients for longitudinal care. This will ease the pressure for the rest of us so to take on new patients in an already full practice. This would also relieve us of patients who have moved further away and keep coming back to us (usually with a list of problems).Patients should be better educated with a province wide campaign about many of the frustrations of family doctors as mentioned in the comments below. We should not have to spend 1-2 minutes per visit trying to explain to patients why we can't discuss their 3rd problem or why we can't fill out their forms the same day. They should also be educated about their rights as patients as well because so many are not getting longitudinal care and being brushed off in 5 minutes or less by walk-in clinic doctors.Allied health providers need to be incorporated INTO our daily practice and not have to see their own set of patients (as proposed for NPs). I really don't think my time is best utilized checking blood pressures, giving B12 injections or vaccines, prescribing refill medications for stable conditions (stable TSH, A1C, BP etc).Less paperwork! I have recently been trying very hard to complete patient chart notes during the visit so that I don't have to work after my 3 kids go to bed at 9pm. The MSP fee code should reflect a 10 or 15 minute visit which includes documenting in the chart, ordering tests, requesting consultation, filling out special authority requests etc. And again the patients should be educated on this too. And then there is the "Inbox" which should not be filled with extras like repeated pending blood culture results, revised transcriptions (with the same content but a date change etc) and repeat Lifelab results (with the entire result and one new level sent every day for sometimes 5 days until completed).

RichmondMD 3 months ago

Have just read the first 10 comments and pretty well agree with everything said! Especially appreciate comments by Dr S and locumdoc. As a GP in an urban area ( but not Vancouver), I have been ignoring the growing disparity between my increasing workload and my income for years. I love my job, and my patients thank me daily for providing longitudinal medical care. However the disparity is now so great, the morale amongst my colleagues so low, the line up at the walk-in-clinic next door so long, the desperate requests to take on orphaned patients so painful, and the lack of young doctors willing to take my place so blatantly obvious, that I have been forced to take notice. Those of us who provide primary care in this province provide almost the entire infrastructure of primary care out of our fee for service billings. With the increasing complexity of practice ( which others have described in some detail), we can no longer continue to do so. This burden is just too great. We need help, and we need it quickly.Are PCNs the answer? Now we also have the burden of trying to design PCNs without any clear promise of adequate remuneration to do so. I spend my free hours sitting on committees and stressing about how can we continue to keep the concept of longitudinal care from disappearing forever. The crisis in primary care is so bad, that many of us are now prepared to trade our autonomy for a salaried position. So now I also feel the burden of trying to advocate for the autonomy of family doctors. Having physician voices outside the local health authority is important. We need those voices in the trenches to advocate both for patients and for system efficiencies. So thank you for providing a forum for sharing our voices while we are not yet bound to silence by an employer. LV

LVeres 3 months ago

I see how my peers with equivalent family medicine training are valued by the government, as reflected in the much more lucrative contracts for hospitalists and those in the new Urgent Care Centers, and I am definitely on the short end of the stick as a community family doc in terms of lower pay, out of which I pay overhead, receive no vacation benefit, and have work that follows me home. With these contracts the Health Authorities have, inadvertently or not, set a benchmark on the value of a family doctor, and if that’s what they think I’m worth, that’s what I should be getting paid. And, as a patient in the system as well, that’s what I feel my family physician should be paid.

CMDMD 3 months ago

Paperwork!!!Forms for referrals that are continuously changed and not updated through the EMR venders. It is possible to keep up with the ever changing forms and still requires a paper copy to be completed as the forms are not in the EMR'sPatient expectationsDownloading of work and follow up from specialists to the Family Physicians both clinical follow up as well as referral and booking follow upsDocumentation of clinical notes and the fear that the documentation will not be considered complete if college assessment or MSP audit is done. How much charting is enough???No clinical back fill for office work when physician is taking a leadership role on committee work both with the health authority as well as the Divisions of Family Practice. Division work sometimes feels like it is becoming by 2nd jobPatient expectations of needing everything urgently. It is impossible to meant their demands or timelines when other patient issues are also being dealt with.Lack of locum coverage for conferences and vacationsLocums not willing to do extended care/ long term care workLawyer's requests for records and medical legal reportsFacilities requesting updated lab work when the lab work has expired because it has taken so long for the patient to get an appointment

user216 3 months ago

Heavy student debt burden, still, 6 years into practice. Plus now having to pay a nanny as well in order to allow me to go to work! Waitlisted x3+ years at 5 daycares. My practice is going into further debt every month!Completing a referral or imaging request, only to have it sent back with an updated referral form to transpose ALL of the SAME information on! Patients are unaware of the fee structure and don’t view their family doctor as a small business owner. They come in with a long list of issues, I suggest that we can do several but not all of them in one visit, and they respond “I asked your staff to book a double appointment and they said I couldn’t.” I’ve taken to bluntly explaining that I’m a small business owner and what they are asking for when they book a double appointment is for me to take a 50% pay cut to see them. I’m concerned about documenting appropriately enough to survive an audit. Especially the attachment fees (chronic disease management fees, complex care plan, phone calls to patients and specialists). I find the requirements for documentation unclear in the billing guide. If I use my emr templates for CDM visits, I’m weighted down with tedious drop-down menus to document all the same info I would if I wasn’t using a template. I’d rather be allowed to use my brain vs a computer template, but I’m uncertain it’ll fly in an audit if I do a Htn visit as a SOAP note instead of a Htn CDM template. Pet peeve of the week: Notification of Hospital Admission asks something along the lines of Do you have psychosocial information about this patient that would affect their care in hospital? and allows a box to be checked to call me (with my direct cell number) for more information. On the rare occasions I have checked this box I have NEVER been able to make contact with the MRP in hospital. Not once. I don’t think anyone looks at those forms, and when I call the ward to speak to the MRP nobody calls back. Discharge summary eg: “Mr Smith will follow up with his cardiologist, Dr Chan, in one month. Mr Smith will follow up with his neurologist, Dr Jones, in two months. Mr Smith will see his family doctor within 72 hours after discharge.” How come the family doctor, the first and most consistent point of care outside the hospital, is not specifically named like the specialists? EVERY TIME.

CMDMD 3 months ago

The disability tax credit forms. I don’t think people read them, then are upset when they don’t qualify.

jk6071 3 months ago

Increasing cost of overhead - pushed to work more to cover costs of working, while sacrificing both family time and career goals. I would love to have further training in areas I am already working, yet cannot afford/get the time off (due to both overhead costs, and finding locum coverage). Rural / urban split. I am rural and was recently told by a specialist that it was my patients choice to live rurally and not have access to their care. I hate to break it to the urban folk - but not all people that live rurally choose to live rurally. Increasing complexity of clinic patients. It is really disheartening to find out that a lot of our patients are seeking care online through video services (Medeo, etc) for all of their quick easy problems, and only come in to office for complex ones. For the same MSP billing! This adds to complexity of our days, when previously, those quick visits were what allowed us to catch up/write notes/etc. Increasing patient expectation. Multiple medical problems at once, work issues, relationship issues. Recent PSP work helped me identify that 20% of my visits truly are mental health related. Work-life balance. I often spend 2-4 hours after clinic trying to catch up on notes, referrals, etc. All cutting into time I would rather spend on hobbies, healthy lifestyle, and caring for my young family. Cost of maternity leave. I've had two short mat leaves (less than 4 months each). I wish I could say I that was my own choice. However, as the main income earner I truly could not afford longer, and will still spend years paying off the extra debt incurred during that time.

Dr A 3 months ago

1) Fear of audit and fine if work is not documented adds to the burden of excessive time spent documenting each day. (Of course the work was done but now I have to spend hours documenting it!) Having to write visit times in the visit notes and billing section is ludicrous. It adds no value for the patient, but wastes time for me. The fact that counselling fees are an audit trigger when we have to mange so much psychiatry in our offices as there are no specialists available is also ridiculous. Many of us attend a lot of psychiatry CME to be able to manage these patients on our own.2) Patients receiving prescriptions from naturopaths and having adverse reactions to medications we may or may not know they are taking. Requests from naturopaths for lab testing that we do not agree with, but patients beg us to do as they have been told we can order it for free. This is a waste of time in my office.3) Various referral forms for each specific place and most frustrating is having them returned as they have updated the form and no longer accept their own old forms! Our EMR referral notes are very thorough and they should accept them. 4) GPSC billing for family physicians, is so complex and we have to spend ages learning about it and looking up the rules. They keep increasing the documentation required and again we need to document time spent. The rules frequently change and now they threaten to audit us. This started out to reward those of us doing full service family practice but is has become so onerous that this alone is enough to make one consider leaving full service family practice. The money would have been much better spent increasing our visit fee so that we could now afford our overhead.

1234 3 months ago

Office inefficiencies, the need to focus on billings and the business focus on patient volume are major contributors to the sense of being overburdened. Doing work that could and should be done by others is very frustrating. Always feeling like patients expect more and more from us while they have no idea how we are paid. Also the expectation that we be responsible 24/7 for patients and their results is very burdensome. Since we are able to access our office EMR and results 24/7, we are expected to review these results in a timely manner. If we do not, our inbox gets totally out of control.There are so many patients looking for a family doctor who require regular follow up which puts extra pressure on us to take them on, making wait times for an appointment unacceptable.

userdjs 3 months ago

The volume of patients with diverse needs is my biggest burden. So many residents of BC don't have an identified primary care physician and there is constant pressure to take more on. It is so difficult to say no to requesting family members, friends, etc. Therefore, the volume and demands in my practice increase. There are so many forms - referral, insurance, special authority etc. which are required to be filled out on my own time. I can charge patients for some of them but this somehow feels wrong.Lastly, in this day and age I should be able to send scripts, requisitions, etc. electronically without having to make a paper copy.Thanks for listening

drrichardson 3 months ago

1. The amount of patient results and documents in our inbox (ie: specialist consult reports, results ordered by other doctors for our patients, etc) is quite elevated as a result of advancements in technology and EMR platforms. As a comparison, in Quebec, given many hospitals are still paper based, colleagues of mine inform me that they don't receive consult reports or results ordered by specialists. This results in a significant imbalance in the amount of non-remunerated work we end up doing. For a 1500-2000 patient panel, this can be up to 5+ hours per week spent on our EMR inbox and does not even include physical paper work.While asking for remuneration for this work would be a simple answer but an unlikely outcome, we need to find a way to minimize the burdens associated to our overflowing inboxes. One idea I have had was the following: specialist reports should have a tick box at the top that advises the physician if action needs to be taken or not. We often have to sift through long reports to ensure the specialist hasn't included a line such as, "I will leave it to the family physician to manage such and such result". As a result of this we have to sift through very long reports that can be quite onerous, especially if you have sick elderly patients who each have 3-4 specialists writing back to you. Having the option to say, hey, I just saw this patient and am updated on their status, I don't think I need to read through this whole report and it seems as if the specialist has not flagged me to take any actions. This would save countless hours over the weeks!2. Burdens associated to starting a practice and accepting patients. While this does not pertain as much to older physicians who built their practices prior to the time of EMR, for new to practice physicians, accepting patients has become a very time consuming process.Entering data into EMRs (ie: medications and PMHx one at a time into the EMR registry) can take almost as long as the intake visit. For complex patients that do not have a CDM diagnosis, this is a completely unreasonable amount of work that is not compensated.Not to mention that intake visits can simply take more time than usual visits as you are essentially doing a complete review of their medical history as is done at a physical exam/periodic health assessment. Other professions, ie: physiotherapist and allied health professionals are allowed to charge more for initial visits but physicians are limited to MSP codes. This means that for a new to practice physician, the time burden associated to accepting 1500 patients can actually dissuade one from starting practice given working at a walk-in or as a locum would pay just as much but not have the associated work load. What is gained in annual CDMs can be easily offset by private patient billings seen in walk-ins. Other provinces pay a one time fee for taking on patients, regardless of diagnoses. This addresses the time burden associated with taking on a patient and does not discriminate based on health conditions. Furthermore, a capitation style bonus rather than only offering annual bonuses for certain diagnoses address the full scope of work tied to maintaining the chart of a patient.

User4444 3 months ago