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.

Thank you for giving us the opportunity to share the burdens. I hope this sharing will lead to some positive change as we desperately need it. The burden of wanting to provide longitudinal care for patients, but finding it is so poorly financially supported is difficult. I don't understand why so many other types of practice continue to be so much better supported. The burden of managing staff and living in a high cost area with escalating needs for wage increases, rent increases, the need to now pay IT support people and purchase new computers, scanners, monitors, printers on a regular basis when I cannot see a high volume of patients to cover these costs is stressful.. The huge time waste of constantly trying to track down results for patients, or help them negotiate a very fragmented system is undervalued. How has it been that our healthcare system has been allowed to develop such fragmentation? Having to support them and explain that it is a really long wait to see that specialist even though they are struggling.... One other stressor is the feeling at times you have no power to help your patients. It used to be that what the doctor said mattered but now there is constant questioning of that. Insurance companies don't want to pay patients they want them working even if they are too sick to do so...they also want me to write notes so my patients can access their benefits like massage and physiotherapy...why should I have to be involved in this??? We are asked to do Drivers's Medicals that can become very disruptive to the doctor/ patient relationship. It seems like many companies are downloading their work to us as physicians. It is also difficult to see my colleagues around me struggle with all of this as well.

LG 3 months ago

Issue #1: It is unacceptable that EMR platforms are not compatible one to the other (i.e. when it comes to migrating patient's charts from one EMR vendor to another EMR vendor). There need to be policies and regulation of this industry. There should be a requirement for basic compatibility between all EMR systems such that it is not an ordeal for a physician to move their patient charts from one EMR vendor to another. Not having easy transferability of patient data from one system to another severely limits physician portability (ie. when a physician needs to move from one clinic to another). Having gone through two EMR migrations (not by choice) in the past year, I have experienced first-hand that EMR migrations require multiple test transfers (which can be costly to the physician and require hours of unpaid time invested by the physician) to ensure that patient data is not being lost or mutated in the data transfer. All of this could have be avoided if EMR companies were regulated to ensure cross-compatibility and easy transferability between systems. A physician used to be able to take their charts off the wall and go to another clinic. Now, moving electronic patient charts is a huge financial and time burden on physicians.Issue #2: The rise of overhead costs is outstripping increases in physician pay, especially in communities where the cost of rent increases astronomically every time a lease has to be renewed. Physicians will be forced out of practicing in certain communities, not because they do not want to provide MSP services to that community, but because they are being forced out by the cost of rent. Subsidized rent for MSP physicians (or an equivalent solution) needs to be implemented.#3) The involvement of corporations/private equity, etc. in medicine is becoming a burden to physicians. When a clinic that was previously run by a physician or group of physicians is sold to a corporation, the working conditions often severely deteriorate for the physicians left working in that space. Specifically, physicians may be asked to sign unusual, unfair, or potentially unethical contracts or they may be exposed to inexperienced or toxic managers. I have seen that physicians often leave such clinics, (but after a lengthy period of stress and uncertainty in the workplace, or after the collapse of the clinic). To summarize, to date, I have experienced corporate involvement in medical clinics to be a significant burden on physicians left working in these clinics.

User1177 3 months ago

The fee code needs to be changed to capitation. this time measured billing is a joke. Spend 30 mins for a CCP and note the time down, the truth is the CCP patient will take many hours of extra work over the year why this arbitrary 30 min 'buy in'.When I tell patients that I just got $31 for that 15 min visit..ie a hair cut, they think I am joking. I have to turn the computer screen around to show them the billing.

Victoriagp 3 months ago

overwhelming paperworkI didn't go to med school to fill out insurance forms, send info to naturopaths , write excuse letters for people going to Uni or work time off notes. The insurance companies are now telling us we have to fill many page documents and provide copies of charts and then saying either the patient is responsible and cannot afford it, or setting their own small fee for the service, ignoring the BCMA fee code. Do they do that with dentists or lawyers or accountants. Why are allowing them to deal with us in this way. And if we dont provide what they want , they turn around and tell the patient, we didn't pay your mortgage this month because your greedy doctor wants to be paid for their time.We never agreed to be party to this or any other agreement the patient is involved. The College has also encouraged this sense of entitlement.the BCMA has been toothless in helping urban GPs. Their is a GP crisis in Victoria , dozen leaving, quiting and retiring and almost none taking their place.

Victoriagp 3 months ago

- lack of adequate time for quality patient caring-lack of adequate compensation (income) for what we do - lack of job ‘benefits’ package...I recently had a family member die, and was not able to afford to take time off in the aftermath -we need better protection against abuse/aggression/bullying at work...the College is there for the benefit of patients, but we need it just as much if not more-perhaps we all should be able to opt-in or out of salaried positions

DocSmile 3 months ago

Ditto, everything that has been stated so far!!! We can’t focus on patient well-being in this current state (pressures of scheduling, time, staffing, coverage, EMR, aggressive/abusive patients and other staff whom we have no protection from, etc), and certainly are providing much of our work for free (or very underpaid). I read an interesting personal story recently of a non-health care professional who was reflecting on her career, trying to understand what were positives and negatives of her job, and whether to switch paths in life after experiencing increasing stress and burnout. She drew her job as a heart tracing ECG “heartbeat”, with each good thing making a positive inflection, and bad things a negative one. She quit her job when she saw the outweighing negatives visualized so clearly.Based on this method of self-assessment, our profession as a whole seems to be in a state of critical arrhythmia and structural abnormality. When are we going to “code”?Interestingly enough, I know many physicians looking at pursuing other side or whole pathways now too, outside of medicine.

DocSmile 3 months ago

Family Medicine is a profession that with years of experience I am working harder and earning less every year! I am penalized for providing comprehensive care. Family Physicians have been the safety net that pick up the burden of care every time there is a cut to services. Patients end up in our office because they have no one else to turn to. Early discharge from hospitals with lack of timely documentation. Long wait lists. Our patients are sicker and more complex. Especially mental health. My other burdens:1. Financial pressuresHigh lease cost and staff wages and supplies. High cost of IT and EMR. Cutting PITO funding was a betrayal that left physicians at the mercy of EMR companies. We have to replace computers and servers etc. Still paying my staff to inform patients of their specialist appointments!POMDRA- increases staff time and cost of sterilization. Tax changes. New physicians can’t afford to live in our community. We should be looking at TOTAL overhead including insurance, CME, dues. 2. Working harderI am spending more time charting and organizing care outside of the office visit. Increasing patient expectations- always having multiple problems. Complex system - too many new forms and complex referral rules, pharmacare, frequent requests for insurance forms and medical legal reports. Managing patients while they wait for excessive time for servicesI’m doing far more time consuming psychiatry as it’s difficult to access mental health care. Managing a businessManaging staffComplying with College regulations with no support-POMDRA, privacyMy work follow me home and on vacation. 3. Lack of supportNo health benefits. No pension. No vacation pay or sick days. I have to pay my office overhead to go on vacation. No Locums. 4. Stressful work environmentViolent psychiatric patientsFront line for each pandemic. Fear of auditFear of College complaintBottom line: I work increasing amount of hours, see less patients per day and pay rapidly increasing overhead. All in, my hourly rate is less than most allied health professionals with no benefits. We are tragically undervalued.

Dr. S 3 months ago

The current FFS model is not sustainable. GPs are burning out and leaving full service family practice for sessional and salaried positions. I left FFS and work exclusively in sessional roles now due to the crushing workload and demands in FFS. From the endless paperwork to managing patients’ unrealistic expectations, it was too much. I do miss the diversity of patients and cases I saw in full service family practice and I am hyperaware of the fact that I am losing a lot of my skills by working in specialized clinics but I don’t think I would ever go back for the sake of my physical and mental wellbeing.

User12345 3 months ago

mounting digital "paperwork", more time and less pay, frustrated patients, many non MDs ( NP ) who feel they can do my role

user3088 3 months ago

Unhealthy culture of Medicine: We have not, as a profession, kept up to current learning around optimal brain functioning and healthy work/life balance. An example of this is the benefit of regular brief breaks (5-10 minutes every 60-90 minutes) and non-working lunch breaks. Too often work pressures lead to "working lunches" or missed lunches and no breaks leading to cognitive fatigue. Impact of this is less ability to problem solve and impaired emotional regulation (increased irritability/moodiness)

pegibson 3 months ago

Patient email requests are adding burdens.Lack of access to GPs means patients call out office for help for non specialist issues.Paperwork with pharmacare is getting more and more complex

YVRMD 3 months ago

the pace of practice has escalated exponentially over recent years. More demands from patients (emails, Rx renewals)Many things get added to work load but nothing ever gets taken away.Dissatisfaction with GP care and access puts added burden on specialists - more and more requests to do things outside my scope of practice.

YVRMD 3 months ago

I am a new grad working as a locum. I truly believe in the value of longitudinal patient care and acutely feel the burden of the lack of access to family physicians. I was trained as a family doctor and want to do my part. But working as a clinic-based FFS has so many burdens that do not exist with inpatient/hospitalist, urgent care, or more focused practices. Everyone seems to believe in the value of family doctors, yet these other areas are paid more, with often more predictable/confined hours, limited after-hours work, and way less of a psychological and emotional burden. So, as the GP, you have a harder job in so many ways, work longer hours, and get paid less. Why would I sign up for that? Essentially the GPs are donating their time (compared to similarly trained colleagues) because they believe in family medicine. That doesn't seem fair.Many recognizable burdens:- poor information sharing/communication between health authorities, clinics, hospitals likely leading to overtesting, increased costs, and worse patient care- A big disconnect between patient's expectations and the what the system offers - patients want to be seen when it is convenient for them, right away, and have all of their issues dealt with - if we had a model that could support this (ie. pay for longer visits) ultimately this would save patients time as well as the system as a whole - why should patients take multiple half days off work to come see the doctor because we only get paid for a 10 min visit?- Patients lack of understanding of the system - I think patients think that going to 6 different walk in doctors is just like seeing your own doctor 6 times about an issue. It isn't. There is no effort from a public health perspective to educate patients on when they can wait to see their gp, when to go to urgent care, what is appropriate for emerge, how to get chronic issues best looked after. - paperwork burden- in clinic i easily spend an extra half day per clinic day on unpaid paperwork including charting, labs, referrals- high patient expectations in a limited resources economy - we are the gatekeepers of so much additional spending - consultations, investigations, imaging - patients are now more anxious and have higher expectations of what our testing can do and we have to spend a large amount of precious time explaining why they don't need that MRI - at some point I feel like I'll just order it to save my time and headache but if everyone does this our system can't take it- More and more regulation - every year dealing with cumbersome licensing and privileging processes. Then there is the college assessments on sterilized equipment. Then there is increased expectations for documenting procedures to maintain privileges.

Locumdoc 3 months ago

-poor electronic health records-disjointed records from various systems, various health authorities, with overlapping populations-overworked with old antiquated workload measures-constant delays from the operational side -unfair MOCAP contract

RealLife 3 months ago

1) EMR was promised to be more efficient. It has definitely improved RETRIEVAL of information, data mining and care planning. However, 10 years after adoption, I still spend more time than ever in documentation, charting, long evening of catch-up. Not to mention the annoyance of a computer device between me and my patients. Physician Assistants or Scribes are needed !!2) Too many forms, electronic referral templates. Need a degree in computing to practice medicine, it seems. Such a waste of highly-trained physicians' time, IMHO.

Jeff Dresselhuis 3 months ago

-Never being off, never being free from the labs, phone calls, charts. -needing to document chart notes between midnight and 5am so when I get home from clinic late, I can try for an evening with my kids and get to charts later. -making referrals through EMR and then again through PDFs, no charge referrals, q6 month rereferrals -incredibly slow EMRs, insult to injury as I attempt to keep chart current-being unable to accomplish any self care including basic nutrition breaks, exercise or down time due to significant demands of in clinic and after hours documentation-spending half day on charting/labs/referrals for each day worked, further time away from my family and poorly/not compensated-lack of mental health support in community for patients

RecentGrad 3 months ago

Expectation that all office time is dedicated to patient care and paperwork is to be done at home/remotely. Burdensome expectation of ++detailed paperwork, particularly for medicolegal. Patient expectations of laundry lists during appointments. Pay structure not reflecting the amount of work associated with each patients visit including documentation, investigation follow up, referrals etc. Significant overhead and starting practice with significant debt only adds to this uphill battle.

RecentGrad 3 months ago

- Lack of locum / leave coverage, trying to take a mat leave and can’t find coverage - yet have overhead and patients to cover - Hours of daily labs, paper work, phone calls to hospitals, facility and patient, and other unpaid or underpaid services - High overhead - unreasonable patient and facility staff expectations of my availability - patients requesting labs from their naturopath be ordered by me because they expect MSP will then pay, and the painful, repetitive, time-wasting conversation about why this isn’t how it works that I end up having multiple times a each month. - unpaid meetings - inpatient care; having to leave time at the beginning of my day for potential inpatients I may or may not have, then having to provide what feels like underpaid care in what feels like an unsupportive, time limited setting.

BOwl12 3 months ago

1) Paperwork- constant forms, insurance documents, disability/EI, etc. Lots of after hours work that is poorly compensated (if at all). Patients have expectations that these forms will be filled out asap and that they can just drop them off to be done at their convenience. It's also up to the MD to inform the patient of any associated costs and this turns medicine into a business transaction. 2) No sick days/no vacation days- I've been working for 10 years and have gone to work with pneumonia and countless other illnesses. I throw on a mask and wash my hands repeatedly and suck it up. Others will say that's irresponsible but calling in sick is not an option. I have a full day of clinic booked and the time and money that goes in to cancelling and rescheduling patients is a nightmare and I end up doing a full day's work from home for free if I don't go to the clinic or hospital. I worked throughout my pregnancies (no time off) pretty much up until the day I delivered due to inability to find locum coverage. I had terrible nausea and vomiting in pregnancy and just went to the bathroom between patients and washed my face and hands and went back to work. I get called at home (when not on call) about patient issues with no pay. I get called on vacation by pharmacies, allied health, patients (also without pay). I am expected to answer all of these calls. I work stat holidays without any additional pay while my family enjoys the day off and my nursing colleagues are paid double time. 3) Frustrations with the discrepancies between specialties and income. We all work hard- there's no reason a specialist/sub-specialist who attends an additional 2-3 years of residency should be paid 2-5x what other physicians make. There is a lack of recognition for family doctors, internists, psychiatrists and peds for the most part. Also the downloading of work from specialist offices to family doctors is horrendous despite new college guidelines. Specialists who argue "we should all be paid more" are ridiculous. There is a sum of money coming from the ministry and if we want lower paying doctors to be fairly compensated some of the docs making $500,000+ need to take a modest pay cut. Changes to compensation models need to occur asap before you have no family docs left. They are already migrating to hospitalist work and other focused practices due to this. 4) Physicians should have dedicated time to do QI work, team meetings, teaching and should be compensated for it. Doing it "on the side/after hours" is draining and discourages physicians from contributing as we know it just means more work for us (and stress)

user78 3 months ago

Working in a non-MD run clinic. Understaffing of MOAs as manager does not want to pay out more money to hire. MOAs are overworked, stressed out. Moral low. Translates to poor pt care and MOAs unable to support the doctors in running a smooth practice. Having to stock my own rooms. No proactive help from staff to run my task list and filter out immediate vs. nonimmediate tasks. MOAs used to do this when faxes came via paper through fax machine. Now faxes go straight to MD inbox. MOAs on verge of giving notice. Makes physicians anxious as we are already grossly understaffed and worse if MOAs up and quit. Also, patients can't get through as not enough staff to run rooms and answer the phones. Affects pt care. Trickles down to MDs as patients relay their stress/difficulties next time they see us. Increases MD stress/burnout. Trying to make patients understand they cannot come in once every year and expect me to solve a list of 10 issues. They don't understand that we get paid the same whether we spend 5 minutes or 35 minutes with them. They don't understand that after overhead and taxes, we may take home 1/3 of our billings.EMR burden: Trying to maintain the chart is so time consuming. I remember when you read your paper faxes, noted the result at the front of the chart under Procedure or Medical Complications. Now you have to flip to another computer screen, click a drop-down menu, type in something free-hand or code it, maybe add date of procedure and then maybe add a task for follow-up (on yet a different screen). Not sure who is benefits from EMRs????And then if you move clinics and have to transfer to a different EMR, it is NOT seamless. There is always something that does not transfer correctly and needs to be RE-ENTERED. Again, very little MOA help to facilitate this. Falls on MD. Tired of doing unpaid afterhours paperwork!!! For every hour of seeing patient = 3/4-1hr of unpaid work (finishing chart notes, reviewing lab reports, consult reports, imaging reports, writing referral letters). No other profession would do this much unpaid work.Special authority is REDICULOUS. So much work to get a rx for a patient. And then, if MSP rejects Special Authority, patient's extended benefits has a form for me to fill out! REDUNDANT! I am not even comforted by the fact that I can bill the patient for the form. I did not go to medical school to be middle-man insurance form paper pusher! FFS. So many of the codes are so UNDERPAID! IT IS INSULTING.

Fading out 4 months ago