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.

-documentation requirements--I'd love a scribe so I could focus fully on my patients, and wouldn't be left with hours of documentation to finish at the end of the day.-no control over MSP fee codes, which for family practice are at the bottom of the heap, nationally-mounting overhead costs, with fees which have not kept up-lack of successors in practice, due to inability to compete with hospitalist pay, which new grads are signing up for, instead of community practice, and I can't blame them-10+ years of >10 calls per day to my staff asking if our clinic is taking patients (now 36,000 in my community without FP's) because there are 70+ hospitalists here now, many of whom have abandoned their practices for more lucrative work in the hospital.-ridiculous and expensive new requirements for sterilization in our clinics. No problems have resulted from our previous autoclave process. Another nail in the coffin for family practice.-ridiculous need to complete the charts/referrals/acting on results and consults late into the evening every day after seeing patients. -time pressures taking away from the previous pleasure I got from teaching med students-bringing forth sound and expert ideas, solutions and opinions to Ministry of Health tables as part of the PCN process, only to be ignored. Again. and Again.-why does the Ministry of Health not demonstrate that they value longitudinal, relationship based care more than urgent or hospitalist care? Oh, maybe that's because they do not value it more. This disparity is killing primary care.-pay for RN's to come and help us work to top of scope, but only if they are part of my team, and not carrying the expectation of attaching 500 more patients to my practice! I'm nearly drowning in screening, upkeep of EMR, prevention, and timely follow up of my 1360 patients--an RN isn't going to do all the work of actually keeping these 500 patients up to date! I am, so forget it (a PCN funded RN in practice).

vyoung 4 months ago

Time demands of practice, phone calls, paperwork, and ensuring that details of the day are kept up. It is now 9:30 PM and I'm still not done my 8-4 office day. The monetary concerns of making a practice work, are on my mind EVERY SINGLE DAY! This is very, very stressful. The constant GRIND does make me wonder how much longer I can maintain this. I'm not quite 20 years into practice and if I'm thinking this, then I know a heck of a lot of others are thinking it too!

suzilegg 4 months ago

Increasing overhead cost (staff, lease) pushing us to see more patients in a day just to cover our overhead and be able to pay ourselves a decent wage after tax. Spending more time with my aging/complex patients but without being compensated for it and worrying about overhead costs. Paperwork takes at least an hour a day with no compensation.

User2812 4 months ago

I experience a significant amount of morale distress about the fact that patients who I see in the inpatient setting do not have access to mental health care in the communities, where they need it the most. It makes me feel like no matter how well I can try to do my job as inpatient doctor, that patients will ultimately not get the help they need once they leave the hospital. It makes it very difficult to feel hopeful, and to instil hope in my patients who are often in great despair. Working as a psychiatrist in my health authority, I feel that we are constantly being told to do more with less resources. We are constantly being told that we're not doing a good enough job, and how we are falling short.Particularly, there is almost always a greater number of patients to serve that I can see and provide quality care. Another significant barrier to providing the best care for patients is continuity of care. Patients who are receiving mental health care in the community have a separate EMR from the hospitals. Different health authorities have different EMRs. It often takes me 15-20min to try to locate information about my patient's mental health care in the community, which is sometimes a luxury of time that I simply don't have. Communication with GP's is often minimal, and I find the only meaningful communication is if I have time to pick up the phone and actually speak to them directly. Again, this is challenging when there are more and more patients to fit into the day.I feel that I am constantly struggling between my desire to meet the demand for my services, but to provide quality care, which includes explaining the diagnosis and treatment plan in appropriate detail to the patient and family members. I could make more money by seeing more patients, but I know that I haven't provided them with meaningful help if I don't have time to do the education and treatment planning. Perhaps a somewhat separate issue is how physicians are treated in terms of employment. I have no one to call on when I am sick. I go to work when I am incredibly sick, because if I ask a colleague to cover for me, I am asking them to essentially do 2 jobs at once. The same goes for planned leaves like parental leaves. Despite my advance notice of leaving for parental leave, no appropriate coverage could be found, and this resulted in my practice partner becoming so overwhelmed that she eventually left while I was still on leave. If physicians are to be treated as "humans" they need to be able to take leave when needed without the current catastrophic effects of colleagues.

randomness84 4 months ago

Teaching demands of medical students, residents, paramedics, RT's, and other physicians with no training on how to teach or how to give effective feedback.Need to run programs or apply for funding and try to effect change off the side of our desk...takes away from patients and is not remunerated.Increasing meetings, paperwork etc.Increased complexity of patients with time consuming conversations.

stweedle 4 months ago

The College of physicians and surgeons is scary for physicians. They are punitive, opaque and frankly, make the practice of medicine difficult by promoting care that is not supported by the fee structures that pay doctors. I agree that preventive, proactive, comprehensive care is optimal, but in our current fiscal climate it is not feasible. The College is out of touch with the day to day practice of primary care medicine. Their standards are ultimately not protecting the public, as they make practicing physicians burn out and give up. The College needs to refocus on what is actually DOABLE not IDEAL.

Coastal604 4 months ago

This province has been very successful at getting EMR implemented. The cost of this is now on the backs of the physicians, and it is SIGNIFICANT. Even if a physician uses OSCAR, there is significant admin/tech needed, and infrastructure. The costs of doing business are HIGH. And the cost of having an office/staff? it's ridiculous! WE NEED TO EDUCATE THE PUBLIC THAT WE ARE PAYING FOR THE OUTPATIENT INFRASTRUCTURE! I see patients who come in to get "free" bandaids, who expect a cosmetic mole removal is $20. Want to talk about sterilization costs? The change in billing of a biopsy not requiring stitches to a 100 code is ridiculous. There are costs to having the equipment to do the biopsy. it's a procedure, for goodness sake! Who wants to do procedures when they pay so poorly! My MIL had an ingrown toenail removed for $200 by a podiatrist. private pay. If I did this - $71.53 plus a tray fee. She couldn't find a GP to do it.

Coastal604 4 months ago

I am resentful that NPs are advocating to do primary care on their own. And pharmacists have a go at this every few years. I believe both have function and utility as part of a team. But honestly, it is insulting to say that they can replace us. NPs seem to be advertising they can replace us "we can do 90% of what family doctors do". Comparing their quality metrics to ours. These NPs are on salaries, and have sick days/pensions/union representation. who protects us? when do we get to take a sick day? Honestly, there is no "WELLNESS" in medicine. You PAY to take holidays, often without coverage. You can't take time off if you have an acute illness. There is no backup. Really, can the NPs do this? And midwives are paid multiples of what family docs are paid, with more time to do the work. How does this make sense? You, FP, see 12 women who are due a month. And their families. And non-pregnant people. You, MW, see 4 women who are due a month. You both get paid the same.

Coastal604 4 months ago

I am a locum physician primarily, early in my practice. I really believe in longitudinal, comprehensive care but it is so poorly paid that I can't imagine myself ever starting a practice in this way. I can get paid much more doing hospitalist work or working at a community health centre working with people experiencing marginalization (also very important work). My hourly rate doing this is almost double what it is after doing fee for service work and paying overhead. Other significant annoyances are LOTS of paperwork (requisition, refused consultations, unclear consult letters or results which then require follow-up just to understand if there is any follow-up to do!!) and very poorly integrated systems (e.g. tracking down hospital results and discharge summaries). Lack of capacity to deal with socioeconomic issues or social prescibing because we don't have access to social workers or there are very fragmented services which never report back to us anyway.

jenl24 4 months ago

1. Rising expectations in the context of limited time and resourcesa) We face increasing expectations from our patients who are more anxious about their health because of the increasing amount of poorly filtered information they receive through media and internet. The expectations include immediate and convenient access to all health services and information.b) We face increasing expectations from regulators (like the College) who are writing and enforcing standards that are increasingly difficult and costly to achieve and with little or no regard to the consequences to us or the health system.c) We face increasing expectations from insurers (like Government) and employers (like the Health Authorities) who, due to unlimited demand and their own resource limitations, put pressure on care providers to do more with less.d) We face increasing expectations from a guideline-obsessed health care system and health care industry that constantly push the latest and most expensive tests and therapies upon the public, insurers, and care providers with little or no regard to the tiny clinical and person-significant benefits.2. Limited Time - this translates for many of us into a financial cost because of payment method. The documentation and administrative time needed to run a physician-owned practice has exploded in the last 20 years. Fee-for-service compensation has not kept up. The latest PMA is an improvement but doesn't even come close to catching up with existing alternative compensation and subsidies available through Health Authority facility work. New Family Medicine Graduates can see this and are choosing with their feet. 3. Limited resources - The most stressful part of my practice every day is to tell my patients that I cannot help them get their urgent care needs met because of long wait lists for important consultations, surgeries, and investigations. I am more frequently having to tell patients to go to emergency because they have no other alternative. 4. Poor communication - This is very stressful for care providers and patients. The irony of community "team-based care" today is that there is little or no coordination or communication. It is a an embarrassment and tragedy that in the age of Facebook and Twitter, we are still relying on paper and fax, that I still can't send a secure message any other way to a specialist, home care worker, or nursing home carer, and that even a phone call is difficult because the clerks have been eliminated in favor of voice mail. 5. Neglect of the longitudinal relationship: This has been undervalued and is now resulting in a loss of general practitioners providing such a relationship and coordinating care. This is going to result in a much more expensive health care system unless steps are taking to fix this. Team-based care will not fix it. Every highly functioning team needs a leader, a leader who has a relationship with the patient. It is very stressful trying to maintain this longitudinal coordinating relationship when it is being undermined daily by Babylon, walk-in-clinics, hospitals, contracted out social and home services, and one-disease subspecialty services that fragment care and do not communicate promptly and adequately with the GP.

Eugene Leduc 4 months ago

Administration at our hospital do not listen at all to us so it's hard to remain involved.We're seeing more and more complex cases with high patient demands.

Doc 4 months ago

Physician support program was inadequate when I needed it for personal mental health. I am hesitant to say much more as I will feel identifiable. This is not a sustainable career for anyone entering med school with pre existing mh issue however minor, as I did 25 years ago. Public mh little help and I can barely afford private

Mami 4 months ago

I strive to practice quality primary care - prevention, monitoring, screening as appropriate. I need more time one on one w people. Every single day I feel I’m rushing people, not fully present... The majority of mental health care/screening/first contact is done by FP/GP in this province and it is INSULTING that British Columbians are allowed 4x 20 min/yr for this care. Throw out the MH planning fee. Give me more time to spend- guess what, a proper hx and physical and rational use of testing will help more diagnostically than a rushed visit/referral into the void (which will bounce back). I firmly believe this will save the system (and the lives of patients at risk) if we let docs do the work. I enjoy the work, but not in these conditions!! Would you want your son/daughter/aunt/husband/wife/friend who is depending on timely mental health care to be allowed 20 min for a visit/plan? I appreciate the tools of the adult and child mh modules, but honestly, they stress me out even more by trying to squeeze quality mh care into 10 min visits! No counselling available for your distress? Here is a one page handout, follow up in a month. Group medical visits are great for skill building, but people/patients deserve a proper diagnosis/formulation (which doesn’t always mean an axis 1 condition!) and individualized follow up.

Coastal604 4 months ago

-unnecessarily detailed paperwork/ forms to fill out--too much inefficient bureaucracy-increasingly entitled and misinformed patients (who like to pre-misinform themselves with dr. google)-high cost of managing an office space, paying for staff, supplies, infrastructure, technology-constantly being disrespected and vilified by the media, unappreciative patients, uneducated and increasingly untrusting public, jealous alternate health professionals-being "above" labour law, as residents working on stats/holidays and overtime without increased pay, working 24+ hour shifts-as physicians not expected to be human, to ever be sick or have our own needs met, to openly advocate for our own mental or physical health without consequence-to be paid very little and be expected to handle several complex health problems in a single visit-as family physicians expected to be the medical "home", this translates into extra unpaid work of managing administrative tasks for patients, specialists, and maintaining records--work is often downloaded to the family physician to do for others--an example: family doctor clinic being responsible for informing patients of their specialist appointments-as a family physician, being expected to be a social worker, clinical psychologist, counsellor, and physiotherapist because of a shortage of these services available publicly -as a family doc in an urban setting, expected to be on-call after hours without renumeration-in the midst of a busy day, constantly being interrupted by non-emergent nuisances such as pharmacy-by-fax inessential inquiries, phone calls by patients unwilling to be bothered with a visit-feeling like a babysitter to patients who decide not to act like grown adults by no-showing to specialist appoitments, no-showing to my clinic, or panicking when they run out of prescriptions at the last minute

hobbesmo 4 months ago

Health system growth- and increased “ flow” via hospital units leads to Increased workload and decreased length of stay meaning that more patients are seen per year.But with less FTE, this poses increased challenges ,burnout ,and increased system pressures. This system does not reward efficiency- it actually penalizes those that are efficient. In that , there are still increasing work demands. The current “support structures' do not offer much in terms of assistance, ie. The current renumeration models are out dated. The FFS model leads to “ one stop” visits and does not help with comprehensive, patient centred care. And the service contracts. alternative payments do not compensate properly for non-clinical work. Hence there are huge inequities left in the system for physicians as their actual time spent working is neither valued, acknowledged nor compensated. This is not the same for all of our other healthcare team members who are compensated to attend education seminars, training and have protected sick time and vacation days. Our renumeration models do not compare to other provinces which ensures that recruitment and retention of qualified doctors is an ongoing challenge. This leads us to continue to lose talented individuals to other provinces, and then the “ cost of doing business in BC’ does not help retain many new recruits. This leads to further problems with infrastructure and lack of physicians to do the work.The clinical complexity of care for hospital based patients continues to increase, with no tech support. The demands on physician time continue to be divided towards clinical and non-clinical work , only one of which is supported, remunerated or compensated. This leads to increased inequities in a system that does not acknowledge the physician as an educator, an administrator, or an advocate. This means that less MDs want to do comprehensive work, and more shift towards clinical, but at the costs of their own time, health and well being.The ongoing changes from Health Authorities and Ministry mandates without physician input or consultation results in further breakdown in trust, respect, and direction. This only leads to further “ poor public image” of physicians as non- team members when in actuality we are the essence of the healthcare system, and a key part of any health care team. Yet always an afterthought in planning, development and role of new strategies which are often developed without MD input- but effect us and our patients the most. There remains a continual lack of engagement of MDs from the health authority, when programs are decentralized overnight and no input is sought from healthcare teams/MDs. But yet the ongoing mantra is “ physician engagement”. This ongoing artificiality towards effective communication leads to further barriers for physicians as they are expected to “ lead the change” yet have no input into it.All of these and more lead to disengagement, system delays, poor patient access to care, and more patient and physician dissatisfaction.

smink 4 months ago

I am unable to provide the standard of care due to lack of services, pressures to do more with less, limits imposed by MSP, expectations for meticulous documentation, and lack of funding to work with complex patients (e.g. individuals with developmental disabilities).There is very little support for conscientious objection in my place of work.These pressures are contributing to moral distress.

MC11 4 months ago

Workload both clinical and non-clinical and its impositions on time and life balance, amid perception that MD's are often targets of government as scapegoats in discussions on healthcare delivery and expenses, all while whittling away at physicians ability to control their finances to any appreciable degree with recent changes to physician corporations

doctorwho 4 months ago

There are obviously a plethora of burdens currently impacting Physicians in BC; speaking as a GP, these would include:* Vast increases in both administrative paperwork - and the frequently ridiculous documentation and hoop-jumping required to support FFS MSP billings and / or protect oneself against medical-legal liability*Increasing complexity of medical practice with longer-lived, sicker, and multiply-comorbid patients; for example, when I started practicing there were a mere handful of Diabetes medications - now they seem almost innumerable, and drug interactions are more likely* Lack of sensible payment for the above; I can easily spend 30-40 minutes to properly address an office visit for which there's no allowable billing code except for an 0100! * Ridiculous limits on both preventative and counselling billing codes; 100 of the former in-toto yearly and 4/patient of the latter - and only then if the patient exhibits well-documented "distress". Yet the College expectation is that we provide comprehensive screening and preventative strategies for every patient. College expectations - while generally not otherwise unreasonable - are clearly NOT reflected in the MSP fee schedule - and this is a constant source of stress and frustration!*Increased practice costs and office overhead not matched in any meaningful way by the fee schedule - regardless of the minor recent increases from our new PMA*Unwieldy, non-intuitive, poorly-designed, time-consuming and inefficient EMR and EHR systems that can't communicate with one another or with the greater community of care* The frustrating responsibility of trying to meet patient needs (or often, expectations) when the system often fails in a myriad of ways to support us in doing so; responsibility without authority or control!* Frequently demoralizing criticism of Physicians in the media - including of-late by NP's, who are touting themselves as equal (or superior!) in knowledge and judgement to Physicians* The inherent disconnect between the provision of good medical care and the obvious necessity of financial self-care; can a Physician providing truly excellent care (with all that necessarily entails) actually afford to practice in our current BC FFS system? There is a paradoxical financial penalty for caring and doing more for our patients!!! I currently net significantly less per hour than ANY of the paramedicals working in my shared office (Physio, Counselling, Audiology and RMT)!* A feeling of powerlessness in attempting to find "medical" solutions to various socio-economic issues which are hugely and detrimentally impactful on patient's health * Patients who seek passive and "medication" solutions to those diet or lifestyle-related illnesses, over which we have potentially some influence - but obviously no control* Challenging relationships with Health Authorities, and the felt sense of a lack of meaningful input towards Health Authority decisions and strategies* I think that's enough for now - although the above list is by no means conclusive!

Lawrence Klein 4 months ago

1) increasing measures by interior health authority to cover themselves legally by making physicians do more clerical work, unwillingness to make their clerical employees do that work, and offloading of their work onto physicians. e.g. privilege applications and renewals online checklists that I have to go through dozens of pages on things like obstetrical surgery techniques that I'm not applying for (I'm an ER doc!) and repeat this work for each site for which I hold privileges. Also, tremendous increase in pre printed orders and long forms for simple admission tasks (MOST; VTE proph; med rec; insulin PPOs; nicotine replacement; bowel protocol; etoh withdrawal; telemetry; etc etc etc.) Let doctors be doctors! We don't have the capacity in our system to take away doctor time from being a doctor and redirect it toward clerical tasks! 2) EMR! Again, health authorities cover themselves by "complying" with some target to implement EHRs by some date, with lofty dreams of using the data to better patients somehow. BUT, no one is using all this data we are generating. The powerful capabilities of EMRs and EHRs are not being used, and again, physician time is taken away from patients and put towards clerical tasks for the health authority. Their priority is not patient care. 3) It's time for Doctors to demand that any new implementation of any kind of "mandatory" extra work for physicians is not implemented blindly by authorities, but rather, is subject to a study of how the implementation will impact physician work and patient care, and whether the improvement to patient care is significant enough for physicians to accept an increase in workload. Any clerical duty should be done by a secretary, who should work to improve the efficiency of physicians, recognizing that efficient, fast-working physicians do more patient care, and that is everyone's priority (or should be). If EHRs or Cerner etc are implemented at your site and you are negatively impacted by it, demand that the health authority pay to hire you a "scribe" to do your computer and clerical work for you. There is increasing good evidence for the use of scribes in this situation, even in Canada. Search this evidence, learn, and demand your rights. You may be a contractor, but the whole machine stops without your service. You do have power. There is a good summary at thesgem.com search "scribes"4) As emergency docs, we need to push back against the frequent addition of new forms for each admission or treatment, let them know that we can be and want to be doctors, that they don't need to "cover" our medical decisions with their forms. 5) Nurses' unions and health authorities won't allow nurses and other allied health pros the autonomy to treat patients and discharge them without seeing a physician. There are many cases where this kind of care is appropriate, and with the coming silver tsunami will be even more important for us to figure out how to meet the increasing demand. However, they are afraid of those practitioners making a medical error, and then they will be the ones sued for it. Instead they transfer the liability to the physician, who carries her own insurance, and makes her responsible for all the actions of those providers carrying out her orders.

bikeskimd 4 months ago

Lack of control over my own schedule based on department policies and hospital policies. Ex. Not allowed to have locums for the department. If a locum is present I cannot be in the hospital but the dates I’m away often don’t line up with locum availability.Lack of help recruiting to our department. Lack of specialists ex. Neurologists and dermatologists so the burden of care falls to internal medicineLack of flexibility in our department so I am forced to cover general internal medicine when I just want to do Respirology (despite internists looking for work and enough Respirology work to keep me busy).Shared office practice where I don’t get to dictate how the office assistants work for me.The expectation of 24/7 patient coverage including EMR results.Lack of support for parental leave.Lack of support for new parents to return to work. Ex space to pump in private Lack of payment for some of the work we do - for example I am medical director of our pulmonary function lab but there is no payment for this. We’ve been asking the region for 6 years with no success.Lack of access to the support staff and equipment we need. For example our hospital will not allow Respirology to put in pleurx catheters because they won’t dedicate the space or staffing.Long patient wait timesIncreasing patient complexity without financial recognition.Inequalities of pay between specialties. For example, the general surgeons make more money to see a breast cancer consult than I do to see a lung cancer consult but it takes them less time.There is also hugely discrepant pay between radiology and my specialties (GIM, ICU was Respirology) on an hourly basis. Fee for service models that don’t compensate for more than one issue addressed so you either are rushed, anger patients, or lose money in clinic.

mls12 4 months ago