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.

Poor sense of team with other specialists co-managing patient careComplexity of care without patient navigators FFS versus salary/contract

dvmd 4 months ago

Expectation to be all things to all people No benefits such as sick time, extended health etc. If you get sick, you may be sicker than the patient you are caring for, but can’t call in sick After hours paperwork Weekends worked with no extra compensation More and more paperwork with questionable true benefit/purpose

dvmd 4 months ago

complexity of care and many new treatments (it's good that patients live longer, but the workload with no fewer patients is increasingly enormous and the patients are sicker following multiple treatmenst). lack of multidisciplinary support- a supporting nurse model would make this a team effort, rather than individual, and use each of our strengths. And true secretarial/clerical/nursing aide, etc support. Research demands that I can't meet. I have a family, have a busy clinical practice. But I need an outlet for the tough clinical workload, but don't have time for that.Admin pays lip-service to our clinical demands, but really means "suck it up."Unpaid work that's just and add-on.No true workload formula to clarify what I do. We're the only ones that don't have hours of work, so if it's not done, it's up to the MDs. We're free labour.Patients searching for multiple opinions in an already burdened system; physicians providing consultative services but not treating the patient.Documentation is difficult- time consuming with FESR (slow system that IT doesn't seem committed to fixing), and the added burden of upcoming Cerner in which we will lose efficiency before coming back to the baseline efficiency 6-12 months later;.Everyone (most) is overworked, so then we work more + more in silos and less interaction. FFS GPs are underpaid + overworked (I'm a specialist!), yet other specialists require a rereferral q6-12 months (e.g. for a colonoscopy in a patient that has medical reasons to need it yearly)- waste of money. GPs have NO way to game the system for any benefit to them.Patient expectations- it is sometimes just easier to give in and do an unnecessary test, than spend the time explaining why it won't be helpful, etc. Why don't I just give in and stop caring about the evidence and the cost involved (and I don't bill for this as I'm salaried). I am burning out. I'm trying to do things to avoid this, but at the end of the day, it's my clinical workload that's killing me. And I can't just cut down my numbers; we're expected to see everyone that's referred.

MD2003 4 months ago

Automation of practice care - rigid protocol and proceduresDifficult admin not being supportive of physician engagementLack of engagement with front line health care providers about policies and changes to models of careNot feeling valued in hospital settingHospital setting not conducive to providing a healing experience - dirty/short housekeeping / no privacyNot being properly reimbursed for providing medical education although impacts office practice financially

MJA456 4 months ago

A few words might suffice - Complexity in primary care not paid. My unpaid work is over 50%.Visits all same price means I pay to see them if it goes over 20-25 minutes, depending on age, which patients expect even before we get to my agenda (update prevention, cancer, incidentaloma and valve surveillance, tie up the loose ends from recent visits, tests and consults, somehow they just don't see that as their agenda). The extra codes look like they are written by two committees, one that wants to let us bill for some of our unpaid work, and one that puts enough rules in so we can't.(Ten minutes to review chart and try to find specialist, ten minutes to implement the plan, but if I didn't keep the specialist on the phone for 7 1/2 minutes I get nothing. Prevention - is it counseling bad health habits or making sure all procedures done? - just put both in the definition and only pay for 100 a year even though we do 1000. Two specific chronic diseases, not the most time consuming ones, and once a year if you do thirty five minutes of visit and chart review you hit the jackpot, but that much work is done several times a year, and for many more patients than have those diseases, nada. FYI: DM and IHD usually don't take too long in a stable patient - RA with chronic pain plus cancer plus mental illness and/or MCI vs dementia -and guess who has to try to figure out which?- plus they missed their specialist appt but still want it so I need do another referral, those are the ones that are never stable. Then there's the physical, an extra OK paying visit once or twice a year only if you can think of a good medical reason to physically examine every organ system, I can't... Counseling 20 minutes - only allowed if mental illness interferes with ADL's? What's that got to do with it? They don't even want me to just linger and listen a bit and commiserate the first visit after someone's spouse died because they can still make toast?!) All these rules to get around paying us for our time, which would be so fair and straightforward, with physical limits to how much it can be abused. The lack of pay for time is also just downright insulting, implying we would somehow waste it which no other professional is perceived as wont to, as if we had time to waste, as if a minute talking about hobbies has no value for improving care by establishing rapport and trust, as if having some doctors billing ten visits an hour is somehow better.The there's the refusal to deal with futility. These boomers are turning 75 and will soon have several declining organ systems and that's OK, I'm the expert in multimorbidity can manage it (see above, I prefer not to have to pay to manage it though). But why do the patients want a specialist for each one and why are the specialists all willing to see them every year and do all the things they can when the patients in their studies that got some marginal benefit from that were all much healthier? The greatest generation didn't ask for that. The ones between generally do and don't seem the better for it. But the boomers, they will multiply the expense and effort and bankrupt us with it. Drives me nuts that I have to coordinate all this care which is going to break the health system before I need it and is harder than doing it myself. But the system doesn't support me when I say I can do it myself, so why would the patient believe me? Patients enrolled in hospice care and palliative benefits are still getting it all as well, despite agreeing not to when signing up. Even the geriatricians and pall docs don't seem to want to slow it down.And no one will refrain from demanding more from us, as if they haven't noticed those of us doing continuing care are disappearing or can't figure out why. The health authorities even write us form letters about what they "require" and what we "must" do; not just low on politeness, dripping with disdain. CMPA wants every lab tracked! I assume then I must fully take on the parent role and call them if they haven't got around to it yet? Recently they switched from saying the ordering doc is responsible for the results to saying everyone listed, doubling or quadrupling the work. The College won't let me see a patient without being perpetually responsible for them, 24/7 forever, but somehow that rule doesn't apply except to primary care. They want more documented than we can get paid to do. Rules that no one can follow are demoralizing. If they want that kind of service than they should lobby MSP to pay for it, not leave us all noncompliant out of necessity so they can do selective enforcement on a whim. Why not just enforce the essential rules on those who always skip them, like having a health history? Home nursing not integrated with medical care, not even when it's palliative. A different nurse every time makes it impossible for me to change that, no matter how hard I try, never mind is not great nursing.Pharmacy faxes! I made the med expire at this time because I thought it would be a good time for reassessment, so please tell me something more than "out". Perhaps you could explain why they or you think they don't need reassessment, or that they are homebound (really helps locums), or coming in in a week but out in two days. And please don't use a fax for urgencies as if I hover around it 7 days a week. The whole rest of the health system uses phones for that, or other mobile messaging. You are the only reason I have to have an MOA in the office when I am working elsewhere. If you don't want to call, just tell the patient to. And too many specialists expecting to use my secretary to schedule their visits and explain their office policies. Or seeing the patient forever (whether referred for that or not) but with none of the benefits of comanagement - ie me being able to communicate with them occasionally between their immutable q 6 or q 12 month visits.In any field except medicine and the domestic sphere, the one who oversees the entire organization and makes sure everything gets remembered and done is the one with the high pay and prestige.

Bridget Reidy 4 months ago

Feeling devalued as a GP when other allied health practitioners or NPs are boasting that they can do the same job. I would like some evidenced based decision making around policy decisions about funding NPs vs GPs with respect to cost of care (ie how many average patients are seen in a day, how many specialist referrals are avoided, how many unnecessary tests are avoided)

user33 4 months ago

Patient expectations and decreasing level of trust in the medical system. Makes the work much less rewarding. Working all day telling people that they don't need the "reverse T3" that the naturopath recommended is demoralizing and a waste of taxpayer's money.

user33 4 months ago

Moral distress - inability to provide the standard of care expected due to lack of capacity and resourcesLeadership gaps - few physicians stepping into leadership roles, making the few filled roles overwhelming

jconley 4 months ago

Why are you showing the results publically before they are even in.That will skew your results.

Patrick Nesbitt 4 months ago

Over-regulation by the CPSBC is the main annoyance.

Patrick Nesbitt 4 months ago

The paperwork can be quite onerous in documenting what was discussed and accounting for time for billing purposes taking away from time that could be spent with patients. Due to reduced availability of specialists - often limited to "consult only" care for children requiring psychiatric services.

amandad 4 months ago

Paperwork and documentation suck up so much of my time outside of seeing patients, and most of it does not contribute meaningfully to improving care or outcomes in family practice.Mental health issues- I do not have sufficient training or skill to provide the care that many patients require and it is so difficult to access ongoing support from a psychiatrist. For patients with more mild mental illness but who cannot afford counselling, I am not compensated sufficiently for the time I spend counselling or charting all of the required notes.

Kasandra 4 months ago

Paperwork - time to dictate, review dictations, send letters to colleaguesComplexity of patients - follow ups can take 45 minutes for a complex craniofacial child, but is only counted as a single encounter no matter how complexShifting staffing - several colleagues working towards retirement are no longer accepting consults, which makes our waitlists longerInability to get patients seen in multidisciplinary clinics within an acceptable period of timeInsufficient funding for multidisciplinary clinics, despite 10 years of attempts to convey the need by multiple measuresBurnout

E 4 months ago

Managerial aspects of running an office. Pressure to take on more patients and then feeling unable to meet everyone's needs.

1140 4 months ago

Working overseas compared to working in Canada:(1) I spent a very pleasant 6 years working in the Middle East and over there, work hours and call are limited, and when you are off duty, you are off duty. I never had as much spare time or the ability to do things outside work as I did working in the Canadian hospital and Abu Dhabi. Compared to working in the Canadian hospital, it was like night and day, heaven and hell. There is a complete hierarchy of junior and senior house officers, junior and senior registrars and specialists before things get to your level as the consultant. In addition, my office was free in the hospital and all health care benefits were provided. In addition, housing and a car and a ticket back to your point of hier were provided along with 40 business days of annual leave.(2) I spent a lovely year working in Scotland in a regional hospital and again, due to the European working directive, week work hours are limited to 37.5 hours a week and call this restricted to 1 weekend a month, taking call from home. Again like the Middle East, there is a complete hierarchy of junior and senior house officers, junior and senior registrars and specialists before things get to your level as the consultant. In addition, in Scotland, my office was free, in the hospital, and not only where my benefits covered but I received a state pension.

OldTraditionalSpecialist 4 months ago

Workload - for my entire career as a physician in Canada, the main burden has been the crushing workload. The more qualifications you have, the more you are expected to do. I have 3 fellowships in internal medicine, respiratory medicine and critical care and was expected to do triple call simultaneously for all 3 services. In most hospitals that I have worked up until recently, call (which can be as many as 3 times a week) essentially means you work all day in your clinic/doing Hospital Rounds, then you work all night on call in the emergency department and in the intensive care unit and then you work all the next day taking care of the new patients that you admitted while you are on call. For most of us, that means a 32 hour nonstop shift. For weekends, call could be all day Friday, all Friday night, all day Saturday, all Saturday night all day Sunday, all Sunday night and then you have to put in a full day's work on Monday before you can get any rest. That means many weeks are 100+ our weeks.

OldTraditionalSpecialist 4 months ago

1. Ever increasing cost and complexity of practice. Constantly understaffed, training staff in increasingly complex roles 2. Managing ever increasing amounts of data an information for which primary care is the repository 3. Poorly functioning EMR. The frustration of having no influence over holding the EMR vendor accountable to maintain minimum standard of operation4. The prospect of even more complexity and cost associated with "team based care" and being at the centre of system 5. Paper work and data entry .....................6. Perception that family practice is not valued while other allied health care workers are branding themselves as more valued 7. The need for increasing collaboration with a HA that does not have GP's anywhere in their decision making structure and does not seem to value this input. Frustration with the seeming powerlessness of this relationship

kk 4 months ago

Hard to retain staff. Many staff use our office as a short term stepping stone to specialist's office or hospitals. Having to see more than one problem per visit is really stressful. It forces me to be less thorough and frantic. The end result is very unsatisfying to both patients or doctors. It's like making an appointment to see a dentist and you expect the dentist to fix 3 teeth in the same visit.

ktu32 4 months ago

1) High level of threat from patients and very real daily risk of violence on wards. Regular verbal abuse. Physician not infrequently feeling vulnerable due to lack of security / poorly designed unit / patients with extreme forensic Hx of violence and crystal meth.2) Lack of safe and decent accommodation for the discharge planning of vulnerable patients.3) Inability for community teams to continue optimal medications such as Clozapine, resulting in individuals not receiving best evidence based treatment.4) Lack of beneficent paternalism from society. It is deemed acceptable for people to be homeless / in substandard SRO's etc as there is an assumption of autonomous decisions. More safe / secure / decent social.housing would help immensely.5) The revolving door of Crystal Meth misuse and sequelae.6) Inadvertent deaths by OD of huge numbers of patients. 7) Increased non-clinical demands eg front end dictation.7) EMR's that are unlikely to be clinically useful.8) Other non-medical health professionals attempting to dictate clinical care.9) Burn-out and rapid turnover of non-medical team members eg the "working life expectancy" of a social worker and charge nurse is approximately 18 months. As a result new staff repeatedly need training etc

MarieF 4 months ago

- the expectation to continue to do more, with the same amount of resources- certain specialties not as "valued" as others, as reflected by how funding/resources are allocated

User2222 4 months ago