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.

1. Lack of respect from hospital administration. Health authorities and hospital administrators like to talk about the important role physicians play in making decisions about hospital policy, equipment, etc. but this is really just lip-service. The only administrators that my department engages with are relatively low-level and do not have any decision-making authority. One of these administrators actually told us (probably by accident) that physician input only accounts for 10% towards making major decisions!2. The College and society in general are putting more and more onerous expectations on physicians. We are expected to dedicate ourselves to patient-care, never miss work, always be available, and never complain. I cannot remember the last time I or one of my colleagues took a sick day or cancelled patient appointments/procedures to deal with personal/family illness/emergency.

GIMD 4 months ago

Practice management such as policy and procedures and privacy legislation compliance. Each specialist having their own referral form rather than letting me write them a letter with my concerns.Having specialists refuse to see the same patient for two related concerns and requiring a second referral for the second concern. On call demands.

Salo 4 months ago

1. PaperworkI'm a family physician providing longitudinal care in my office, in residential care, and in patient's homes. I'm 6 years into practice. On a typical day, I can only see 30 patients in 6-7 hours because outside charting, I spend 2-3 hours on paperwork. Every day patients bring in countless forms from insurance, social service, school, work, and exercise class. Every patient wants their form done that very day. A lot of this paperwork is not paid for or poorly compensated for. This is draining and exhausting. If I don't have to do this many paperwork, I can attach and see way more patients a day.2. Practice RequirementsThe new CPSBC Physician Office Medical Device Reprocessing Assessments (POMDRA) was a huge challenge for my office. I pride myself for doing lots of procedures in my office instead of referring out. To comply with this College assessment, and to continue providing these services to my patients, my overhead went up, I spent hours and thousands of dollars upgrading equipment and training staff. I receive no financial support from the Ministry. Procedures continue to be poorly paid. It is actually easier if I decide to abandon doing the procedures and refer everyone out. I'm sure my ENT colleague won't be pleased if I refer my patients for ear irrigation because I can't afford to reprocess ear syringes in my office.3. Patient ExpectationsDealing with angry patients is an everyday occurrence, and it is exhausting. Patients expect the family physicians to do everything for free. They don't know what their MSP coverage covers. Patients got angry and upset when they're asked to pay for services outside their MSP coverage. To make matters worse, chiropractors send pt in to see FP for XR because when FP order, it's free. Naturopaths send pt in for blood work because when FP order, it's free. Dentists send pt in for preop physical because it's free. Patients got angry when I refused to order image and lab without a medical indication. Patients called me 'heartless' and 'unsympathetic'. Patients want me to make up reasons to order these things for them so that they don't have to pay. In the end, the patient-physician relationship is broken. I wish that there can be more public education on MSP coverage. The public needs to know what their tax dollars fund for.4. FinancesI have started transitioning to aesthetic medicine because MSP FFS does not pay enough to cover the overhead cost. Aesthetics pays a lot better and is a lot easier.5. Culture of MedicineConsultants expect FP to notify the patient and give complex pre-appointment instructions, and send no-charge referrals every 6 months even though the patient has been followed for the same condition for many years. Family Physicians pay their MOA to do all the work that benefits the consultants. Even though CPSBC has revised the Referral-Consultation Process in July 2018, nothing has changed about the referral process. Family Physicians, out of fears of not having their patients seen by consultants, continued to do all the work for consultants.

fammedbc 4 months ago

1. The BC College makes it EXTREMELY difficult to attract non Canadian doctors. They make it difficult for not just permanent docs but learners and even observers to come to BC.2. The Health Authorities and doctors work in independent silos. "Us" versus "them" mentality serves neither well.3. Proposed solutions for many issues, even when $ is not the issue, but solutions would result in savings, are often dismissed because change is required.4. Unions, unions, unions....

SG 4 months ago

being a GP is such a drag. No one wants to do that kind of work any more. I am sad to see the GP's so sad and disheartened and leaving practice (at every opportunity, it seems)

Joelle Bradley 4 months ago

Expectation of hospitals that we do hospital committee work for free College guidelines sometimes are not rooted in reality

Tbarnett 4 months ago

Increasingly complex and extended disability forms. Multiple faxed renewal of medsUse of walk in clinics and poorly integrated care

Tbarnett 4 months ago

I was going to type out some examples, but from browsing the posts before me, I think there's a wealth of examples already. I came across this CMAJ news article, and I think it pretty much summarizes the problem with us - the healthcare system takes advantage of our professionalism and work ethics. The system, hospital, administrators just want us to work for free. My nursing colleagues tell me, "When I get off my shift, my work stops, and I don't take work home". I wish we can be like that. This article summarizes the root problem: https://cmajnews.com/2019/04/30/health-care-system-takes-advantage-of-doctors-work-ethic-cma-109-5751/

above&beyond 4 months ago

Rapid access to specialist support needs to be addressed on an ongoing basis. Improvements in on-call programs and telephone availability over the past years have been positive steps. Now we need to expand those services with more telemedicine.

GP1956 4 months ago

CME is getting very expensive. This is an especially important issue in rural communities where current and relevant CME is not readily available. It often requires travel along with higher and higher tuition fees. The increase in online CME is helpful but certainly does not fill the gap.

GP1956 4 months ago

Locum coverage is a big issue for many physicians in both rural and urban/suburban centers. The latest fee increase in the rural GP locum program was the first in many years and was helpful. However, the funding for rural locums needs ongoing review with appropriate increases in both daily rates and travel time and expenses. We also need to devise, refine and review, a better a program to help physicians in urban/suburban communities get relief.

GP1956 4 months ago

Rising overhead costs are a big concern. Good staff needs to be well paid. Technology in the office is expensive to maintain and upgrade. Now with the rising expectation that primary care networks and patient care homes will become the norm, I am concerned that GP's will see further increases in overhead. The recent master agreement was a step in the right direction but not enough.

GP1956 4 months ago

I was recently subjected to an MSP audit, this spanned 5 years from the 6 months before to first 4.5 years after adopting EMR. The audit process took 3.5 years to complete. During this time I would suddenly receive requests for information that would have to be supplied within 30 days or face consequences. I would then not hear from the billing integrity program for a year or more, at which time other orders for other time-limited responses were issued. Absolutely no credit was given for the countless hours of work (nights and weekends etc) work I put into creating a complete and thorough, fully coded and accurate EMR of my patients. As if the EMR was purchased populated. During this audit I was treated like a criminal and felt bullied and helpless. We are all assumed to be billing experts in addition to the rest of the work we do. I believe most physicians are honest hard working individuals who may make billing errors out of ignorance rather than trying to cheat the system. I would like to see the MSP billing integrity program assisting us rather than trying to punish us. The copious and redundant note making needed to comply with all MSP requirements has added many hours to my work week. The day after my audit was completed I received a letter from the College that I have to undergo a routine 360 practice assessment, I found this an honorous task with little or no value and felt it was more about the CPSBC justifying their existence than being of value to myself or my patients.I have just renewed my hospital privileges, which is now a 7 document process in which the health authority have created "Cactus numbers" and other features which have to be completed, to make audit and data collection easier for them. After successful completion, I am now also be entitled to pay for annual parking when I attend my inpatients.Part of my practice entails looking after frail seniors, I am pressured by administrators to send some of them home as part of the "Home First Program" because they have not exhausted all resources in the community. Some have been sent home and repeatedly readmitted with frailty, injury, illness. I find myself having to advocate for patient care and safety against an administration which appears to be more concerned with numbers, budget and statistics. Attempts to deal with this through policy change become watered down by repeated meetings at increasing intervals with no outcome.It is an observation that much of the documentation required of physicians is more about making data collection easier for audit and statistics than patient care. This burden is not remunerated. Governments at various levels do not seem to feel any need to pay for the services they demand. Revenue Canada often sends out documents questioning the validity of disabilty tax credit claims in physician completed applications, requiring another detailed form completion or the claim is dismissed. Fraser Health expects lengthy detailed form completion to assist them in returning injured or ill employees to work, but send the form with the health care worker and refuse any responsibility for payment. This program operates in addition to Worksafe.Pharmacare requests are seldom refused, yet still, require new and renewal applications. There is no longer the easier phone access to expedite routine applications for patients

Peter 4 months ago

Heavy focus on fee-for-service model of physician reimbursement

dannylee 4 months ago

1) Increasing load of paperwork without any remuneration. In our fee for service model we only get paid for actual patient contact with no remuneration for hours of paperwork (charting, referrals, calls to on call specialist, pharmacare applications etc). In other words, we only get paid for 50% of the time spent to complete our pt care. We also do not get any remuneration for pharmacy refill requests which leads to more pts filling doctor appointment spots which could have been prevented if they remunerated doctors for the time spent to safely fill reasonable pharmacy requests.2) I am of opinion that physicians, like lawyers and other professionals, should be paid for their 'time' spent, not just a fixed rate per visit irrelevant of their 'time'. We only have X amount of hours per day and sould not be financially worse off for taking care of complex pts. Due to the complexity of our pt care needs it often happens that you need to bring your pt back for multiple visits to be able to get through all their concerns and medical problems, where if we were paid for our time spent it would likely cost the system less to allow a doctor to spend more time when needed with remuneration in order to sort through the multiple complex issues. I believe this will increase pt and dr satisfaction and lead to better health outcomes.3) The family physician is the pt 'data collector', 'navigator' and should oversee and ensure holistic pt care, however we do not get remunerated for these functions, we only get remuneration for actual pt contact and not for any time spent on the over crucial functions of a family physician. 4) Technology is fantastic and having EMR availability has certainly changed the way we practice, but it also came with increased responsibility and no time away from work. The only way you can have time off from work is if you have a locums to cover your office and paperwork - which in BC is HARD to find, partly due to poor remuneration for locums and also due to the different licensing requirements of different provinces. We live in the most beautiful province and thus one would expect BC to be an attractive locum option, yet licensing requirements and remuneration is a deterrent to locums. I would really support one license/registration governing body for all family physician across the provincial boarders in Canada, since we all write the same examinations and have the same qualifications.5) After hour call or cover is to be remunerated. No doctor should work 'unpaid', even if just on call, like in other professions.6) I am of opinion that a centralized patient data base (containing all the pt labwork, special investigations, specialist reports, medications prescribed, vaccinations provided etc) which all physicians involved in pt care can access, will improved pt care and outcomes and assist with better decision making and save on the cost of re-ordering things that has been done before and also be a big time saver for physicians not having to chase results/reports.

user1880 4 months ago

No burden because I have stopped practicing due to the lack of resources and lack of collegial support

Ovesen 4 months ago

I have run out of the milk of human kindness. I see the problem with health care today stemming in large part from the increasing bureaucratization of health care. Greater than 60% of health care dollars are sucked up by non-care-giving costs and employees. That means that there is a huge divide between hospital-based docs and those in the community. I stopped providing clinical care after two suicides in patients I had sent to hospital. I was not told that they had been discharged with in minutes of being seen. When I tried to follow up I was told that their job was to buff and turf anyone they could. They spoke of the bureaucratic pressure not to admit patients and thought that was an ample excuse. I feel guilty that my skills are not available to people who might need my help but I can’t stand any more of the health authority BS.

Ovesen 4 months ago

1. Paper work ! Everyday. In between and after hours. 2. EMR , data capturing and documentation all after hours.3. Financial pressure to support my employees and family. Tax burden. Unable to afford a vacation. The cost of running a full service family medicine practice is astounding.4. Increasing College expectations and multiple practice guidelines making it impossible to see enough patient’s AND provide good care, AND stay up to date.5. Patient expectations unrealistic and impossible to meet. Problem lists. Appointment availability. Waiting time at office. Lack of timely accessibility to services and investigations. Disability support expectations. 6. Asked to do the work no one else wants to do or take responsibility for.7. Very frequent , all hours, telephone calls from nursing due to inexperience, poor handover, and knowledge of patients under their care. 8. Loosing full service colleagues due to list above, resulting in increased work load and unattached patients. 9. Poor self care and health due to all of the above.10. Struggling family. I am not available for school meetings, sport events, birthdays, anniversaries, or just a regular weekend. (Over easter weekend, despite being off duty l was phoned 13 times, and had to go to the hospital twice.) I give all I have to my patients and health authority and country, only scraps left for my poor family. 11. Involvement in leadership roles difficult due to poor physician engagement and lack of trust in MOH and health authority. 12. Lack of respect from other disciplines often seeing themselves superior.13. Strained interpersonal work relationships.14. Undervalued and replaceable. Allied professionals are being paid for the services l provide, but are less liable and responsible than me for errors. They have lower insurance, training and college fees, and are not expected to provide 24/7 care. 15. Reading that I am a tax evader in the media despite all I sacrifice.16. Rate your doctor websites. Lack of rate your patient websites. I am angry, frustrated, discouraged, guilt ridden and exhausted. Looking at the comments I am not alone.

User101 4 months ago

Increased complexity and detail requiring identification and documentation, resulting in longer reports. A diagnostic report for breast cancer used to have one line, "Invasive ductal carcinoma", and maybe a mention of surgical margins. Now it has 20 or 30 with all the little features we must find, measure, and identify, as well as the ancillary testing which must be performed and reported (biomarker staining, molecular studies). The number of cases we can get through per day becomes less and less as there are more and more requirements, and yet the volume continues to increase year after year and the number of General Pathologists available to do the work in rural and community hospitals continues to dwindle.

Launny Lowden 4 months ago

80 emails a day during the work day, 75% of them personally addressed to me and requiring my input or decision about something - that's an email every 10 minutes! Where am I supposed to find the time for direct patient care work? Not to mention the meetings, phone calls, and constant interruptions with people at my office door.Desperate lack of funding to support new laboratory equipment as our analyzers are long past the end of their lifespans and have frequent breakdowns, compromising patient care and causing a lot of stress for the lab physicians providing oversight.Disparity in compensation vs work performed across the province and even within health authorities, using outdated workload models in inappropriate ways that incentivise certain types of behaviour and work and leave other important work undone or poorly/quickly done because it is "unpaid".Desperate human resource shortages, and in particular a lack of General Pathologists, leading to overworked and overwhelmed physicians trying to carry the weight of the empty positions and resulting in long hours, very few days "off" (which the colleagues left behind pay for in extra workload), and ultimately physician burnout.Both of the factors above leading to decreased collegiality and unpleasant work environments. Limitations in informatics technology (EMRs, lab information systems) and lack of funding for adequate staffing levels in IT to address problems, pull and analyze data, and do any quality improvement to current processes. There are free online programs that function better than our expensive healthcare related programs do. Getting one little change, like the ability to schedule an appointment at the lab online instead of patients waiting and waiting, is essentially impossible due primarily to IT staffing shortages. Why must our computer systems always be so slow and complicated and inefficient and the opposite of user friendly? Slick user friendly programs are all around us - why can't we use one of them?

Launny Lowden 4 months ago