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. Administrative Burdens- associated with ENDLESS emails for those of us involved with engagement work- physician engagement work is crucial to improving physician input and involvement into healthcare policy, decision making, and change- it helps to bring enthusiasm, pride, and voice to local medical staff associations and physician groups- however....it has become a full time job!! - emails are endless, a burden, and extremely time consuming- trying to find a balance with allocating administrative time slots into my day has helped, but really in order to manage this properly, it would take about 1.5 hours per day which unfortunately is time removed from patient/clinical care2. Clinical Complexity- wow - this sure has changed since I graduated at the turn of the millennium!- patients exceedingly more complex in the past 10 yrs3. Work Environment- despite ongoing involvement in Physician Engagement groups and initiatives, my feeling is still that we have a very small voice in decision making and that our voice is not valued- decision making continues to happen by administrators with what feels like very little involvement from front line staff- front line staff (physicians) are told about change AFTER the change has been made

kmcclellan 4 months ago

After disagreement with the HA regarding the quality of Older Adult Care I was villified and essentially assassinated. If we confront the Administrative Resources from Gov't the exhibit quite similar behaviour. After the forensic accounting of the HA activities proved malicious intent , I seem to have been a necessary casualty. I am better without working along in this medical system. In some sense, not missed.Reviewing the topic over the past 15 years of Physician wellness literature some efforts of our peers have fallen to the neoliberal model of "fixing" (By command), the physician. Systematic villification of physicians who step forward is fear based. Fear is not a plan. Courage is a plan.After reviewing the comments of my colleagues, these same comments in tenor are very like the comments of the last 25-30 years of workings in the Health Authority systems.....anybody?

fmd50 4 months ago

How is it that we live in a world where - when I take my car to the mechanic, he charges me for the oil change, the brakes, and the other three things I needed to get done- when a lawyer charges me in 10-15 minute intervals and $30 just to OPEN and READ my emails (and extra for actually doing something with it)-my hairdresser's booking system is free or costs pennies and can send me txt reminders for my appt that I can add to my calendar (which she will charge me for three separate items)but I live in a world that - I get paid the same lousy $31 no matter how long it takes, how complex it is, how many issues I deal with and if I bill for a second item, I only get paid 50% for it (rather insulting I think)-that I don't get paid for any of the "after patient encounter" work that I do (paperwork, phone calls, faxes, blah blah blah)-and the EMR that costs me $2500/mo requires an "value added" third party module to send appt reminders that costs me $5,000 to set up plus more monthly fees?Somebody's rigged the system. and it's definitely NOT in our favour.

SlayerofDragons 4 months ago

I read the first four pages of responses and I had to stop. It was depressing. it was like I wrote each one of those myself - here I thought I was the only one and was obviously doing something wrong because other docs go home right at 5, but I'm here most of the night - but I guess that's the "prize" I get for owning and running the clinic to which I "donate" 30-40% of my income. all of the issues mentioned are ditto for me. the EMR I pay $2500/month for can't even do what a cheaper word/excel/outlook can do instantly but I need to fill out, print, sign, fax and document for 15 minutes for yet another fax from a pharmacy for a patient that missed their appointment - which somehow becomes my emergency to do ASAP. I have had two physicians leave because they have multiple overhead they can't afford and I have been trying to recruit for the past three years with no luck. Not sure how I am going to handle the extra patient load when I already wasn't coping in a healthy way. Like most of us, I went into medicine to do a good job, but the system just beats that out of you. I have a focused practice in addiction medicine. most of my patients come by referral so I act as a consultant but get paid GP wages. for each consult I get paid I get paid a whopping $76 - 95, I cannot do the MH plan because they have a GP. the largest fee for a consult was an 85 yo geriatric pt with a bonafide chronic pain disorder, benzodiazepine dependency, alcohol dependency, living on her own. I got paid $115 for something a psychiatrist treating a geriatrician would have been paid $365. I wonder why I do this sometimes, and then remember I thought I could make a difference which I don't care about anymore because I haven't seen my kids all week, I haven't had a lunch break, and I haven't had a chance to go the washroom all day.I try not to have a "one issue/visit" policy because I'd like to feel I'm doing a good job, but then the patients are angry at ME because they've had to wait so long....before they proceed to pull out the long list they've brought with them that they need to have done/ordered/referred. my focused practice not only includes addiction, but chronic pain as well. at the end of some days I feel like slashing my wrists because I've been listening to patients complain about how they can't afford massage, physio, and other useful stuff, yet they continue to spend $200/mo on cannabis which is "medicine that works" and they are wondering if I will prescribe it (which is about 4 hours of back and forth paper shuffling, only to find out the licensed producer has run out of what you wanted). I've had college complaints from patients because "I didn't treat their pain," I took away "the only thing that ever worked," and because I wouldn't prescribe them hydromorphone to inject TID. I've also had complaints that we charge a clinic fee for our counseling service, which we are entitled to do, even though the patient spends $100/mo on cannabis and takes at least one overseas vacation each year. while "health authority supported" addiction clinics also charge that, they are paid $60/mo for every pt on SA/PWD by the Ministry, we are seen as "unethical" and money hungry because apparently I am a "private, for profit clinic" (that is NOT making a profit) and so the HA won't work collaboratively with us. I'm also done with Social Workers, RNs, NPs, mental health clinicians telling me how I should do addiction medicine. Not sure who died and left them in charge, but there is no physician input into anything MH related. and why is it that a specialist gets paid a higher sessional rate than I do for sitting in the same meeting and doing the same work? for that matter, who decided that specialists should get paid to be on call (even if they don't have to go in) but GPs have to be available 24/7, often on call, and never see a dime of call payment? I'm not angry at the specialists. it's not them that's to blame. I'm blaming whoever it was that decided that my time with my family is less important than somebody elses. because of the complexity of my patients, many of my visits are extended (hard to treat a homeless person with severe mental health issues, opiate and alcohol use disorders who now has cellulitis and pain in a 15 minute apt), so I bill a fair number of counseling visits to get paid FAIRLY for the work I do. But all that does is put me at 4SD on counseling visits on my "mini profile" which has flagged me for an audit. all I want to do is do good medicine, get paid fairly for the work I do, and go home at a reasonable hour. I don't want to spend it doing paperwork, answering the 100 emails that came that day, or sit in meetings UNPAID (when all the MH clinicians get paid to be there) for things that are never going to happen. I'm a single parent putting two kids through university after paying of significant med school debt. I don't know how long I can do this or even want to do this because my quality of life is aweful. recently, I reached to to the PHP, the D of BC, the CMPA, the CPSBC and the HA for help with bullying behavior from a senior male colleague. THERE IS NO HELP for us, even in this day of #metoo and #timesup. Good thing I'm not being sexually harassed because I certainly would not speak out because, quite frankly, it feels like no body is listening and no body cares.

SlayerofDragons 4 months ago

i agree with many of the comments already posted. also the cost of EMR tools that improve use of technology (prohibitively expensive for add ons), expensive training to fully use the emr to improve office efficiency.

jae95 4 months ago

Number one is the increasing cost of wages for staff. Both the increase in minimum wage as well as the increasing complexity of care required by the Ministry of Health is pushing overhead into an unsustainable state. Though the GPSC has done well with lobbying for complex/chronic care fees, they are not enough to mitigate the rising overhead in community owned practices. In the two rural places I've worked, we've run the data and found that the clinic overhead is well over 30%, which is the going rate that locums expect in rural BC. This makes it less sustainable to get people to locum without losing income in doing so. If the ministry does not directly supplement staff wages in our offices in the future, I don't think community owned practices in rural sites will be able to survive in the coming years.

user6419 4 months ago

workload, patient expectations, poor access to specialty consultation (long waits) no compensation for preventive/proactive medicine. complicated patients, living longerpateint engagement, education on how best to use the medical system, focus on disease treatment vs health promotion/disease prevention, working in full scope of practice for physicians, moa and RN or AHP to unburden physicians (bolstering PMH before throwing physicians into Primary Care networks, ministry of health agendas being thrust on physicians without really hearing their concerns (unionized staff working in non unionized environements)

jae95 4 months ago

High cost of leasing office and maintaining equipment and staff, in addition to CMPA cost. Inability to find locum coverage for time away. Paperwork. EMR is cumbersome and follows me home.

skm3919 4 months ago

same as prior answer

userX 4 months ago

Poor IT infrastructure leading to excessive amounts of time trying to obtain patient dataDifficulty communicating with patients/families due to language barrier and lack of social supportsLack of time-based payment structures for non-proceduralistsExcessive amounts of time on dictations/transcriptions

userX 4 months ago

Health Technology - This does not improve efficiency and is expensive to maintain. I spend more time with each system, they don't communicate with each other and often end up being a 'storage area' for a bunch of individual files. Paperwork takes as much (if not more) time as patient contact - so many forms, letters etc that each patient brings for all sorts of organizations. Patient expectations are very high and we are under scrutiny for policies like 'one issues per appt"; patients have very little understanding of how medical offices operate and what we are/are not paid for. Finances - Family physician fees are minimal at best (4 patients/hour is approx $140/hour), 30% (at minimum for most practices) goes immediately into the office overhead. This means that a Family Physician earns around $100 an hour, prior to other expenses being taken out. This is not a sustainable income with the increasing expenses of maintaining licensing etc. Idealist goals of a health authority - CERNER which is an absolute waste of resources - the cost vs benefits is absurd and physicians are expected to absorb the cost of inefficiency (and training time). I have had more critical errors with CERNER from misinformation input in the computer than prior to this. PMH and PCN - again we are expected to create and absorb the costs of this or participate without our opinions being truly heard- our physicians have zero engagement in this project as we have repeatedly been asked what we want/need and then told we can't have anything, despite sums of money being spent on 'planning' over and over again.

S2S99 4 months ago

- Taking home a tremendous amount of paperwork- Hard time fitting in CME- Living in fear of a College complaint or litigation

bourde3 4 months ago

1. Amount of paperwork and documentation requirements for medical- legal reasons 2. Slowness of health authority EMR (PARIS in FHR) Not practical to use with patients in the room so hand written notes are needed in addition to dictated notes that end up in EMR - waste of time 3. Decisions about changes in how community care teams (Mental Health Teams) will run are made by non-physicians with no regard for our how it will affect our practice, livelihood, income. All of a sudden we are told you will now be seeing this new patient population - one you are not as skilled at seeing nor interested in treating. How is this good for patients or physician satisfaction?4. Med reconciliation orders. All fine in complex cases but do I really need to waste my time and energy signing and dating blank pages and getting marked on this skill by the health authority on a monthly basis?

Banan 4 months ago

The lack of remuneration for work associated with the patient visit ( after they leave the office), the lack of recognition and remuneration for extended visits and the generally poor fee for service remuneration for General Practice office visits combined with high overhead and patient demand make the situation I face impossible to continue. We need to address a time premium on office visits over 15 minutes, contributions to high office overheads and an increase in basic fees ( as a starter).

usergrad1987 4 months ago

I am a primary care physician who practices maternity care as part of a group practice. I struggle to get through my tasks in the day and often find that there are not enough hours to accomplish all that needs doing. Between seeing the number of patients needed in order to make my overhead worth it, and completing the hours of paperwork that my office day produces, it is a real crunch. I often have to choose between staying late at the office or going home to see my family at suppertime, and subsequently staying up way later to complete it all.I have sought to make every accommodation to gain work-life balance, such as exercising on the way to and from work, or ending my day earlier, but at the end of the day, medicine has a 'bottom line' of cost to it that makes it unsustainable to work less. CMPA fees, college fees, overhead, CME, etc, etc, etc. I have been dismayed at the 'made to order' medicine that our population has come to expect. Often I can feel like a 'pen and prescription' rather than a person who is being consulted to thoroughly look into an issue. There seems to be a lack of respect for profession, and people are going to naturopaths and 'alternative medicine' as first-line more often these days. We cannot advertise, so how do we compete?Finally, I am concerned about the lack of respect given to primary care by the general public as well as our governing bodies. Newspaper articles arise regularly complaining about how hard it is to find a family doctor, and that the new generation of docs doesn't work hard enough. It can lead one to feel defenceless and defeated. We need respect or we will crumble as a system.

JRiemer 4 months ago

Paperwork, paperwork, paperwork. No doubt it is the bane of my existence. I have residents about 8 months of the year, and I was reflecting today why it is they are leaving the office before I am. Perhaps they type faster, perhaps they don’t get unloaded with all of the patients issues, as they are seen as ‘substitutes’ for me.... but I strongly believe it is because they don’t have to sort through 25-50 labs and extra documents a day. This is the true burden of family practice in 2019

User0515 4 months ago

Legal concerns and the college complaint process. I frequently feel backed into a corner to respond to unreasonable patient requests and demands for specific resources (ie tests, referrals, etc). I dread the 12-18 months of being dragged through the coals if a legal and/or college matter were to arise from a dissatisfied patient. It is extremely time consuming and distressing. I seriously wonder how many resources our system wastes because MDs feel they cannot safely say NO to unreasonable patient requests for fear of retaliation.

interiormd 4 months ago

The paper work and documentation has become increasingly time consuming and no truly improving patient care or outcome.Patient expectations are unrealistic and frequently based on the latest Google search.Work environment with an increasing demand to see more and more patients...

Hasta512 4 months ago

I recently took a leave from my practice due to impending burnout, probably the second or third one of my career. I was noticing that I felt that I was leaving a little bit of myself behind at the end of any day, and I started to become afraid that I would lose my empathy altogether. We are held to a standard of perfection, and punished if we do not attain this, either by ourselves, our patients or our college. I have returned, but with a much greater focus on my own physical and mental health, but at the expense of availability for my patients. But I think it's better to be partially available over being dead.There seems to be an ever increasing demand for physician services at the same time that we are receiving news reports that graduating medical students are unable to find residency positions, and graduating specialists are unable to find jobs. At the same time, we are asked to provide this care to an increasingly aging population, with no reasonable expectation that there will ever be backup or relief.

tinecrop 4 months ago

Where to start? Increasing overhead costs with decreasing skill of available MOAs. Nurses who don't want to do office work because I cannot pay them competitively results in a decreasing ability to meet the Ivory Tower's standard of the Patient Medical Home. Increasing demands on my time that I never get paid for. Yet another guideline or recommendation dumping more work on family doctors to screen for more and more - in a 10-minute appointment, no less (because to book and get paid for a physical, I must examine each system, try adding this onto screening for 17 things in a 20-minute visit). Specialists who dump patients on me inappropriately and are only interested in helping me for the first two days of an admission (if at all).Physiotherapy and massage not being covered by MSP, which means my patients can't afford the help they need for their chronic conditions - leading them to my door asking why I can't do more for their pain.The fact that the most recent PMA STILL HASN'T ADDRESSED THE MUCH-NEEDED INCREASE IN FEES FOR BASIC OFFICE VISITS, and the only way to access all this money they've set aside for projects is to take on more work and create a new project for myself.The Divisions of Family Practice and Facility Engagement programs wasting money with gala events and wining and dining their local representatives at monthly meetings, yet my having to beg for funding to start up a project that improves patient care.There's more, but I'm burnt out from all of these surveys, too.

Anon 4 months ago