Chronically-ill patients boost doctors' workload

Bill Doskoch
http://www.ctv.ca

Patients with chronic conditions, coupled with a shortage of family doctors, are increasingly sources of strain on the health-care system, says a new survey.

The 2007 National Physicians Survey, released Tuesday, said 80 per cent of physicians believe the needs of chronic patient care are the biggest demand on their time.

“I think the National Physicians Survey has shown once again that the system is under extreme pressure, due to low numbers (of doctors), increased burden of chronic disease and an aging population,” Dr. Andrew Padmos of the Royal College of Physicians and Surgeons told Canada AM on Wednesday.

Dr. Ruth Wilson, president of the College of Family Physicians of Canada, told CTV.ca that she’s seen changes in her own practice in Kingston, Ont.

Wilson delivers babies and provides care throughout the child’s life. “It used to be a good portion of my time was spent looking after them and taking care of their various childhood illnesses,” she said.

“A lot of that work has fallen off. What I do see is quite a number of people still living together in their 80s and both of them with significant problems — one with bad arthritis and one with heart disease,” Wilson said.

Some of the factors that can make elderly patients more time-consuming to treat include:

  • Mobility issues
  • Hearing problems
  • Multiple medications

“They often have a number of important questions to address, so it often means the rhythm of my day has changed substantially,” she said.

The survey found that 86 per cent of family doctors are caring for patients with a chronic mental illness, and 88 per cent have patients suffering from either heart disease or hypertension.

In addition, Canada has a chronic shortage of family physicians, something that Wilson said could be traced back to a mid-1990s decision by governments to reduce the supply of doctors.

Partly as a result of that, five million Canadians don’t have family physicians, she said.

The survey found that 65 per cent of family physicians can see a patient within once day, only 37 per cent of other specialists can do the same.

This has led to people getting care from hospital emergency wards, which Wilson said was not “appropriate, efficient or cost-effective.”

On top of everything else, family doctors as a group are aging, with the “baby boomer” class to which Wilson belongs nearing retirement. The survey said 33 per cent of family doctors are 55 or older.

The new generation of family doctors isn’t willing to work the hours that the boomer generation did, and that could further affect access to care, she said.

According to the survey, about one-third of family doctors plan on cutting back on their hours in the next two years. In a 2004 survey, one-quarter had planned to cut back on their workload.

However, there is some good news on the horizon.

“We saw an upturn in the number of students choosing family medicine as a first career choice this year, and we’re back up to 31 per cent, which is the level we were at 10 years ago,” Wilson said.

“So that’s great news. I hope we’re starting to turn the tide,” she said.

Other measures have been adopted in recent years to make the professional lives of family doctors easier, she said.

Pay has increased, more doctors are moving to group practices and several provinces are allowing nurse practitioners and other health professionals to work with family doctors, she said.

“Family doctors don’t have to carry the whole burden by themselves,” Wilson said.

Padmos said the team approach to chronic care patients make sense. “The family physician plays a vital role,” but shouldn’t have to do everything for every patient, he said.

But the investment to establish a team-based primary care system is substantial, and it could take a generation to fully evolve, Padmos said.

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