Family doctors are becoming a scarce resource in Canada, with 6.5 million people in the country without a regular doctor. Although, since last year, pharmacies have been allowed to prescribe drugs to assist in the treatment of minor ailments, but this is not enough.
As a result of this shortage, expensive private clinics have sprung up to serve the wealthy. At the same time, more and more family doctors are choosing to leave due to the prospect of earning less and less money, as well as tedious paperwork.
One of them is Fan Wah Mang, a 53-year-old Chinese doctor who ran a family practice in Mississauga, Ontario, for more than 20 years, but the reality did not support her to continue working. In an interview with Toronto Life, she exposed the major shortcomings of the current Canadian public healthcare system through her own experience.
Currently, the fee is $37 per appointment, with an additional $3 for patients enrolled in the Government's Family Health Plan program. Rates vary for each patient based on gender and age.
Fan has about 1,000 patients and brings in about $2,000 per month. In 2003, when he first started working, Fan's annual income was about $90,000. In 2022, that figure is about $142,000.
For a while, the clinic was financially okay. But in 2015, with the departure of three doctors, the clinic was left with Fan and another colleague who could not afford to pay the nurses or hire new ones.
At the same time, inflation has made equipment expensive. By 2015, the Ontario government had eliminated subsidies for electronic health record systems, and Fan and his colleagues had to pay out of their own pockets for the $5,000 annual membership fee for the software. By the time of the pandemic in 2020, various protective measures had increased spending. To protect them from hackers, they also purchased $2,500 per year of cyber insurance.
During the pandemic, Fan lost a lot of patients. Due to the cost of living and employment issues, many patients move to cheaper places. These people have no way of finding a new family doctor, so they have to make appointments over the phone. The Ontario government allows billing for phone appointments, but in 2022 reduced the cost of phone appointments by 15%. However, this type of consultation does reduce the clinic's revenue.
With the digitalization of medicine, Fan and his colleagues are increasingly overwhelmed by various administrative tasks. Increasingly, healthcare system partners, such as pharmacists, are required to be signed by doctors. Fan's inbox receives 100 administrative reports per day that need to be approved for review. In July 2023, the tedious work forced Fan to reduce the number of medical appointments per week from four to three, meaning one full day less per week.
However, the patient's questions do not decrease as a result, and Fan needs to call them on their days off if they are responsible for answering. This kind of work intensity makes Fan anxious, he goes to the office at 8:30 in the morning and leaves at 7 in the evening, and he can't rest on Saturdays and Sundays, and he needs to sit in front of the computer at all times.
The straw that broke the camel's back was when Fan found that she couldn't find time to care for her two teenage sons, who had to cook instant noodles and often ask her mother when she could be with her.
So, when he learned that he needed to renew his office lease in May 2024, Fan resigned and left. The other colleague thought about it and said, "If you go, I'll go too." "And just like that, the clinic was going to be disbanded.
However, when Fan was overwhelmed by objective reasons such as rising costs, inflation, and redundant administrative work, the guilt for her patients fell on her. Many elderly patients between the ages of 85 and 90 fear that they will never find a GP again. One of them was silently crying behind a mask, feeling that he was too old for a new doctor to accept her.
Some young patients are also worried that they are not aware of the risks to their bodies and that the lack of guidance from their family doctors is likely to be unexpected. For example, a 19-year-old female patient with Fan felt pain urinating. Before asking Fan, she went to the pharmacy to describe the problem, and she was prescribed a medication to treat urinary tract infections. However, the real situation is that she has trachoma urinary tract infection due to her lack of sexual activity, which can lead to infertility if left untreated. Family doctor clinics provide more authoritative and sustainable medical assistance than regular pharmacies.
As for the future, Fan said she would never consider turning to private healthcare, and she didn't want to run a clinic for the wealthy. As for Canada's public health care system, she said it was difficult to see what its plans and solutions were. To some extent, at least, Ontario wants to replace family doctors with other health professionals, such as pharmacists and nurses.
Fan wanted to stay and continue to help her patients, but as she stands, she can't hire enough nurses, and the cumbersome and unpaid administrative work hinders her motivation – under the current public healthcare system, family doctors don't want to make huge profits, they just want to make enough money to make ends meet and be responsible for their patients.