Loss of autonomy, gaslighting, abuse, exploitation, and hypocrisy are all strong words. Just writing them brings to my mind the harsh reality of my experience and the collective experience of others who have dared to speak up. These words come to mind when I think about primary care in Canada. I recognize similar sentiments are heralded by my U.S. colleagues and those in the United Kingdom. The system is failing. It is not working. The very people on the front lines, taking care of patients day in and day out, are being failed by the system. We are overworked, underpaid, and undervalued. Our opinions and expertise are often disregarded. We are told to do more with less and given impossible deadlines. When we speak up, we are often met with gaslighting and denial. This is not sustainable; something has to give. Many of us have already given up. We have left primary care altogether, or we have gone part-time. We have burned out and become frustrated. So, the next question is what a person should do with these feelings. One can retreat and isolate oneself, be proactive, and turn challenging situations into something positive. Initially, I chose to reflect, but now I am taking action. When I was younger, people would say, “wow, you want to be a doctor,” or even as an adult, as I grudgingly admitted to my profession, there was generally a sense of admiration from people. Then, the next question people often asked was, “what is your specialty?” I would say ” Family Medicine,” and I could feel the palpable disappointment in their response. It was as if the Family practice was somehow less than. Strangers did not just make these sentiments, but colleagues and those who knew me closely. So many years ago, a doctor’s wife remarked, “Oh, why are you picking family medicine? It is not very glamorous.” Even in medical school, students are often discouraged from applying for family practice residencies for many reasons. Unlike, what many assume, family medicine was my first choice. I felt it was an area of specialty where I could use my vast knowledge base and help a patient. I also believed that the knowledge I gathered could save someone’s life and potentially even my future family’s life. Little did I know that my understanding and persisting stubbornness saved my life and my family’s life when I became the patient. However, the longer I stayed in the profession, the more I realized that medicine had been glamorized to perhaps hide the truth–as physicians, we are essentially puppets in the health care system. Politicians might smile and claim they are making changes and listening, but we, on the front lines, often don’t see these claims turn into measurable differences. After all, many people see health care professionals as their “health care taxes in action.” I remember hearing comments that made it sound like physicians are somehow indebted to the tax dollars. As a result, it is our duty to do whatever it takes to get the job done. The system was failing, and it was failing us. It took a lot of courage to decide I could no longer be part of a system that was so broken and causing such immense suffering — not just to patients but to those of us who swore an oath to first not harm. So, I decided that I would no longer be an accomplishment to inaction and poor leadership in health care. I felt I was part of the problem by enabling those who should be the solution to avoid making real change because they know that health care professionals will continue to take the abuse. And so, I left and took a break from family medicine. It is time for those on the front lines to speak up and demand change. The status quo is no longer acceptable. We cannot allow the slow death of primary care to continue. It is time for a revolution in health care, and it starts with each of us taking a stand. I now realize that the system will not change overnight, but we must start somewhere. We must begin by demanding better physician support and working conditions. We must advocate for our patients and fight for the changes needed to save lives. Before I publicly announced to my practice that I was stepping down as a clinic owner and from having a practice of my own, I did some major soul-searching. I remember asking myself, “what am I doing with my life? ” I felt I was wasting my life in full-time medicine and wasn’t using my talents entirely. I knew I was missing out on so much that life had to give, and this had to change. I loved being a doctor, but the business side of things, the policies, and, quite frankly, the gaslighting, drained my energy and took away the enjoyment I used to get from practicing. The system is sick. And it is making us sick. I am concerned about the slow death of primary care. Primary care is the foundation of health care and must be treated. Instead, it is being strangled by a system that values quantity over quality that puts profits before people. In primary care, we are asked to make proverbial bricks with no straw- with more and more expectations being placed on one. In many areas in Canada, we are asked to act like ” the health care system” without adequate financial and human resources to do the work. We are often blamed for system problems that have nothing to do with us. You see, competent, knowledgeable health care providers don’t manage health care. Health care is often managed by individuals who know next to nothing about health care leadership; they know very little about health care and the short and long-term consequences of their actions. When the solution to long wait times in emergency, and long wait times to see health care providers, is to hire more administrators- that, in my mind, is a red flag. So, you see, we don’t need more administrators. We need people who know what they are doing and listen to the health care providers who are unfairly carrying the lion’s share of the work. When you look at how our health care system is structured- there are way too many people in charge who know very little about health care but are making decisions that affect all of us. In my opinion, the slow death of primary care is a direct result of the mismanagement of our health care system by individuals motivated by power and greed rather than by a genuine desire to improve people’s lives. We need to take back control of our health care system and put it back into the hands of those who know something about health care. This is not sustainable. It is not suitable for our patients and is not good for those who have dedicated their lives to caring for them. We need to speak up, we need to demand better, and we need to fight for the future of primary care. Otherwise, we will all continue to suffer. Primary care is slowly dying across the country, and everything that primary care supports is failing too. The emergency departments are being flooded, comprehensive care is lacking, millions of individuals do not have a family doctor, surgical wait times are ballooning, and so on. This is not the fault of the individual doctor. I repeat: this is not the fault of the individual doctor. These are excellent physicians practicing in an unsustainable model of care. Put simply, great docs in a bad system. I believe a better-trained physician workforce will help to rectify the current system. The relationship between physicians and health care organizations must be strengthened, the trust between them must be renewed, their visions reevaluated, and their mutual expectations must be clarified. And this ought to be initiated by physicians themselves. Manager-run institutions and their executives will automatically see physician leaders as equal and important partners in efficient health care delivery and overall organizational efficiency. As the organizational structure transforms for the better, there must be increased attention toward identifying high-potential physicians and grooming them through formal development programs. And this will just be the beginning of how doctors can more proactively shape the future of health care rather than passively being on the receiving end, along with the patients. Source
