About the Project
As a community based longitudinal family physician working in Victoria for the last 20 years, Dr. Anna Mason is acutely aware of the shortage of family physicians (FPs) in the South Island. She regularly sees and hears about the impacts of the FP shortage on both physician colleagues and patients. Talking to specialist colleagues, Dr. Mason heard about how the lack of family physicians was materially impacting specialists’ work and life experience. The lack of family physicians has exacerbated capacity strains on specialists in profound ways; however, these impacts weren’t well documented in the literature. Dr. Mason set out to engage her specialist colleagues in a project to explore how the ongoing crisis is affecting their personal and professional lives and the lives of their patients.
Dr. Mason’s collaborators in this endeavour are Dr. Kristin Atwood (Sociologist) with the Victoria Division of Family Practice, and Frieda Hodgins (Medical Student, UBC Island Medical Program) who contributed to this research for her FLEX project. Dr. Ashley Jewett (Psychiatry) was instrumental in the early stages of planning for specialist engagement.
To respect participating specialist physicians’ time, the team sought to make the process both engaging and accessible. Two methods of engagement were offered: a qualitative interview over secure video or an opportunity to comment anonymously on a private online forum.
In total, 37 interviews and 21 online forum comments were conducted, transcribed, and analyzed. This represented specialist physicians from over 20 different medical and surgical specialties from the South Island.
The research team was able to demonstrate through qualitative analysis of the narratives gathered that specialists are suffering because of the lack of primary care infrastructure. Specialist physicians describe the complex effects of managing a patient panel that is increasingly unable to access primary care. At the practice level, patient flow from intake to discharge is profoundly congested; volumes are unsustainable; and specialists experience scope creep that carries medico-legal risks. At the individual level, specialists report eroding work relationships; moral injury and other health effects; and disruptions to career trajectories and skills development.
There is a tendency to view specialists and FPs as separate and siloed, and to assume that what affects one group might have little impact on the other. In reality, specialist and FP services are intertwined, and the FP shortage exacerbates existing capacity strains on specialists, creating a ‘squeeze’ which may escalate current trends toward specialists’ early career exits that will create further chaos in the system. The research team concluded that understanding specialist perspectives is essential to managing the healthcare workforce crisis.
In addition to the above effects on specialist physician experiences, the team was able to gain specialist perspectives on the impacts that the lack of access to primary care has directly on patients. Aside from the obvious impacts, such a decline in access to preventive health care and disruptions to continuity of care, other health outcomes (risk of harm; morbidity/ mortality; downstream impacts on families/ employment) and quality concerns (accessibility, appropriateness/effectiveness, equity, efficiency) were delineated. It was clear that the implications of FP shortages are not limited to issues that are in-scope for primary care, but ‘ripple out’ to affect patients’ ability to receive safe care across the system. This compounds existing inequities for vulnerable patients with conditions requiring specialist intervention. The patient impacts described by specialists demonstrate the need to strengthen primary care as the hub of the healthcare system.
In summer 2022, preliminary findings were shared with the Doctors of BC Representative Assembly. This past spring, Dr. Atwood presented two papers based on this research at the Pacific Sociological Association Conference in Washington State, “Personal and Professional Impacts on Specialists of the Primary Care Shortage in Canada” and “Impact of the Primary Care Shortage in Canada on Patients Receiving Specialized Care.”
In order to share the findings of this project more broadly, the team commissioned a short video, which will be used to raise awareness and spark discussions among the medical staff as well as provincial groups. There is tremendous interest in further specialist engagement for input into our health system reform and sharing the findings broadly will help inform such engagement.