Canada has more doctors than ever, so why can’t you get one?

it's about 7 A.M we're in South Ottawa those headlights over there that's Dr Ali Ken Abdullah he's coming to pick me up he's a family doctor that's something that's in short supply these days I don't have one he's about to show me why almost nobody wants to be one not these days Dr Abdullah my day is just starting but I know you've been up for a while yeah we're in a rush let's get going thank you so you've started your day already yeah exactly it's going to be a busy day today we have to get

through about 25 30 people so it's important to know you know what they're coming for or collect the data pre-prepare the charts if possible make sure we're not missing anything so we can be as efficient as possible is that a typical day no it's not this is a hard day but there are days like this typically in a week so two or three days like this this is not an anomaly within your week no that is absolutely true what are you thinking when you're driving into work like this in the morning it's like what's going

through your mind yeah no that's a very good question because I I'm contemplating all the things where I'm going to potentially have problems with and that always makes me feel a little worried and anxious you know Omar I always feel like I'm gonna make a mistake or I'm going to miss something that's really important it's a sense of dread in some ways you know I've been working all weekend to prepare for this week you know the opportunity to get a bit of a break hasn't really happened and you know I want to do a good

job you know I feel obligated to do a good job and uh it's people's lives it's their outcome it's the quality of their life it's the the family um you know what what struggle and suffering that they go through in their lives it's um it's a big heavy responsibility I take it seriously and I want to make sure that I do the best that I can for each and every person that I see I'm not sure if it's going to work out but I'm always hoping for the best no matter what you do no matter

how hard you try no matter what the level of of energy and effort that you put into it the system defeats us each and every turn and because it does that on a more consistent basis it almost seems like you're patching holes of a of a dam that's going to burst over and and that is not a good feeling you know if you're looking for a cause to burn out that happens for doctors on a day-to-day basis it's the fact that we probably feel that we lose more battles than we win that's a serious problem

yeah [Music] okay let's go and you've got about what an hour before your first patients arrived yeah about about 45 minutes yeah [Music] come on [Music] that's adorable okay and here we prepare for the day I'm just one of the estimated six million Canadians without a family doctor most of those doctors will tell you when it comes to their job the model that we've been using it's broken and as if that wasn't enough thousands of them are reaching that age where retirement might be just around the corner fantastic a little bit of light in here

that's okay oh hi Nancy it's veteran returning double how are you I'm okay there thank you uh yeah so we got our first patient here so let's get started on the day I'm gonna have to put on our running shoes hey Bruce how you doing today it's good to see you thank you for coming in just get our range of motion in so go all the way up straight any trouble there left shoulder right yeah and then we'll do up this way not bad not bad but you can see you're grimacing a little bit right

and hold it there yeah you can see how you're you're fixed and you're not moving as far as you can push up against my hand yeah so you're weak there uh summarize the fit test has been sent to you as soon as that comes in the colonoscopy will be sent out I'll put you in the hopper for that with no cortisone today okay good deal excellent thank you you take care of yourself okay see you later thank you for being here no worries so now the key is is to get all of the the notes

done we were fortunate we started a little bit early so it's 902 so we're okay I got a little bit of a window before the next person comes in so what struck me about that was that you uh seem to have an encyclopedic knowledge of every single thing that people come in with but is that because you were studying their charts earlier because you knew they would come in with those problems or do you just have that all in your brain no no there's no way I can have thousands of people in their in my

brain so the mark of doing good family medicine is understanding what people are likely going to have problems with so there are problems that they're following there may be new problems that they bring and then there's a trajectory that they need to go on and you're studying all that in the morning before they come in exactly and that's why we got here so early in the morning to do that and and for us I get a little bit on the weekend we're like studying for an exam exactly every every single day that I'm here is

an exam right let's get let's get back on it's 11. you're 11 22. you're on your seventh patient of the day hey Scotty how are you thank you so much how you been what's going on um you know what to this last couple days have been the best I've felt and I've been 15 months foreign 715 you've seen it go up and down there's a graph right there you've been a lot higher before you're kind of normalizing but you're normalizing at a level higher than normal [Music] when symptoms are intermittent Scott that suggests that it's

fixable yeah if they're there all the time then we have to worry especially if they're getting worse no no it kind of peaked I'd say about mid-January and hopefully I think it's getting better what happens your stomach didn't you have some issues with your stomach the stomach's been okay like you don't have a gallbladder problem or a liver or pancreas problem it's fantastic uh naproxen I'd like to get I'm on my last refill I'm going to give you the same thing you had see you later [Music] okay for you okay so you see the pace

we got to keep going what's coming up next [Music] who are you if you think this morning is hectic think about this Dr Abdullah shares his workload with a team so he's got a nurse practitioner a secretary a few other doctors helping to spread that workload and that's kind of crucial when you find out three to four hundred calls come into this office on a typical day he's been doing this for three decades so he knows how to make it work but the demands of the job have changed his patients are aging their issues are

piling up our Health Care system is lagging behind and whether it's a terminal diagnosis or something else less severe it's up to him to break the news both good and bad to each of his patients and he's got 5 000 of them can you tell us from the story behind us yeah so this is the hard part of our job when we have to tell people they can't drive anymore or they can't look after their own finances anymore or they can't live in the home anymore that they've you know lived all of their lives with

right this is something you're gonna have to do later today I'm gonna have to do that later today yeah probably at seven o'clock in the evening so it's not going to be a pleasant conversation he's going to have issues with memory uh and then in addition to that there's going to be a bit of a fight there right you can't tell someone after 50 years if they've been driving you don't be able to drive anymore right It just strikes me like that you're saying it without a family doctor this is this is the stuff that

gets overlooked yeah absolutely and so you have people driving on the road that maybe yeah just haven't been observed yeah absolutely their faculties aren't there to be a safe driver anymore exactly and if you think about it a lot of people they drive in a car alone so no one's sitting there checking in on them to make sure that they're doing the right job right so that's going to be a problem he used to see more than 50 patients a day these days he can barely manage half of that number and he's got a Target

20 minutes tops for each patient and their paperwork any longer than that and it's going to be impossible to complete the entire work day I'm well thank you I did have an opportunity to review some of the notes that he had said in regards to your medications My worry is in that process where you're trying to get yourself feeling better it's hard to concentrate on yourself feeling better and also try to give your best at work right would there be a possibility that we could be off of work for a while until we get this

plan in order so that's Jonathan he has a few mental health challenges that he's dealing with he's got physical ones as well can't go back to work his family's relying on him to pay the bills and so it's up to Dr Abdullah to help him find Solutions that's going to take up a lot of the doctor's time if you try to go through medication changes and you're trying to do the counseling and you're trying to do your job somebody's going to get yeah so it's not uncommon that if you try to do too much at

one time then you won't be successful in any of those things and I don't want that to happen to you we've worked hard to get to this stage it takes time for one drug and its effects to go away and another drug to build up so hopefully in 30 days you'll feel better about that good I hope so yeah okay we get through a lot of stuff how does your prescriptions okay take it easy we'll see you later so that was a that was a good case huh so if he was a person that didn't

have a family doctor that didn't have a relationship with him they didn't understand the impact of One Versus the other you know I know the child I know the I know the parents of this man and I know the wife and so if I didn't understand the whole context of that he would be coming into a walk-in clinic asking for a form to be filled out which will probably be declined because they wouldn't have any information or background or context for it and uh he would struggle he would have portions of his life slowly fall

apart like a domino effect and so hopefully we can protect him from that and make sure that he gets the best outcome to manage all of his health issues and his lifestyle issues at the same time and make sure there's money coming in yeah right I would imagine are you seeing him more often than you'd see other patients I have to yeah I'm probably going to see him in a week or two you know I try to Pace people out for four weeks six weeks eight weeks because there really isn't that opportunity there are no

spots for me over the next four weeks I'm gonna have to figure out when to see him so it'll be lunch hour it'll be the evening I'll see him on a weekend or something like that we'll get them sorted out okay are you available to come on Thursday this coming Tuesday or in person [Music] we're a few minutes late let's get let's get in there and see Alex Alex nice to see you nice to see you tell me what you have as your list of things that you want to work on today just to find

out what you've learned about my name sure let's let's talk about that so if you look at someone that has a normal knee you can see there's space between it your knee has no space between it when you go down and do a full squat you can feel the impact of that joint and how it tightens up if you lean into it or whatever you feel that right yeah so because it's so bad for all intents and purposes you really need a hip a knee replacement that would be the best scenario for you [Music] let

me show you that exercise you're sitting here you hold up your leg you tighten it you get it as long as you can handle it you put it back down you do that multiple times in a day the stronger this muscle is the less pain you have here okay so I'm giving you a prescription for a hinge knee brace I'm going to send a referral to the doctor that's at my old Clinic to bring you in and do the evaluation and do that knee for you good still that all right good okay take care Alex

here take care so you've kind of bought yourself some time now for what are you doing now like you just finished the appointment you said because you wanted to have 20 minutes per patient and so what do you use the rest of the time so now what my hope is I'm gonna do a couple things I'm gonna send the referral along that he requires I'm going to make sure that if there's any messages in my system that I deal with them and I also have to go back in time because there's some people and interactions

that I haven't checked in and and uh documented and built to the government so I want to clean up on that stuff as well is this all the admin stuff exactly the men's stuff that drowns you that admin stuff eats a huge part of the problem and it's what's pushing a lot of new medical grads away from family medicine because after you put in more than a decade of your life studying and training at the end of the day what you want to do is help people but these days a third of your day is

likely going to be spent filling out forms there's documenting what you did filling out prescriptions Insurance paperwork following up on referrals reviewing charts the list goes on and the those forms they're getting more and more complicated and doctors say a lot of them are unnecessary and that's a huge responsibility because if you get it wrong the person who's liable it's you so more forms fewer patients oh and most of that admin work it's unpaid now you might think hey we just need more doctors but that's not really it this is more than just a supply

issue if you want a clear picture of the problem just take a look at our supply of doctors these past few years the number of doctors per capita it's rising we've been able to reach record highs problem is most of them choose a different medical specialty no one is lining up to be your family doctor here's another major reason why it's how they get paid it's complicated and it's part of the reason that you might feel like you're being rushed through the door a very small portion of them gets to work in a team-based environment

they're paid through an alternative payment model that's the model Dr Abdullah is allowed to use so he shares his workload with a few other colleagues only one in every four doctors gets to work in that kind of team-based practice here's how that model Works in Ontario your doctor gets paid a flat yearly fee to see you that's based on a few variables like your age and your sex bottom line it's a fixed fee and so whether you go once a year or every single month a few minutes of your doctor's time or an entire Year's

worth of care your doctor gets paid the exact same but the province sets a limit on how many doctors can actually work that way the other three quarters of family doctors in Canada they're stuck working in a fee-for-service model these are Solo practitioners and they're typically getting less than forty dollars each time you visit in either of those models the outcome's the same because we treat our doctors like independent contractors and so all of their costs the rent the secretary even their own medical insurance their retirement savings all of that has to come from this

small envelope of flat fees our health care System turns everything into a business calculation so you hire a cleaner or do you do it yourself and here's the thing doctors never trained to be business people in school most of them only ever learn to work in a team-based model of care all Family Medicine residents train in this patient and role fix salaried model that's all they train it they've been training this model for 10 years they know nothing else so when they graduate they have a small proportion of them that can move into a salaried

model the rest of them have to go into a model that they don't know anything about right if you're a fee for service doctor you don't have time to do them in your job is to get as many people through that door as you possibly can so can you imagine having to go through 40 50 60 people with whatever amount of clinical time you did and adding on 20 30 40 50 have had been time can you imagine that this is all her job these are complicated people they require a lot of care and attention

and there are some of these people that will come in today that they're saying I'm not going to be able to make sure that they get a good outcome when they leave so that warm and fuzzy that I'm supposed to get being a doctor is not going to happen at the end of the day and so it's going to make it very hard for me to sell this to young people to say come and be a family doctor like me because you're going to end up getting burnt out and washed up and pushed on and

you're going to have the challenges that I have and not have the work-life balance do you really want this there isn't enough family doctors there's not enough going into them no one finds it interesting or exciting um and there are more and more burdens upon us to manage and so the possibility of being able to get people their family doctor is going to get smaller and smaller over time yeah let's go there we go thank you hey Catherine good morning how are you [Music] look at the day describing sort of how difficult the job is

to the point where not a lot of people want to do it anymore why do you still do it yeah great question I I love the people I love the relationships I love the opportunity to be able to make a difference in people's lives and with that comes gratitude and cards on holidays or they remember my birthday or if they see me in the street they come and say hello there are people that have given me hugs they're people that have mentioned my name in their obituary there are people that uh you know that remember

uh unique moments in my life uh and so they're part of my family and so that's why I love this job you feel like you've been making a difference in their lives yeah I do I do it's harder now than it ever used to be but I couldn't be anything else except a family daughter [Music] oh good nice to see you it's been a day it's been a day is that it are you done that's it I'm done for the day your last patient's gone yeah and it's just a little bit of paperwork at the

end and we'll call it quits we can head home the house call that I originally had has been looked after through a phone call yeah um so yeah so this is It's been what it's it's just after eight o'clock so you've been here you've been working since seven o'clock and maybe you started with some paperwork a little bit before that so so yes you've been going at it for about 14 hours yeah have you missed a lot of I want I've been wanting to ask you this have you missed a lot of family time over

the last three decades yeah I can I can say honestly my first marriage was destroyed because of being a family doctor the relationship with my children are been damaged in some way uh I'm re organizing my life my new life moving forward I'm hoping not to make the same mistakes I try to Mentor other medical students and residents to make sure they don't make my mistakes and that they provide themselves enough balance in their life These are important questions we need to discuss well I will let you get some rest yeah thank you for joining

us uh you guys were awesome and hopefully you get a flavor for what it's all about we did and you've been really generous with your time and with the access so uh I want to take care of Dr Abdullah thank you very much drive safe okay okay look after yourself bye-bye foreign day that's becoming a recipe for Burnout for a lot of family doctors and that's just part of the reason why so many of us don't have one but here's the thing Dr abdullah's work date that is typical of every single family doctor that I've

spoken to a lot of them say they're hanging on by a thread and until we fix that it's going to be really difficult to recruit new doctors even just to retain the ones we've already got [Music] please [Music]