Good afternoon.
My name is Dr. Peter Kuling. Thank you for this opportunity to appear before you to discuss the committee's study on health human resources.
I've spent most of my career practising family medicine in Prince Albert, Saskatchewan. There, I had an office and a hospital practice, where I did obstetrics, emergency, and both minor surgery and surgical assists. I had a predominantly aboriginal practice with very complex medical problems.
For the past ten years I have practised in the Ottawa area, again providing both office and hospital care. Now I train new family physicians, both Canadian and international medical graduates. This is all part of my role as the medical director of the Ottawa Hospital's interdisciplinary academic family health team. As someone on the front lines caring for patients while also training my eventual replacement, I see what has been called the perfect storm of demographics facing medicine every day.
Research done by the Canadian Medical Association backs up what I see. Most physicians work 50 hours a week, but 70% of them work an additional 30 hours on call. Only half of physicians are satisfied with their work-life balance. In fact, physicians have twice the suicide risk of the general population. One in four physicians experience mental health issues, with female physicians being especially at risk.
My typical work week involves seeing patients in the clinic and in the hospital and doing both resident and medical student teaching as well as administrative duties. However, I also have two rotating call schedules: one covering the hospital service, which is a predominantly geriatric population with dementia and medical and pyscho-social problems, and the other is my obstetric and newborn practice. This past week I delivered four babies after hours. One night I was the hospital from three in the afternoon until midnight. The next night I was in the hospital from ten p.m. until seven in the morning. Even with these two disrupted nights on obstetrical call, I continued my usual weekday clinics, teaching, and administration.
My work-life balance is better here than it was in Saskatchewan. In a rural setting even physicians who are not on call get called. They get called out at night to assist their colleagues. In my case, in Prince Albert, it was to deal with an overburdened emergency room, or an ambulance transfer of a patient, or assisting in the OR, or for an emergency surgery, or a number of other issues.
I have to tell you a story. I had a physician couple who are friends of mine from Prince Albert come to visit me in Ottawa. They're both physicians, and they have separate phone lines on each side of the bed. When they arrived in Ottawa, they were visibly exhausted. In fact they slept most of the weekend and then went back to Prince Albert. Why? Well, over the previous 30 days, one or both of them were out of their bed every night between midnight and six in the morning caring for patients. Did I add that they also have three children?
I'm not trying to pass on a sob story about physicians. The overwhelming majority of my physician colleagues love to care for patients, as I do. That's why we got into this work. However, the current reality is that the number of hours worked by doctors in clinics, hospitals, and offices across the country is not sustainable. The impact of hours on the health of physicians is devastating.
Our failure as a nation to develop a sustainable physician supply and an appropriate health workforce planning policy is driving physicians to alter, restrict, and, worst of all, abandon treating patients altogether.
We must never forget that all of this has an impact on our patients. We have too few physicians trying to do their best, caring for too many patients. This was made all too clear for me very recently when I came to our office and saw patients lining up in the cold weather outside our door before it was opened. They were lining up because one of my physicians decided to increase his patient population by taking five new patients a month. On the first day of the month, there's a lineup outside our door.
We simply must build a national strategy to ensure that all Canadians have access to a family physician, while also incorporating measures to improve access to specialty care. Such a strategy must recognize that the new and next generations of doctors are not working and will not work the ridiculous hours that physicians of my generation work.
Primary care physicians can and are providing excellent front-line care by working with allied health care providers in collaborative team environments. We must support these initiatives with strong workforce strategies or risk that the number of patients without a family physician will increase, and this will further clog our emergency rooms and our hospitals.
The core of any health care system is access to a primary care physician. With a strong, clear strategy we can strengthen that core while building a healthy physician workforce with a better work-life balance, because healthier physicians will lead to healthier patients.
Thank you.