It sounds like a contradiction to say that someone working “less” will do more, but in primary care that may be the case. Currently there is a culture shift happening among family doctors – many younger doctors don’t want what the previous generation had: responsibility for opening and operating their own family practice clinics where the doctors are supported by a receptionist, but otherwise do everything from soup to nuts.
I sat down with Dr. Daniel Heffner, a pharmacist and now family practice resident in Vancouver. Dr. Heffner is currently working in one of VCH’s Community Health Clinics, and looking forward to his career as a family doctor. Beyond his talents as a clinician, Daniel is also a virtuoso flamenco-fusion guitarist.
Daniel identifies himself as part of a new breed of family physician who loves being a generalist but doesn’t feel like it’s possible to do everything perfectly for every patient on his own. Daniel says: “providing care is so complex now. For example, prescribing used to include detailed knowledge of only a few categories of drugs, but now the number of new medications, complex indications and the circumstances of every patient make it challenging even for specialists to make the best decision within their area of expertise.”
Another issue we discussed is a culture change among many young doctors. Younger doctors want to have a healthy work-life balance and time to raise their children, something that is difficult when doctors have responsibility for operating a health care business business and providing comprehensive care for their patients, with little or no support.
So how will it be possible for family doctors to provide the best care as a generalist in an age of great and increasing complexity? And how can we have a system that provides more care to more people with more complex conditions, when many in the next generation of GPs wants to do less of what we have come to expect of family doctors?
A new way of providing care can help us achieve more with less, according to Daniel. Working as part of a team that includes physicians, nurses, pharmacists and other care providers will bring a range of expertise to the diagnosis and treatment of illness, so fewer errors will be made. We discussed primary care settings where nurses will be a core part of continuous care, by being an initial contact and supporting the patient’s treatment plan. Pharmacists will use their specialized expertise to determine the right medicine for each person’s personal and health circumstances.
In this situation, doctors can focus on what’s important – the continuous care of the patient, the diagnosis of disease, and the best course of action to treat the patient and their illness. With a team of providers available, patients can get easier access to the care of their family doctor, avoiding trips to a walk-in clinic or emergency department.
It’s not just about adding more clinicians to the mix – doctors will always be the lead in diagnosing and prescribing treatment. The change requires working in a different way so that doctors can be freed up to focus what’s important. Daniel thinks that’s good for him, that it’s the way that many clinicians want to work, and it will ensure quality of care and access for patients.
Daniel points out that “the new generation of doctors are still Type A: we want to be all things to all people. But now we realize that better care for patients results from involving the patient and other care providers.” Working in this way strengthens the doctor-patient relationship because “the doctor is able to focus on what’s most important to the patient.”
Daniel also wants you to help figure out the solution. He says: “Society needs to decide what kind of care they want, and then help make it happen. Do people want access, shared care, community health centres? Do they want a situation where doctors operate as a business? There is an opening for citizens to get involved in shaping the health care system.”
The time is right for new primary care models that will improve access and be functional for the younger generation of clinicians. In my next article, I’ll discuss how new models can expand the range of preventive services provided by a new generation of team-based clinics to improve wellness.
Incidentally, Daniel is also a virtuoso flamenco guitar player – you can check out his videos at www.danielheffner.com or catch him live in Vancouver or Calgary.