#Docxit on the Rise, Means More Trouble for Our Health System

Acknowledgement: I want to thank my friend Dr. Graham Slaughter for coming up with the term “Docxit”. Graham is not only a brilliant internist, but is incredibly talented at wordplay and music. Plus, he has really thick, lustrous wavy hair!

A bunch of stuff has come to my attention recently in my social life and on my social media feeds. I’m saddened by all of these and even more saddened by what this means for the residents of Canada.

Item 1: a friend of mine in her early 40s confided she is going to give up her family practice. She loves her patients, but the admin burden and the poor remuneration make it no longer feasible to do this work.

Item 2: two more friends of mine, also in their 40s, are actively making plans to leave medicine altogether. One of them told me she knew four family physicians (all in their 40s) who left this year alone, and two others in their 30s who have moved out of country.

Item 3: I came across a social media post from a friend of mine from my days in OMA leadership announcing he was now a real estate agent. Amongst the people congratulating him on passing his real estate exams were other physicians also saying they were look at ways of getting out of medicine.

Item 4: The family health organization I’m part of in the Collingwood area has gone from 52 family physicians to 47 as some have retired without finding a replacement, despite trying.

Provincially of course, there are many more such stories. Three family doctors in the Ottawa area left their practices earlier this year. Twenty per cent of family doctors in Toronto are planning on closing their practices in the next five years. The list goes on.

It’s not just Ontario. British Columbia is facing a “dire picture” when it comes to family physicians. Doctors Manitoba, through their excellent (now past) president Dr. Candace Bradshaw, pointed out the need for more doctors on more than one occasion. I could probably find articles from every province highlighting issues with recruiting and retaining physicians, but you get the point.

Doctors, it seems, are looking at leaving the profession (for either retirement or other jobs) in alarmingly high numbers. This phenomenon, dubbed Docxit by Dr. Slaughter, is happening at a time when our health system can arguably least afford it (if it ever really could).

This is particularly a concern as our younger physicians seem to be more likely to quit. A report by Statistics Canada suggested that up to 47% of physicians with less that 5 years experience are intending to leave or change jobs in the next three years. To be clear, they are not intending to retire, just do something other than what they’ve trained for.

This phenomenon is not just present in Canada. The American Medical Association is concerned about “Medicine’s great resignation” as 1 in 5 physicians in the U.S. are also planning an exit in the next two years.

The situation in Europe would appear to be even more dire. The Politico article I linked to states that seven million people in France do not have a family doctor, with more family doctors retiring than setting up a practice. There is a shortage of two million health care workers in Europe. Brexit has badly worsened the shortage of doctors in the United Kingdom. Spain is running out of doctors. And so on.

Once again, those leaving appear to be over represented by younger physicians. It’s so bad that European Junior Doctors (an association of younger doctors in continental Europe) issued a press release warning the health care system there was going to collapse.

What’s going on then? Why are so many doctors leaving? I mean, despite the few (but loud) vociferous miscreants on social media, being a physician is still the most respected profession in the world (at 83% we’re tied with farmers and scientists). Studies show that Canadians trust their doctors to make the right choice for them and are afforded a measure of leeway that politicians and bureaucrats must surely be envious of. And you know that stereotype about first generation South Asian immigrants always wanting their kids to grow up to be doctors because of their status in society – it’s true (trust me, I and many of my friends lived it).

But the reality is that over the past ten years, practicing medicine has devolved to where it is no longer about caring for patients (which is what all good doctors want to do). In Canada, it’s been about fighting bureaucracy. With doctors now spending up to 19 hours a week doing paperwork (that’s a half a work week for most people) or fighting nameless, pointy headed, basement cellar cubicle dwelling bureaucrats to get them to actually pay for surgery that a patient needs, medicine is now more about who can do paperwork better than who can promote health care better.

In the United States, the rise of corporate entities eating up private medical practices has fuelled an explosion of a different kind of paper work, all with its own stresses. One study suggested that each physician spends almost $83,000 U.S. a year interacting with insurance companies.

Add to that the ludicrous number of options and waivers and liabilities and I sometimes think it’s easier to understand Einstein’s Theory of Relativity than it would be to understand U. S. Health Care. Dr. Glaucomflecken does an excellent job of explaining the frustration here:

I don’t know what the reasons for #Docxit are in Europe, but I imagine they are similar. The over bureaucratization of medicine is taking its toll everywhere. As was stated in the Politico article:

“At its core, it’s really that there is the perception that potentially medicine is no longer an attractive career choice, a choice for people to stay in for a whole career. And this will really endanger the sustainability of health care systems in future,” – Sarada Das, secretary-general for the Standing Committee of European Doctors (CPME)

There are so many crises in our health care system right now, it’s honestly hard to keep track. But two things are for certain. First, we won’t be able to fix health care without retaining doctors. Second, as more doctors opt for Docxit, we would appear to be doing a lousy job at retention.