Dr. Jessica Chan
I always knew I wanted to help people, but it was a pursuit of meaningful engagement that drew me to family medicine. I love getting to know my patients and following their stories. There’s something deeply satisfying about seeing a patient recover from an illness or watching a baby I delivered grow up healthy. It’s a unique kind of bond that comes from treating someone over the years, seeing them through different stages of life. When I finished my residency, I worked locums (“substitute doctor,” analogous to a substitute teacher), covering other doctor’s maternity leaves, for example. Even though being able to diagnose and treat patients was fulfilling, it wasn’t enough. I needed continuity, a way to see how my diagnoses and treatments panned out over time.
The longer I’m in family medicine, the more I know I chose the right path. After 20 years of practice, some of my earliest patients are still with me. They’re getting older now, but they’re active and healthy. I must have done something right! It’s a reminder that the longer you do something that you are meant to (and love to) do, the more rewarding it becomes. But staying in family medicine hasn’t been easy.
Balancing the demands of patient care with the financial realities of running a practice has been a significant challenge. B.C.’s new family doctor payment model—the Longitudinal Family Physician (LFP) Payment Model—has made a difference. It’s not making me rich, but it allows me to practice in a way that aligns with my values. I can afford to work at a pace that’s sustainable. It’s given me the freedom to balance my professional life with my personal one, including taking care of my own family.
Before, a lot of the essential work I did—like setting up reminders for follow-up tests or actively tracking preventative care—was unpaid. It was part of my job, but it often felt like volunteer work. While I have always been an avid community volunteer through my life, being forced to work for free day-in, day-out can wear you down over time. Now, with the new payment model, these tasks are recognized and compensated. It justifies the extra effort I put into making sure my patients get the best care possible. For example, if a patient needs an extra reminder for a follow up test in six months or twelve months, I can set that up without feeling like I’m adding to my unpaid workload.
One of the most encouraging signs I’ve seen since the LFP plan was introduced is the renewed interest in family medicine among medical students. Just the week the payment model was announced (on Halloween, as the announcement was so significant that every part of that day has been etched in my memory in technicolour), one of my rotation students, who had been sitting on the fence about going into family medicine, told me they were finally sure. They had been worried about whether it made financial sense to pursue family medicine, especially since they had a spouse and kids to support. But with the LFP plan, that last barrier was removed. They could now focus on finishing their training without worrying about the debt. That was the first student to express interest in family medicine in eight years!
That week, another two students with no prior interest in family medicine at the beginning of their rotation suddenly started asking questions. They began to see it as a real option, something they hadn’t considered before. This is a significant shift. For years, I watched my rotation students choose consultant specialties over family medicine because the pay for family doctors didn’t seem to match the effort. Seeing this change is heartening, but it’s not a full solution. There are still other specialties that pay much more, so while the new payment plan puts family medicine back on the map, it doesn’t solve everything. This is becoming apparent now, as more than 18 months after LFP Payment Model kicked in, most family practice clinics are still struggling to recruit new grads into “traditional” family medicine.
There are still challenges we need to address. The administrative burden, for one, is still significant. I opened my own clinic recently, and the process was eye-opening. There’s so much more administrative work involved in running a practice—scheduling, liaising with staff, setting up systems—and not all of this is adequately compensated, or supported.
Overhead costs remain a significant challenge. When I opened my modest 4-exam-room clinic, I faced a staggering $120,000 in renovation expenses alone, a substantial out-of-pocket investment. Each month, I deal with overhead costs for rent, utilities and insurance. Every 2 weeks, staff salaries. On top of that, purchasing essential medical supplies, like disposable gowns, ear-syringing sets, suture removal kits or liquid nitrogen refills, falls on my shoulders, without any financial or administrative from the province. The firefighter has not only paid to set up the fire hall, but is also paying of their salary to run the firehall. These expenses reveal a stark contrast between the perceived earnings of family doctors and the actual financial demands of running a practice, making community-based family practice a very financially unattractive option to practice for anyone with this training, licensure and experience, especially considering the many other viable alternative work available.
The LFP Payment Model is a positive step forward. It’s helping keep experienced family doctors like me in the field and is making family medicine more attractive for new doctors. But it’s there’s still work to do to ensure family medicine remains sustainable for doctors and provides the best care possible for patients. Next time you visit a family doctor for a checkup, take a moment to mentally recognize that everything you touch in that clinic is, figuratively speaking, ‘subsidized’ by the family doctor, who is often paying out of pocket to support our publicly funded healthcare system. A quiet internal ‘thank you’ goes a long way.
Dr. Jessica Chan has practiced family medicine in B.C. for over 20 years.