I hope that Greg Stoddart and Morris Barer1 read an article that appeared in the same issue as theirs, and I hope that the College of Family Physicians of Ontario read it too. Comments in that article2 certainly struck a chord with me.
I worked in a private group family practice for 14 years before I left, partly due to burnout. I only worked part time and had plenty of backup from my partners and call group, but the weight of responsibility involved with managing an office and providing comprehensive care took its toll. I now work at a community college's student health clinic and do some locum work. The pros: no administrative responsibilities, no call, no pager, no overhead, time off without having to find a locum, and working as part of a team instead of at the helm. The cons? I'm trying really hard to think of one.
I was fortunate to find another doctor to take over my practice, because most family doctors who decide to retire or change focus end up walking away from their practices, leaving patients scrambling to find a new doctor. Perhaps part of the reason there is a physician supply problem is that new graduates are not interested in setting up a private practice. The primary care reform pilot projects in Ontario and the recent initiative by the College of Family Physicians of Ontario3 don't change the status quo, which sees the private-practice physician coordinate all patient care.
The method of remuneration is not the issue. I believe the shift in preference away from fee-for-service medicine reflects a desire to devolve administrative and patient care responsibilities. The community health centre model comes to mind.