In the trenches.

As I previously blogged we are in a fee dispute with our government who want to cut remuneration to specialists in particular anaesthesiologists in order to redistribute the money to physicians who are "working in the trenches", meaning family docs, geriatricians and psychiatrists.  One of my colleagues copied me on a letter he sent to the president of our union and I really could not have said it better.

So to hear that I'm now being told to take a 25% pay cut and be insulted every second day by this minister really rubs me the wrong way. He has said that he needs to support the "workers in the trenches" (family practice, gerontology, psychiatry) and this causes me to scratch my head. If looking after a young pregnant woman with PIH at three am is not "In the trenches" what am I doing then? Missing my kids soccer games, dance recitals or just bedtime because I am on call? 

There are few lucky anaesthesiologists who work in cosmetic suites, dental offices or just do arthroscopies and ACL repairs on health ASA 1 and 2 patients.  These are a very small minority.  For most of us we take whatever comes in through the door and try to get as good a result as we can.  Not to sound bitter but our job is made one hell of a lot more difficult by those front line "in the trenches" family docs, geriatricians, emergency docs, (don't get me started on internists) etc who haven't worked up their patients properly, haven't treated their medical concerns and often sat on their obvious problems, turning what should have been an urgent procedure done during the day into an emergency in the middle of the night.  And unlike most specialists in our city, when an anaesthesiologist is on call, he is in the hospital caring for a patient or else he is at home, on a 30 minute leash, NOT sitting around having residents and hospitalists look after his patients for him.

Not to mention that when you phone most GPs offices now, after hours or even during the day, you get a message telling you to go to the nearest emergency room or call 911.  (Of course they can't take your phone call, they're busy out in the trenches!)  At least in the city now and in a significant amount of the country, GPs no longer do house calls, work in the emergency, deliver babies, work in hospitals or do nursing home visits.  So who the hell is in the trenches?  Not the person doing well-baby care from 9-5 and weekdays.  Geriatricians, who are for the most part GPs who took a weekend course, are insulated from any patient care by layers of nurse practitioners.  I don't see a lot of them at night in the hospital.

In defense of GPs or as they like to be called, Family Doctors, they were largely forced out of hospitals, emergency rooms and obstetrical units over the past 30 years that I have been in practice.  I don't remember a lot of kicking and screaming but it did happen.  They certainly have never gotten much respect for anybody, have been blamed for much of the increase in healthcare costs in past and had to put up with practice restrictions.  And quite a few of them do provide reasonably good care for their patients.  And unlike my generation who got a one year hospital based rotating internship where they saw lots of sick patients, FPs now go thru a two year family practice "residency' where they predominantly work with academic family docs and learn how to deal with healthy people and wash their hands of everything else.

Working in a quasi community/teaching hospital one realizes how much infrastructure is necessary for doctors to do their jobs and it is these people who are actually in the trenches.  This includes residents, hospitalists, nurse practitioners, physios, lab etc all of whom insulate doctors from their patients.  These people are the real people who are in the trenches and I don't think any of them are going to see the money that is about to be stripped off me.

Every doctor of course thinks what he does is the most important thing in the world and the best strategy from a government point of view is to get us fighting over who gets paid how much for what.