Dr. Barry Dworkin

Ottawa – A family doctor in Ottawa is feeling so overwhelmed with her workload that he has decided to let go 200 of her patients.

CTV News first reported that Dr. Lynsey Bartlett was scaling back her practice after one of her patients, Fred Martin, forwarded the network a letter he had received from Dr. Bartlett. In it, she said that she would no longer be able to care for him, and that “the current political reality of practising family medicine in Ontario has made our practice model unsustainable.”

Dr. Shawn Whatley

“She wanted to be crystal clear that this has nothing to do with the federal tax cuts,” said Ontario Medical Association President Dr. Shawn Whatley. (Dr. Bartlett declined to be interviewed by the Medical Post, instead asking that Dr. Whatley—who had spoken extensively with her about her situation—speak on her behalf.)

Dr. Whatley said her decision is the direct result of a series of fee cuts made by the Ontario government over the last two years.

Dr. Whatley said her net income has dropped about 30%. She also claimed, through Dr. Whatley, that they haven’t been able to hire more staff because fee codes designed to encourage those hires have also been cut.

This has all been particularly difficult for Dr. Bartlett because she signed many of her patients from Health Care Connect, a central referral system run by the province. Dr. Whatley said patients in this database are often some of the most challenging to care for.

She’s extended her clinic hours to care for more patients and, as a result, is now charting until midnight every night. A third of her day is spent with patients with complex mental health issues. According to Dr. Whatley, she’s also having trouble ensuring patients referred to specialists are seen in a timely fashion, and so she’s managing patients far beyond her training and experience.

“She said it over and over: she’s feeling overwhelmed,” Dr. Whatley said. “She’s a real genuine salt-of-the-earth doctor who has worked to the point of breaking.”

Dr. Whatley emphasized that the patients she let go were chosen carefully (he said her patient roster is about 1,300 patients, but was unsure whether that included the 200 who were let go). All were medically stable. None of them were complex, vulnerable or suffering from serious mental health issues. Many of them lived in other cities, some as far as Kingston, Ont.—about an hour and a half away.

She’s a real genuine salt-of-the-earth doctor who has worked to the point of breaking.Dr. Whatley also pointed out that while her situation is exceptional, the problems she’s facing aren’t.

“She had the courage to say what she’s doing and why she’s doing it,” Dr. Whatley said. “With most other doctors, they’ll get to a point where they can’t keep running their office they way they’ve always done it and they’ll make the heart-wrenching decision to move into a city where there’s a larger group, or a hospital, or they’ll get into emergency medicine or long-term care…”

“It’s the small practices, the doctors at the lower end of the income scale, who are already squeezed that are feeling it,” Dr. Whatley said. “People think these cuts are coming from a doctor’s champagne budget, it’s not.”

When asked whether Ontario Health Minister Dr. Eric Hoskins felt any responsibility for this situation, his spokesperson didn’t answer directly. Instead she said he has “great respect for doctors and the important work they do every day for patients.” She also said the provincial government has introduced initiatives to ensure “every Ontarian has access to a doctor when they need one” (she also claimed 94% of Ontarians already have access to a family doctor).

Fee negotiations are currently underway between the OMA and the government and they are, by most indications, going well. Dr. Hoskins’ spokesperson said they are “optimistic” those discussions will “continue to be positive.”