The evidence regarding Canada's physician manpower shortages are indisputable. Canada's doctors are aging. Some are leaving medical practice as they naturally reach the end of their careers, however many are simply 'walking away' from the stresses of trying to manage practices in an increasingly complex and less rewarding environment. Family practice has taken the brunt of this change as one of the less popular specialties. Many family doctors have taken salaried positions as hospitalists or other salaried positions. Others have abandoned traditional family practice in order to work in walk-in clinics. An article in MD Pulse (2005) discussed some of the issues that physicians face when considering retirement (.pdf)
In May 2006 Dr. Ruth Collins-Nakai (President Canadian Medical Association) talked to the Canadian Club of Edmonton. "Naturally, the physician population is also aging. The average age of physicians in Canada higher than the average age of the population. And one third are 55 or older. Over a quarter of physicians plan to reduce their workweek within the next two years. And almost 4,000 doctors may retire in the same period - we call it the perfect storm for the health workforce. When you consider these facts, is it any wonder that 4 million Canadians don't have access to a family physician? Here in Alberta, we have a shortage of 1,000. In Ontario, one of Canada's other "have" provinces, the shortage is 2,300. To read the full article: Physician Population Aging.
Given the physician shortages, the inability to 'sell' or transfer a medical practice and the migration of existing physicians into retirement or other practice settings, what are we to do with the hundreds of thousands of medical charts that are being placed in 'storage' as a result of this practice shift? Physicians are required to store patient records for 7-10 years beyond the date of last visit. In the case of children, although the requirements vary from province to province, medical records need to be retained for 7 years beyond the age of 18 - that means storing the record for 25 years. It can cost up to $400/month to store paper medical records in a storage facility in order to be accessible by patients. This is a significant cost and liability for many physicians who never considered that they would not be able to transfer their practice to another physician at the end of their careers.
A potential solution is to scan one's entire set of paper medical records at retirement e.g. into a standard format such as .pdf files. The entire practice could then be stored on one or more DVDs. This would result is a greater cost up front, however the downstream benefits would be significant. No monthly chart storage costs. Easy transfer of medical records if a chart is requested. Simply copy to CD and mail, rather than costly chart access from storage facilities. Even less expensive would be secure record transfer via e-mail (when a secure communications network is available). Even more important, as we have more practices that implement an EMR, those practices would be better geared to receive a digital file than a paper chart. In fact, some practices may refuse to accept paper records, leaving both the patient and original physician in limbo in terms of what to do with the patient record.
What are your thoughts? Do you think it is reasonable or logistically possible to scan an entire medical practice into digital format for archiving and transfer purposes? To add your thoughts, click on the 'Comments' link.