‘Much less stressful, but I have to do out of hours again’
I moved to Canada last August and I now work in a small rural practice about four hours from the nearest big hospital, so I have had to brush up my emergency medicine skills.
The clinical scope covers everything you would expect in UK general practice, plus emergency medicine (minor injuries with the occasional significant medical emergency or trauma).
I am paid per patient I see and bill the government for the work I do. The additional paperwork burden is not arduous and having six extras at the end of the day doesn’t seem so bad any more.
As well as billing a flat fee per patient there are chronic-disease management bills that can be submitted for patients to show you have provided high-quality care over the year. These are documented like the QOF, but relate to the work of the individual GP, rather than the practice.
The other big difference is on-call work. I did very little out of hours at home, but here we are responsible for our patients 24/7. Fortunately, I am in a group practice and we share the burden. The rota works out at one in four nights on call and a similar number of weekends. Being a small rural town, it is generally not arduous although there have been nights where I have ended up accompanying a patient to hospital (definitely an exception).
Overall, I have much less work-related stress, my work-life balance is excellent and there is the option to make significantly more money if I choose to work harder.
I feel like a well respected member of the community and live in one of the most beautiful areas on the planet - something money just can’t buy.
Dr Nick Fisher is a GP in Pemberton, British Columbia, Canada
‘A clinical session is long, but I see only a dozen patients’
You get more time with patients as a GP in New Zealand. Fifteen-minute consultations are the norm, which seems luxurious by UK standards. That equates to around 12 patients a session.
While clinical sessions are relatively long (three to four hours), there are very few home visits, and it is easier to get away on time. I am home for dinner with my children every night, instead of running in at bedtime to kiss them good night (if I’m lucky). Plus, having seen only 20-odd patients, my brain isn’t completely fried.
And there’s no QOF. Although New Zealand seems intent on trying to import most of the worst ideas from the NHS and there are more performance indicators of late, there is nothing like the same level of intrusive regulation. The QOF was one of the reasons I left the UK.
Dr Greg Brown is a GP in Wellington, New Zealand