How I came to be in a family practice

How I came to be in a family practice

Many years ago, when I was a high school student, I decided that I wanted to be a doctor.

It was a lot simpler in those days to enter medical school in the Netherlands. All you had to do was to pass a rather tough government exam that gave entry to any of the Dutch universities in any of the different faculties.

My high school prepared most of the students very well to challenge the exam and, as a result, I passed with very good marks. That opened the door to enroll in the medical school of my choice.

There were no interviews or any other evaluation before signing up to see if I was suitable to become a doctor.

There were 110 medical students in my class to start with, but after the first year, quite a few failed to pass the required tests to proceed and had the choice to repeat the year or to drop out altogether.

During the next four years, we lost a few more fellow students and about 80 of us obtained their M.D. degree.

This is in sharp contrast to the current state of affairs as very few fail or drop out, because of the rigorous selection process in finding the best candidates to become physicians.

Before I could obtain a license to practice in the Netherlands, I had to take another two years of postgraduate training. That was a great experience and I acquired a lot of skills and knowledge to serve my patients well.

Half way through medical school, I took four months off to travel to North America and explore what it would be like to be a physician in either the United States or Canada. One of the reasons for this was that there was a glut of doctors in the Netherlands, and if you wanted to open a practice you had to buy an existing one from a retiring doctor. The going price was a full year’s gross income of the retiring colleague, and that meant going into debt in a big way.

I discovered that there was a shortage of family physicians in both the U.S. and Canada, and in comparison to the very crowded country of my birth, there was a seemingly endless amount of space.

In order to practice as a physician in either country, I would have to pass a number of examinations, followed by further training and more examinations to obtain a license.

The Canadian bureaucracy made it extremely difficult to even get the required training and it would take years of waiting for a spot to open up. That is still a problem and many foreign physicians ended up working as taxi drivers or finding other work for years to pay the bills before overcoming all the bureaucratic hurdles.

Things were different in the United States and that is where I ended up, even though my preference was to become a Canadian physician. It took me a little over a year to complete the required training and examinations to make me a full-fledged licensed physician in the U.S. I joined a practice of a colleague in Seattle and got the hang of running the business side of being a doctor in private practice. How to hire and employ medical office assistants, dealing with landlords, telephone companies and other service providers and many more things I had never heard of while in medical school.

Yet all that knowledge was indispensable if I wanted to be able to provide for my family. After two years, I felt ready to strike out on my own and settled in a small community that was very short of doctors. The first day I opened my practice, 20 patients came to see me and I did not even have my name on the door.

Despite the fact I was meeting a real need in the community and I had a thriving practice, my dream of working in Canada did not go away. The reason for this dream was that  the Netherlands were liberated by the Canadian army during the Second World and I thought that serving as a physician in Canada rather than the U.S. was my small way of saying thanks to those who gave the ultimate sacrifice to free the country of my birth of the oppressors.

Within  five years in the U.S., I made enquiries about moving to Canada. Being fully licensed by our southern neighbours, it now was relatively simple to obtain a Canadian license.

I had to take only one examination and my dream of working in Canada became a reality. But things are seldom easy in life.

In contrast with the U.S., there was no shortage of family physicians in southern B.C. in the late 1960s, and it was customary to buy an existing practice for the same price one would pay in the Netherlands – a full year’s gross income.

The alternative was to be prepared to live off a greatly reduced income for a few years while building up a practice from scratch. After all, most patients had a doctor and if you wanted to be really unpopular with your colleagues, then a guaranteed way of achieving that distinction of being disliked or worse was to lure patients away from them.

Before making the move across the border, I discovered that there was an opening to join a very busy practice in what was then called Haney, and I joined the most senior and highly respected Dr. Sid Arber.

If you wonder why I am telling you all this, I wanted to paint the background of physician supply and demand and how that affects an individual physician and tell you next time how and why we currently are experiencing a serious shortage of physicians and, therefore, still have to import many doctors who were trained abroad.


Dr. Marco Terwiel is a retired family physician who lives in Maple Ridge.