COVID-19 has exposed so many cracks in our healthcare system. One that has received little attention is how to organize family doctors to provide the best possible care for patients.
As it becomes clear that COVID-19 will be with us for a year or longer, the role family doctors play in preventing and managing chronic health conditions like diabetes and heart disease will be increasingly important. We need to ensure family doctors are organized, paid, and resourced to deliver the care patients need.
Like everyone else, family doctors have had to change how we work to adapt to the COVID-19 pandemic. We have deferred non-urgent visits and are assessing more patients virtually by phone, email, or video. We still see some people in the clinic – pregnant women, kids needing immunizations, and people who need to be examined – and are careful about how we do so. In some large practices, only one doctor is in the clinic at any one time. This approach saves personal protective equipment and reduces the risk of us infecting one another or our patients.
Some family doctors have made these changes with the support of a large team and are getting paid just as much as before the pandemic. But many other family doctors have been alone in navigating these changes and have seen a precipitous drop in their income, threatening their ability to care for patients.
Right now, the majority of Canadian family doctors have independent practices that run a lot like small businesses. They are paid by the visit – which means income falls when non-urgent visits are deferred.
Most work in an office with a couple of other doctors but are not necessarily in regular communication with colleagues outside their practice. Staying up-to-date on the latest guidance and rapidly changing routines to meet the challenges of COVID-19 is arguably much easier for those practicing in a large group, especially if the group is connected to a hospital. These connections mean you can share expertise, cover for one another, and that ultimately benefit patients – from faster adoption of technology to creative and robust infection control practices.
Only a minority of Canadian family doctors work in teams with other health professionals. Patients of these practices have access to more resources – they can see a social worker free-of-charge to support worsening anxiety or a pharmacist to review medications. And the doctors who work on these teams have the resources to identify and proactively reach out to their patients who are at high risk to develop COVID-19 complications.
And then there are the millions of Canadians that simply don’t have a family doctor. This is especially true if you are Indigenous, a new immigrant, or living in a poor neighbourhood.
It’s time we levelled the playing field – for family doctors and patients.
COVID-19 should provide the impetus we need to move to a system where all patients are guaranteed access to a family doctor – the same way all Canadian children are guaranteed a place in an elementary school.
The benefits of this outweigh potential drawbacks. Research has shown time and again that a longitudinal, continuous relationship with a family doctor leads to better health. Accessing care from a virtual walk-in clinic doesn’t deliver the same benefits.
We also need a system where family doctors are paid a set fee per year for each patient they are responsible for, not paid by the visit. The fee should be set fairly so that doctors have an incentive to care for sicker patients. A fee per year per patient gives doctors the flexibility to follow-up in whatever way is best for the individual patient, be it in-person, by video, phone, or email.
Family doctors should also be set up to work in teams with other health professionals with a tie to a local hospital. Shared administration might mean compromise, but it would also mean shared support for infection prevention and control, technology adoption and more.
None of these ideas are new. Some have been realized for a few doctors and patients. But none have been successfully scaled up within a province, let alone Canada. It’s time to change that.