In Walkerton, Ont., a new family medicine practice accepting patients drew a line of hundreds of people, some waiting in the cold as early as 2 a.m. One person described securing a family doctor as “winning the lottery.”
A new study from Health Canada says we are short a jaw-dropping 23,000 family physicians in this country. We need more doctors – especially in primary care. But that alone won’t solve the system-wide capacity issue we’re facing. We need to scale up new models of care in which health professionals support each other in coordinated, cooperative teams.
Last week, I was in Halifax, where Canada’s health ministers met to discuss our country’s health care needs. Organizations representing Canada’s physicians and nurses came together to highlight that first and foremost, health care is a human resources system – one where we can’t afford to lose any more caregivers. Supporting, retaining and investing in health-care workers is crucial.
The federal government has taken a step in the right direction with a new interpretation of the Canada Health Act. In a letter in January, federal Health Minister Mark Holland clarified that provincial/territorial health insurance should cover medically necessary care from nurse practitioners, midwives and pharmacists as well as physicians.
Language such as “physician-equivalents” included in the interpretation letter is causing confusion and should be clarified. Doctors play a unique role in our health-care system that can’t be duplicated. Simply asking provinces and territories to foot the bill for more siloed, fragmented health services will not address the access-to-care gap plaguing the health system either.
Working together in teams, health providers can optimize resources.
But while the role of family doctors is a fundamental part of primary care, not every problem requires a family doctor, whether it’s managing certain chronic illnesses or refilling specific medications. Working together in teams, health providers can optimize resources – easing the pressure on physicians and the larger public system, while responding to community needs.
It’s important that Minister Holland reiterated that charging patients for medically necessary health services will result in financial penalties for provinces and territories. Patients shouldn’t have to pay out of pocket to work around a struggling health system.
In fact, on a cross-country listening tour about the balance of public and private health care in Canada, the consensus was that access to health care, regardless of the ability to pay, remains a bedrock value. And Canadians are ready for more team-based primary care. In a national survey conducted by OurCare, 90 per cent of respondents said they’d be comfortable seeing another member of a health-care team if a doctor or nurse practitioner recommended it.
Eradicating lineups like the ones in Walkerton requires urgent action on many fronts. This includes funding digital solutions to assist clinicians in their work and ensuring we can access critical health information across systems. It also includes improving doctors’ mobility through pan-Canadian licensure, reducing the administrative burden placed on family doctors, and greater accountability.
Opening the door to publicly funded, team-based primary care where all professionals are recognized is a welcome start. Now urgent investment is needed to make this standard practice, so every Canadian can be assured access to a primary care team.
It’s time to break down the siloes in health care and focus on collaboration instead. No one wants to leave patients out in the cold.
Doctors are choosing not to go into family medicine. In the middle of this crisis the College of Family Physicians wanted to increase the training to 3 years. This group is part of the problem not the solution in my view. Although I never thought I would say this, it may be time to take all the money spent on training family doctors and use it to train Nurse Pracitioners. The NPs would then be able to refer directly to specialists. We need some thinking out side the box. More the same old, is not going to solve this problem
While I am certainly not opposed to new models of care, there is no model of care that will solve the problem without a long term commitment to adequate funding. In Ontario we have four options for compensating family physicians, Fee for Service, Blended Capitation, Salary and Alternative Payment Plans – each was designed to ensure family physician compensation was fair, appropriate and tailored to the population served. Ontario also has team options – again designed to best meet the needs of specific populations – Family Health Teams, Community Health Centres, Aboriginal Health Care Centres and APP physician groups.
What all family physician compensation models and primary care teams have in common is several years of government disinterest and neglect. Government much prefers to announce new solutions, rather than fix what’s broken. There is no family physician compensation or primary care team model, existing or new, that can survive a decade of neglect.
Before the Ontario government funds new models of care, significant funding needs to be invested in those we have. I think it does a great disservice to patients to blame today’s crisis on current models when they’ve been neglected for over 10 years. Government wants the public to blame the vehicle when the problem is the driver.
Agreed Duff, it’s always ‘more flashy’ to develop a new model, however there is nothing inherently wrong with any of the current models we have except that their funding has lagged significantly behind inflation. Any new model will not work unless well funded, so why don’t we first try to fund properly the infrastructure we already have and avoid all the extra administrative and set up costs of new models?