Health teams incomplete without family doctors
When the time for reflection begins, so too will the soul-searching on our response to COVID-19. As a family doctor, allow me to offer this lesson learned. Family doctors who have been better able to weather the storm have had the benefit of existing and strong connections within their communities.
I can attest to this first hand as a family doctor practising in the small Ontario town of Collingwood, where I work across a variety of settings. Most of our community family doctors are interconnected by virtue of the type of practice we are in – ours happens to be a family health organization. Other family doctors work in hospital-based roles. As a collective group, we connect to each other and to others in the health system like the hospital and long-term care and retirement homes.
As a result, we know who to call on when needed and trust that we will be heard. We know that this type of peer connection can help lessen physician burnout, which continues to be a pressing issue. Connection also means we have more capacity to step up for patients because we can do things collectively that cannot be done alone. Case in point – our local family doctors helped set up and staff our COVID-19 Assessment Centre, work extra shifts in the hospital, and are pooling personal protective equipment (PPE) for other family doctors in need. If required, my colleagues are prepared to lead and staff a local field hospital.
My experience in Collingwood is certainly not unique. As President of the Ontario College of Family Physicians, I hear similar stories of family doctors leading the COVID-19 response in their communities. They too are setting up and staffing assessment centres. They are pooling resources across their offices, taking turns to ensure well-baby and prenatal clinics continue for parents. They are organizing PPE drives and getting hand sanitizers from local businesses. They are developing testing and treatment protocols for their communities.
And yet, I am also hearing from stressed physicians who do not have the same ease of access to help. They are struggling to translate the guidance from the Ministry of Health and from Public Health – which often assumes those connections are already there – into their own reality.
These physicians know, and it is becoming more obvious by the day, that family doctors cannot thrive – or perhaps even survive – by operating without connections to each other and the wider health system. Before the pandemic, our health system was in the process of launching Ontario Health Teams (OHTs). Anecdotally, family doctors meaningfully engaged in local OHT work developed a sense of peer support to tackle COVID-19 together. In some communities with pre-existing connections between family doctors and the health system, family doctors were leading OHTs.
Now, more than ever, we need to have care delivered through a regional system where all family doctors can participate, regardless of how they are paid. We know that a regional approach to health care with strong clinician leadership improves outcomes for clinicians, patients and the health system.
In some communities, it has been difficult for OHT organizers to connect with family doctors who are in individual practices. But it is necessary. Family doctors need to be enabled to attend meetings and be connected. Their engagement must be nurtured and supported.
As we think about the post COVID-19 health system we want, the Ministry of Health and organizers of the OHTs need to see that success depends on putting forward the effort and resources necessary to engage family doctors of all practice types.
Strong health systems begin with patients connected to a family doctor in primary care, who in turn provides them comprehensive care within a “medical home” and links them with a “medical neighbourhood.” Family doctors have seen in this pandemic that we cannot do it alone. We can do it better when we are connected. Most family doctors want to make themselves part of a bigger picture than just their practice. The system needs to work to make that happen.