Sunday House Call, #870, March 19, 2023: The Fall of the Health Care Dominoes

Two to three times per week, I receive emails from various medical organizations like the Ontario Medical Association, the Ontario College of Family Physicians, The College of Physicians and Surgeons of Ontario, and read news stories propagated by interviews with academics and health researchers all of whom have advice and recommendations on how to improve access to healthcare services in Canada; in many instances primary care access.

As you’re aware, about a million and a half people in Ontario do not have family doctors.  Each of these emails and news stories couches recommendations in bureaucratic doublespeak.  The language is always soft and conciliatory towards government agencies responsible for the provision of care.  It is carefully crafted to use inoffensive words. They want to appear reasonable and understanding.

I am less enamored to do so.  Not when people are being harmed by the lack of access to care and the singular focus on the dogma that we must continue to stay the course.  There is no option for allowing each family practice to tailor their provision of services towards their specific patient populations.

Instead, we have people who profess to have the answers who have either reduced their interactions with patients or do not practice altogether or who have never owed and managed large primary care centres.  They work in an institutional setting gathering data that do not represent and have no relevance to the on-the-ground experiences of healthcare providers.

And in many ways, they cannot do so because, as I just mentioned, each practice is different.  Each practice has different numbers of physicians and nurses and ancillary staff, each practice is funded differently with multiple tiers of healthcare services.

If you were to speak with your family physician, if you are lucky enough to have one, and ask them what they need to be able to provide better access to services, reduced wait times for appointments, to reduce the increasing rates of retirement due to stress and burnout, and to reduce the unending paperwork that takes away time from direct patient care and leads most physicians to want to quit their job, the answers would be varied because each physician practices differently.

With almost 17,000 family medicine and general practice physicians in Ontario as of 2020, the numbers likely less now, it is next to impossible to impose a top-down approach by various levels of Government that will satisfy all the different ways primary care is provided.

I cannot speak for any of the other physicians because each has their own solution for their own practice. So I will get personal.

If funding is a major issue, and it seems to be, and that as an insurance plan The Ontario Health Insurance Plan or OHIP, is unable to bear what it costs to provide Healthcare Services, we need to look at how other insurances plans are structured.  If you work for the Federal Government or have an insurance plan, you very well know that there are copayments or top ups for which you are responsible when it comes to prescriptions, physiotherapy, dental care, massage therapy, foot care, amongst many other areas.

So really there are only two solutions of the same coin.  The solutions need to foster support for each family practice on an individual level.  This can only be accomplished through a grassroot or bottom-up approach.  This support comes in the form of adequate funding.  The Federal Government solution is to do more of the same and continually underfund its original commitment to the provinces.  When Medicare was established, it started at about 50% and now has dwindled to less than 20%.  The result we see today was inevitable; the writing was seen on the wall decades ago and no one listened.

So, getting back to two solutions, either the Government provides unrestricted top-up funding for each patient visit to their family doctor of about $10.  If they cannot, patients who earn above a certain income, will pay a facility infrastructure fee of $10 for that visit. Those below the income cut-off will be covered by the government.

This $10 will allow us to hire two nurse practitioners, a physician assistant, upgrade our electronic medical records, ensure adequate payment for our staff commensurate with inflation, provide pro bono vaccinations for shingles, hepatitis B, and pneumonia for those people either falling through the cracks because of their age, or do not have insurance to cover the cost of them.  It would please me no end to be able to provide this to patients.

The nurse practitioners would be able to see many patients thus opening up further access to the family doctors to deal with patients who have more complicated care issues.  It would reduce the burden of stress on the physicians, providing a more relaxed environment within which to work.  The physician assistant would in addition be able to see patients as well and do much of the paperwork that ties down the family doctor.

Please bear in mind that the facility fee goes to the Medical Center and not to the individual physician.  The Medical Center is responsible for hiring staff.  The Medical Center’s only source of revenue now is through physician Billing and uninsured services.  Each physician pays a certain percentage of those billings as overhead to the center.  But because OHIP underfunds the patient visits, the center cannot earn enough income to be able to hire extra staff.  This sets up a vicious spiral downwards as physicians retire or quit or reduce their hours to try to handle the burnout and stress and frustration.

I am growing increasingly tired of academics and health organizations telling me how to practice and navel gazing at themselves touting how wonderful a job  they are doing representing family doctors and physicians in general.  They have not changed in 30 years as they are fully ensconced in the dogma that touts a specific form of healthcare in Canada.

I would respectfully suggest that they change their approach and be honest with Canadians sharing the anger and frustration that we all have.  Instead, they employ diplomatic language that I think frustrates all the people who do not have family doctors, all the people who are suffering because they cannot get access to care, all the people who do have family doctors but have to wait months before they can see them, and all the people who just want to be secure in the knowledge that they can care for their children and families and friends.

Alas, I’m not holding my breath.  Change is hard.  Even when the solution is $10 away.

Your calls about:

  • Elevated PSA levels
  • The difference between the two types of shingles vaccine
  • The two pneumonia vaccines that are available and the indications for their use
  • Diabetic neuropathy of the lower legs