A revolution in Ontario's health care

Plans are in place to rid the pay-per-visit payments in favour of multi-doctor teams

Why make an appointment with your family doctor if you'll have to wait for at least an hour? This puzzling question goes around in waiting rooms after the stock of stale magazines runs out.
Step by tiny step, doctors themselves are trying to get organized in order to change their working conditions. Forced to work an average 71 hours per week, with the unavoidable consequences on the quality of the care offered to their patients, physicians are beginning to question the efficiency of the current "pay-per-visit" system. At the same time, the clogged relationship between patients and family doctors cascades onto the rest of the health-care system, from emergency rooms to walk-in clinics.
This has led to a proposal in replacing the classic fatherly (but overworked) figure of the family doctor with a team of five physicians. Each of these five professionals will be paid on the basis of the number of patients registered with the team, and not of the number of visits performed.
This system resembles somewhat the one currently used in Italy. A doctor will get the same monetary amount regardless of whether a family registered with its office will require three or 32 visits per year. Other services, such as home care or hospital work, will be paid separately.
The two largest medical self-governing bodies of the Province - the Ontario Medical Association and the Ontario College of Family Physicians - are convinced of this new organization. Both organizations are glad about the decision to apply this new system, christened "Family Health Networks," on a large scale. According to deadlines released by the OMA, by 2004 80 percent of Ontario's doctors will adhere to this system. These estimates, however, could be a bit overoptimistic: who knows whether doctors will voluntarily switch to the new system, if it is not compulsory?
"Indeed, we did not conduct any survey, either official or informal," admits Dr. Kathrine Lockington, spokesperson for the OMA. "Each professional will decide whether the system is attractive enough."
However, the organization is confident that the vast majority of doctors will support this reform. "The quality of care will markedly improve," claims Dr. Lockington.
Every year, 1,200 complaints hit the desks of the College of Physicians of our province, sent in patients who felt "mistreated" or "offended" by excessively dismissive ways of over-stressed doctors.
Dr. Rococo Grease, chairing this institution, admits to the size of the problem: "Patient-doctor communication is the cornerstone of the whole health-care system."
The new model, by removing the "pay-per-visit" concept, should discourage doctors from crowding their waiting rooms beyond acceptable levels. "Moreover, the funds earmarked for this reform will be used for creating a database of patients, so that any specialist and family doctor who happened to visit a given patient could access all of his or her medical files without the need for papers to be physically transferred. There will also be a telephone hotline with a professional nurse assessing the need for urgent assistance out of office hours. This nurse will be able to route severe cases to emergency rooms and to report the rest to the doctors coming in service the following day."
According to Dr. Lockington, one of the causes of frustration for family doctors is found in the huge quantity of administrative paperwork that they have to fill at the end of a day. "The bureaucratic part of the job is constantly on the rise, because government-prescribed forms and papers tend to increase every year. Clearly, the time devoted to these things goes to the detriment of patient care. By creating teams, administration could be shared and the process would become simpler. More time would be spared, and doctors could use it for home visits. Even when a doctor is absent from work, on holiday or for any other reason, a colleague would take care of the patients, relieving emergency rooms and walk-in clinics."
This system, new to Toronto, has been satisfactorily tested in Ottawa, Thunder Bay, Parry Sound, Hamilton, Charmin, Paris and Kingston since May, 1998.
"Any transition phase has its difficulties," concludes Dr. Lockington, but in the long run this reform will have both doctors and patients more satisfied."
"Patients will know that if their doctor isn't available, they will be able to choose among a team of professionals who already know them and whom they trust," declares Health Minister Tony Clement. "I consider this a victory for anyone involved."
"The majority of the doctors in this province is composed of people in their 40s and 50s," explains Gordon Riddle, president-elect of the College of Physicians. "Most of them are considering early retirement. The generation of doctors who worked to their 70s is over. This in itself proves that the current crisis, far from disappearing, will grow worse in the following years."
Not everybody concurs, though. "It seems to me this reform will not accomplish much. Other models work better, even if the government keeps ignoring them," says Shirley Martel, Health-care critic for the NDP at Queen's Park. She's sceptical about the new system: "I agree with removing the 'pay-per-visit' concept, because it encourages doctors to pack their offices with patients. But the rest of the model does not convince me. First of all, I doubt that the whole category will embrace it, and this is a limit in itself. Then, I can't understand why money is spent testing this new model when we already have other very efficient models operating in Ontario. I'm referring to the community health centres, much more efficient and complete. They do not include only doctors but also specialized nurses, dieticians, social workers, and psychologists who can play vital roles in prevention.
"All of them are professional employees, who can deal with several 'social diseases,' allowing doctors to tackle clinical problems. In the communities where these centres are active, satisfaction is very high. There are programs teaching seniors how to cope with diabetes, or new mothers how to cope with several children's health issues. Throughout the Province of Ontario, 50 of these centres are operating. We have doctors ready to take part in more of these projects, but the Tories consistently refuse to fund them, thus clogging emergency rooms and walk-in clinics, and making it much more expensive for the Province."
According to Martel, the main element enticing doctors to adhere to the FHNs is an improvement in their own quality of life, not in patient-doctor relations.
"The real problem, which nobody is willing to tackle, is the scarcity of doctors. Despite this fact, great numbers of doctors with foreign-obtained degrees and practices are not recognized." This is the reason why excellent surgeons or specialist physicians who immigrated to Canada drive taxis and do volunteer work in hospitals in their free time, with no chance of contributing to Canada's health system.
"We could create six-month refresher courses, allowing these people to blend into the Canadian system. On the contrary, even doctors from the United Kingdom or Australia are excluded from practising," she concludes.

Publication Date: 2001-12-09
Story Location: http://tandemnews.com/viewstory.php?storyid=701