We all know health care is failing. We all know that the number of orphan patients (those without a family doctor or nurse practitioner) keeps increasing. It is now at 20 per cent in Ottawa and 16 per cent of the Canadian population. Thousands of family physicians across Canada will retire in the next few years. Many more new Canadians require health-care support. The numbers of orphan patients will double and triple.
We all know this will increase demands on emergency departments (ED), diagnostic imaging, specialists and surgeries, and will make waiting lists unfathomably longer. We have heard of patients actually dying in EDs and on wait lists.
I have been a family doctor in Ontario for 30 years and I fear that those who can improve things (political decision-makers) are paralyzed. So here are three simple solutions to improve the situation:
1). To ensure everybody gets a family doctor:
Allow every family doctor in Canada to work in a team-based model, with them leading the team. This allows the expertise of each practitioner to be used to support patients: RPNs, RNs, physician assistants, nurse practitioners and allied health care providers, with the family doctor overseeing this care and the eventual medical pathway for each patient. Administrative work can be managed by the team. Educational support for patients and staff is there.
The team can absorb a greater number of patients than a single family doctor or nurse practitioner. I have seen family doctors who are seeing 800 patients alone increase to 2,000 patients with such teams, and patients get better access and better care. The team also reduces burnout for the providers.
2. To ensure every Canadian gets access to after-hours care:
Link the above teams with other teams in a community. This will ensure after-hours care on evenings and weekends. These After Hours/Weekend Urgent Care Centres should be directly tied to team-based family medicine clinics, not be standalone, walk-in corporate businesses. Ensure they are connected by a government-supported electronic medical record system that is also linked to nearby hospitals.
Work to ensure community laboratory, diagnostic imaging, community IV therapy, palliative care and community nursing for home care is attached to these bigger links, also paid for by government.
3. To focus on primary prevention:
Reduce investments in end-stage care (such as joint replacements) and increase funding to preventative care in team-based family medicine clinics. The cost of a joint replacement is thousands of dollars while primary support — such as dealing with weight loss, muscle strengthening, injury prevention and education — costs a few hundred dollars. Fund these team-based family medicine clinics with all rental costs, IT, staffing, cleaning and supply costs paid by government. New-generation family doctors don’t want to run small businesses.
I have many more solutions to offer, such as fast-tracking international medical graduates into family medicine, national licensure, a national electronic records-interlinked system and so on, but let us concentrate on simple, low-cost solutions. The three listed above could change the present vicious cycle of worsening health outcomes into a hopeful, virtuous cycle.
Dr. Alykhan Abdulla is a comprehensive family doctor in Manotick, board director of the College of Family Physicians of Canada and Director for Longitudinal Leadership Curriculum at the University of Ottawa Undergraduate Medical Education. X-Twitter: @AlykhanAbdulla LINKEDIN: Dr.AlykhanAbdulla
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