Government Takes Aim at New Family Physicians-Why? (part 1)

I was one of the many people who had a hand in developing policy around Primary Care Reform. As a negotiator for the Ontario Medical Association, I had a bigger role in implementing that policy across the province. We worked in partnership with the Ministry of Health, the Ontario College of Family Physicians, the Section of General and Family Practice and PAIRO (now PARO), the group who represent residents. We always consulted PAIRO to make sure that none of our policies hurt new graduates

We were successful in changing Primary Care and today capitated care models are the most popular models of care in Ontario. Family Health Organizations (FHOs) are the natural successors to Primary Care Networks and Health Service Organizations (HSOs), which pioneered primary care reform.

When people argue that physicians need to abandon fee-for-service, I am always puzzled. Many more family physicians practice in FHOs than practice in fee-for-service based models.

Consider three important facts:

  1. In order to practice in a Family Health Team, physicians must either accept a salary or practice in a capitated practice like a FHO. Most choose the latter option.
  2. Family Health Teams use teams of health professionals, including family physicians, nurse practitioners and primary care nurses, to provide patient focused care
  3. Every Family Medicine Resident in Ontario trains in a Family Health Team

Why is the Government of Ontario blocking entry into FHOs and FHTs for most new graduates and most young family physicians?

In 2012 the OMA and the Ministry of Health agreed to limit the number of new physicians entering FHOs to 40 per month. Twenty spots were for people willing to set up practice in high needs areas and twenty spots were for the province as a whole. The OMA was confident that every physician who wanted to practice in a capitated model, a FHO, would be able to do so. We understood that there might be a delay of a few months but it seemed like a reasonable compromise.

In 2015, the Government will cut the number of new physicians able to enter FHOs to 20 per month and all 20 spots will be reserved for high needs areas.

The Government will decide where those high needs areas are, but it is certain that larger Urban areas like Toronto, London, Ottawa and Hamilton and the rest of the 905 area will not be included.

New family medicine graduates will have a difficult choice. They can practice in high needs areas and perhaps be able to enter a FHO. They can practice in Toronto, but only in fee for service or a walk-in clinic. Or they can wait for people like me to leave practice. That’s one way to get young people interested in the obituaries.

The government is abandoning it’s commitment to team based care and making Ontario a very unattractive destination for new family doctors. Medical Students, Family Medicine residents and new Family Physicians feel abandoned by a government who told them they were the cornerstone of the health care system and now view them as an unnecessary expense.

Has the Government abandoned Primary Care Reform? Probably not. I think they are out to save money and don’t really care how they do it.  They don’t care what the impact is on our patients.

Our young colleagues deserve better and so do their patients.

Scott Douglas Wooder, MD

Next, I’ll look at why the cuts to rostering fees and income stabilization are another shot at young family doctors.eat young

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6 thoughts on “Government Takes Aim at New Family Physicians-Why? (part 1)”

  1. Thank you for highlighting the disproportionate burden the government is placing on new family medicine graduates.

    As a July 2015 family medicine graduate I have three comments to offer:

    1) In an informal survey of my peers all of my fellow graduates are looking for non-family medicine work to support ourselves. There is a mixture of plans including ER, hospitalist, LTC, palliative care and walk-in clinic. The irony is with so many people seeking a family physician all the new family doctors will be doing anything but family medicine.

    2) As you are very aware there are rarely “easy visits” now in family medicine. Patients are complex medically and health care delivery is complex. Fee for service is only financially viable for a physician who searches out quick and easy patient visits, such as in a walk-in clinic. The government has eliminated the capitation model which allowed physicians to practice comprehensive medical care, effectively driving us to choose to work only in walk-in clinics. I think the citizens of Ontario expect and deserve better care than this. To date this point has been poorly communicated to the public.

    3) I believe your source for medical school debt is out of date. Tuition alone is now 22-24K per year. Meaning with tuition alone your debt is already at 100K. Add on 4 years of living expenses and average debt is at least 200K.

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  2. I am a family physician practicing in Hamilton and I grauated 3 years ago. My husband and I are moving to Peterborough in the spring where I was planning to join a FHT and start a practice. These government cuts make it almost impossible for me to open a practice. What new graduate wants to go back to practicing in a solo office billing fee for service? Part of the reason I chose family medicine is that I wanted practice on a FHT with the support of colleagues and allied health professionals. So I will wait, I will locum, I will work as a hospitalist and take some ER shifts, and then when someone in a FHT wants to retire I will hope to take over their practice. Meanwhile, the people who are most affected are those with no family doctor because the number of new graduates starting a practice under these new government rules will be few and far between.

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  3. Our politicians are trying their damndest to save money on the backs of the medical profession by cutting back on healthcare services and forcing the physicians to practice rapid-turnover (poor) medicine since they have driven the province into near-bankruptcy by their unaffordable promises, used to buy elections. Also, high taxes, fees for already (over)-paid-for civil servants and their “services” and the resulting high cost of living are driving businesses away!
    They waste taxpayers’ money by such self-serving actions as to move virtually completed electricity generating stations from where they are needed to where they are not needed hundreds of miles away to elect 3 Toronto-area members (Mcguinty supported by Wynne). They know that since there are not many physicians, they are an unimportant voting block and can be easily beaten into submission (by unfairly “negotiating”) and their reasonable requests ignored because it would be virtually impossible for them to withdraw services in protest (unlike teachers, nurses, civil servants)! Plus ca change, plus c’est la meme chose!! Surely, a binding arbitration is needed to replace the government negotiators with a “take it or leave it” attitude.
    If our self serving polititians continue on their present course they are ensuring that access to primary health-care in Ontario will become increasingly unavailable as newly-qualified graduates leave the province or do anything but enter the high-stress/low reward family practice sub-specialty. Yours sadly, Michael Newhouse MD MSc FRCP(C), FACP (happily retired from practice!).

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      1. Likewise, Scott. ! Am enjoying your blogs-the government is certainly broke but how many cabinet ministers, hospital administrators etc are ready to lead the return to fiscal sanity in government by chopping their own excessive incomes? You want to throw up! Love to Laurie, Mike

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