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:
- 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.
- Family Health Teams use teams of health professionals, including family physicians, nurse practitioners and primary care nurses, to provide patient focused care
- 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