Mixed Messages about Family Medicine

I am a little confused by the mixed messages that the Government is sending about primary care and Family Medicine.

In a speech at the Empire Club on February 2, the Minister of Health talked about the importance of primary care. He bragged about all of the new family physicians and Family Health Teams that the Liberals had put in place since Dalton McGuinty was first elected. He stressed the need to build on past improvements and improve access

That speech taken in isolation, would give me confidence that the Government was headed in the right direction. But of course the speech cannot be considered by itself. It has to be put in context with things that this Government has actually done.

By now most readers will understand that the Government has cut physician’s fees by 2.65% and made other targeted cuts which bring the total cuts up to 4.8%. What some may not realize is that because of the specific targeted cuts, Family Doctors face a total cut of 6%. That’s right; Family Doctors face the biggest cuts in the entire profession. And new family doctors are especially targeted.

I’ve previously documented how severely limiting entry into capitated models of care, ending enrolment fees and ending Income Stabilization for most new graduates will make it almost impossible for new graduates to practice in primary care teams.

In his speech, the Minister talks about moving away from fee for service. I should declare at this point that in my 29-year career, I have practiced in fee for service for exactly 4 years. The other quarter century I’ve spent in practice has been in a capitated team. So neither the Government, nor anyone else, needs to explain to me the benefits for my patients who are lucky enough to be enrolled in a Family Health Team.

Here is where I get confused. The Minister announced the need to move away from fee for service 10 days after his Government announced cuts that will effectively force most new Family Physicians to practice in a fee for service model.

That is the mixed message. That’s why I’m confused.

Actions speak much louder than words, so with great reluctance, I’ll have to ignore the speech and assume that the Government is serious about cutting team based, capitated family practice.

Either that or the speechwriters forgot the read the newspapers.

Scott Douglas Wooder, MD


8 thoughts on “Mixed Messages about Family Medicine”

  1. Hello Scott, I’ve been following your blogs for a while…they are fantastic. I just wanted to quickly correct one point, family doctors from an absolutely value perspective is the largest proportion of cuts (dollars). Percentage wise, Nephrologists were cut the most at 7.1 percent. The agreement in 2012 saw Nephrologists drop by 10 percent at that point. Over the past 3 years, Nephrologists have dropped by 17.1 percent. Most really don’t care very much for this point because of the impression that we are paid very well. Unfortunately, the gross billings are very inaccurate for Nephrologists and most actually bill just over the average of the GP…that’s right!! I find that because we are a small section, we get singled out for cuts and have very little voice in the OMA. I know that when relativity calculation is done for us, we actually will be undervalued (no surprise). The sad thing is, our chronic disease premium is being cut and this is what allows us to prevent end stage renal disease. I spend 30-40 minutes with a follow up visit in my clinic and do all of their vascular management (cholesterol, BP, renal issues etc.). I will now be paid $38.05 instead of $56 to do all that. Unfortunately, I’ll have to refer those patients out and do a lot less. We do a lot of GP related things for our dialysis patients (these are free because we feel for these people). Lastly, our section only bills 71 million dollars for 220 nephrologists. If you do the math, we hardly make a dent in the 11.5 billion dollars yet were are perceived to be making tons of money. Certainly some do and the skew impressions. So, in actual fact, Nephrologists are the hardest hit percentage wise. All the best.


    1. Thanks Mark. I was comparing by Assembly. In other words comparing FPs to all Internal Medicine specialists as a group.

      I do understand the lags impact that ending the Chronic Disease modifier will have on nephrology, cardiology, GI and IM.

      Thanks for the feedback



  2. Another great post, Scott. Like someone Tweeted, Hoskins takes credit for a touchdown pass he didn’t throw (or catch).

    I realise politics is hard. I excuse politicians’ lapses in honesty from expediency or distraction. I just cannot understand how a physician who’s a politician can be so duplicitous. It tarnishes us all by association.

    Thanks for taking time to write!




  3. I am a recent family medicine graduate who chose to pursue emergency and hospital based medicine after completing my training with the goal of eventually starting my own practice. With the current political milieu I am essentially unable to open a practice in the community where I currently work. As it stands now I’m not sure I will ever open my own practice, which I think is a loss for both myself and the province. I understand that we as a country cannot afford our current health care spending but I really feel these cuts are only going to end up costing us more in the end and really move us backwards with patient care. It’s very disheartening.


  4. Thanks again Scott for another blog right on the money. The ministry is having a hard time moving forward making necessary changes in primary care. Unfortunately, some of these changes are expensive. Luckily for the minister, talk is cheap!


  5. It’s interesting to think that I had never heard about these important cuts that you mentioned here. I suppose it’s better to be late than never hear it all. I hope that the industry finds a way to fix itself, as my family puts a lot of importance on finding the right family medicine practice. Thanks for the information on such an important topic, Scott.


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