I’m not sure if I’m being relentless of obnoxious in pointing out the problems that are being caused by the unilateral cuts made by the Minister of Health to medical care in Ontario. One of the cuts announced in January of 2015 is a reduction in the number of physicians who will be allowed entry into capitated models of care. These capitated models are called Family Health Organizations, or FHOs.
The total number of new entrants is being reduced from 40 per month to 20 per month and physicians will only be able to join FHOs in ‘high needs’ areas. One could argue that the whole Province is in high need of good quality primary health care, but we will have to wait to see the Ministry’s definition. It will be interesting to track high needs areas against Liberal held ridings. Surely it would be abhorrent for medical care to depend on the capriciousness of patronage appointments.
It seems likely that cities with medical schools won’t be on that list. So no new entrants to FHOs in Toronto, Ottawa or Hamilton amongst others. I can’t wait to see what happens in Sudbury, one of the homes of the Northern Ontario School of Medicine.
In communities that are not defined as high needs a physician can enter a FHO as a replacement for a departing physician. If someone dies or retires, they can be replaced
I believe that the ill thought out policy of the Government is aimed at young physicians and especially young mothers and fathers. Let me explain.
My colleague, Dr. A (based on a real colleague) wants to retire after 40 years of practice. He has worked hard and has a very large practice. He works incredibly long hours to provide good care, arriving at the office at 7 am to see a few factory workers on their way to or from work. He stays late and rarely gets a lunch. His evenings are spent doing paperwork or working in his after hours clinic. He practices in a Family Health Team and is paid through his FHO. He is part of a team that includes a primary care nurse, a mental health worker and a physician assistant.
Dr. A wants to retire in a year. He is smart enough to plan ahead and as part of his legacy he want to make sure that his patients are well looked after. A common practice in Hamilton has been to identify a young physician, Dr. B, to take over the practice and work together for a year to smooth out the transition. It’s a wonderful form of succession planning. Drs. A and B work side by side to smooth our the change. Dr. A is relieved that his patients are going to be patients of a well-trained young family doctor and Dr. B. gets to know that patients in a low pressure setting. After a year each physician is happy that things will work out and a seamless transfer of care occurs.
But now, with the unilateral cuts to care imposed by the Liberal Government, Dr. B cannot enter the FHO until Dr. A leaves. So the smooth transition is against the rules and Dr. A must look elsewhere.
Dr. A is persistent and lucky. He finds 2 physicians who want to share his practice. Dr. C is a new mother. She has 3 young children, 2 of whom are in primary school. The third is looked after several days a week by a family member. Dr. C needs to work but ideally she would work 3 days a week so she can do all the things she want to do at home. Dr. D would love to work in this practice but she has other irons in the fire. She does work in long-term care facility and does some research as well. Drs. C and D plan to job share and between them look after Dr. A’s practice.
There is a problem with this arrangement too. A new physician can replace a departing physician in a FHO, but two cannot replace one. No job sharing allowed. Dr. C cannot work part-time in a FHO while her children are young and Dr. D cannot pursue non-FHO related activities.
My colleagues Dr. A finally finds a single replacement who gets no introduction to the practice and is willing to work the same crazy hours that he did. Who needs a work/life balance? Just work and quit complaining.
This is one example of the problems that will arise with a poorly considered Government imposed policy. Isn’t it time the Government of Ontario and the Minister of Health sat down with real doctors, with the OMA, to negotiate an agreement that makes sense for patients, doctors and the government?
Scott Douglas Wooder, MD