Local healthcare needs a major fix

Here’s the plan to get us there

By Dr. Bert Lauwers

An oft-repeated question to healthcare providers is, “Do you know a family physician who is accepting patients?” Their response is despairingly uniform. The answer is “no.”

For the mother with a child who is ill, or a senior citizen who has just been diagnosed with a serious illness, this answer provokes a sense of hopelessness and despair. The Kawartha Lakes Health Care Initiative (KLHCI) has been a beacon of light in recruiting physicians to the city for many years.

Who is responsible and accountable for ensuring that there are adequate numbers of family physicians to meet the population needs of Kawartha Lakes? Is it the Ministry of Health and Long-Term Care? Ontario Health? The City of Kawartha Lakes? The hospital? The various groups that provide primary care in the city? Is it the Kawartha Lakes Haliburton Ontario Health Team or should we be relying solely on the KLHCI?

Kawartha Lakes – the City – needs a master plan to tackle the shortage of family physicians. The newly crafted Kawartha Lakes Haliburton Ontario Health Team with its member organizations should create this plan. Ontario Health Eastern Region should finance the cost for the creation of the plan. The plan should seek to develop a family physician clinic for unattached patients or those with family physicians outside Kawartha Lakes. The clinic should provide in person care from a physician or team member, seven days a week, eight hours per day, and ensure the emergency department is not consumed caring for medical issues readily addressed in ambulatory care clinics. Also, this master plan should identify the current and future gap in family physicians based on Kawartha Lakes’ population size, and develop strategies to recruit and retain the needed physicians to the city. Several issues have converged that have made accessibility to family physician care and urgent primary care dire.

In the past year, several excellent long-serving comprehensive family physicians have retired. They could not find replacement physicians. In addition, several relatively new family physicians have left family medicine for focused areas of practice. They could not find replacement physicians. Minden Hospital Emergency Department closed. The northern area of the city obtained excellent ambulatory and emergency care 24/7 there for many years. The projected growth in Kawartha Lakes has given estimates of 6,000 new homes, just in the coming years. What primary care medical infrastructure will support the care needs of all these new residents, let alone those who currently live here and do not have either a physician, or a local family physician?

All of this has occurred against a backdrop of a nation-wide existential crisis in family medicine. Residency positions are going unfilled, pay is not commensurate with work demands, and family physicians are buried in paperwork. In addition, challenges with Electronic Medical Records (EMR) and health information systems have added to physician’s burden and increased their work. A recently completed Disability Tax Credit Certificate for a patient in long-term care was 16 pages long, with pages four through 16 to be completed by a physician. The patient had multiple disabilities. It took more than one hour to complete the document sitting with a family member and typing in the fillable form. This is but one example of the referenced burden of paperwork.

Chuck Ames, the former chairman and CEO of Reliance Electric is reported to have said, “Show me a company’s compensation plans, and I’ll show you how its people behave.” Is this statement from industry referable to health care? Would physicians be more likely to become family physicians if their compensation package was improved? British Columbia improved pay for family physicians by about 50 per cent. Early observations suggest an improvement in physician numbers. Compensation matters.

Emergency Department (ED) wait times have understandably grown. Now, by default, patients in need of urgent tests are required to go to the hospital emergency department to get timely test results completed. A program called SCOPE (Seamless Care Optimizing Patient Experience) has been created in large urban hospitals such as the Scarborough Health Network. Family physicians call an intake line, and through a navigator can get timely access to both diagnostic studies, and certain consultant care without the need to send patients to an emergency department. An ambulatory family physician clinic operating in Lindsay could offer both care and the same timely access to tests, should the hospital develop a program with its family physicians to provide such a service. If complex health care organizations with large populations can do this, so can Lindsay.

Attracting and retaining family physicians takes time and careful planning. To correct the current deficit in family physician care will undoubtedly take years in Kawartha Lakes. In the interim, a primary care ambulatory care clinic operating seven days a week for unattached patients and those with primary care providers outside Kawartha Lakes would be of enormous and immediate benefit to Lindsay and the surrounding community.

Large system issues have led to the spurning of family medicine as a career choice for physicians. This in turn has led to the inability to both attract and retain family physicians in the city. However, solutions do exist. It begins with the creation of a comprehensive population-based plan. Kawartha Lakes Haliburton Ontario Health Team, and its member organizations should submit a proposal to Ontario Health for funding to develop the plan. We all want the aforementioned child and senior citizen to get the care they need. The time for action is now.

– Dr. Bert Lauwers is a former president and CEO of Ross Memorial Hospital in Lindsay.