Playing musical chairs with Ontario MDs
NationalPost.com – Family Health – Playing musical chairs with Ontario MDs
Published: Wednesday, January 21, 2009. Dr. Yoel Abells
Replacing the family health teams (FHTs) that were put into place several years ago in Ontario before closely examining what works and what doesn’t in family medical care would be a huge blunder, says Dr. Yoel Abells.Getty.
It was not long ago that the government of Ontario began establishing family health teams (FHTs) as part of its commitment to reform the delivery of primary health care to its citizens. The concept involved creating clinics that would provide comprehensive care using a group of collaborating health care providers (family physicians, nurses, dietitians, etc.). While intuitively the idea made perfect sense, I had (and continue to have) concerns related to this endeavour. Admittedly, these stemmed from a distrust of government – a sense that the real goal was cost control, not improvement of care. I worried that commitment to these projects would wane and the money would disappear. I predicted that, without a careful analysis of the success (or failure) of these models, the government would begin looking to other models of care because this is how government works. The recent decision by the Ontario Ministry of Health to postpone the establishment of further FHTs and instead fund Nurse
Practitioner-Led Clinics (NPLCs), speaks loudly to this concern.
This initiative is troubling for a variety of reasons. First, it reflects the ministry’s poor understanding of what family medicine is about. Let me be very clear: This is not a territorial argument. Nurse practitioners are exceptionally well-trained health care professionals. But they are not doctors, and to imply that they can do what family physicians do is insulting. Second, when one reads the ministry’s announcement regarding these NPLCs, they appear to be no different from the FHTs. They will be “comprised of health care professionals who will work collaboratively to provide comprehensive … care.”
Third, there is a philosophical disconnect underlying the NPLCs. When FHTs were established, a fundamental tenet was that no one would be “leading” the team. Rather, care was being provided “collaboratively.” There was a very deliberate move away from the medical model of care, dominated as it was by the medical practitioner. To call these “Family Physician-Led” clinics was sacrilege. Yet, Nurse Practitioner-Led clinics are apparently fine.
When the FHTs were introduced, they were touted as proven paradigms that would bring positive change to the landscape of primary care provision in Ontario. Yet no such proof really existed. Now, the government has put FHTs on hold and is bringing in a new model, even though the ministry’s spokesman admits that no evaluation of the NP-led model exists. He defends the initiative by arguing there “hasn’t been a similar evaluation of FHTs.” (Most research has focused on specialty NPLCs offering disease specific care such as cardiac care – not ones providing general health services).
Before blindly embarking in yet another direction and introducing yet another tier of care, a proper evaluation of the established models is needed.
-Dr. Yoel Abells appears Wednesdays on the Body & Health page. You can submit your health questions by sending an email to the address below. <familyhealth@nationalpost.com>
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