Family doctors should work where province decides, health conference told

Posted on June 10, 2012 in Health Delivery System

Source: — Authors: – news/canada
Published On Sat Jun 09 2012.   Theresa Boyle, Health Reporter

Family doctors should no longer able to work as solo practitioners nor should they be allowed to set up shop wherever they want, a conference on health reform has been told.

“Long gone are the days of solo practitioners. That has to end,” Dr. Kieran Moore, an associate professor of emergency and family medicine at Queen’s University, told a conference hosted by the Association of Ontario Health Centres.

“It either ends with those people retiring or we start pulling them into a model that is going to work,” he said, adding that these doctors should be working in teams with other health professionals, including nurse practitioners, registered nurses, pharmacists, social workers and dietitians.

Moore is also associate medical officer of health in the Kingston area and he has authored studies on primary care and health inequities. His comments were greeted with loud applause from about 500 people gathered at a Mississauga hotel for the conference on Friday.

There are up to 1,500 family physicians working as solo practitioners in Ontario, a large portion of them in the Greater Toronto Area. Most are older and have spent decades practising this way.

In medical schools today, doctors in training are taught to work in multidisciplinary teams that can offer patients comprehensive care. They provide after-hours service and place a large focus on disease prevention and health promotion, for example educating patients about diabetes.

Solo practitioners and their patients are at a disadvantage because they have access to fewer resources, explained Dr. Rick Glazier, a senior scientist and primary-care program leader at the Institute for Clinical Evaluative Sciences.

“They are isolated from where all the resources are and they often look after really needy patients,” Glazier explained.

Patients tend to be elderly and have been seeing the same family doctors for decades, he noted. They have to pay out of pocket to see psychologists or physiotherapists or do without, whereas the cost of these service can be covered under the team model.

Moore said new grads from medical schools should be prohibited from practising family medicine wherever they want.

“I don’t think in the future any payor should allow any physician to put their office anywhere they want,” he said, noting that primary-care services are unequally distributed across Ontario with big shortages in some areas.

“The most deprived patients are getting the least access. The people who need it the least in terms of access to primary health care are getting the best health care,” said Moore, adding that for too long primary care has been physician focused rather than patient centred.

In an interview later, Moore said it should be up to the province to decide where family doctors work.

“One potential way is (to ensure) that there are only so many primary health-care licences that are going to be given out in Ontario. . . These licences are available here and this is where we will pay you,” he said.

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