Social Policy in Ontario

I had to turn another patient away: It doesn’t have to be that way

Posted on February 29, 2024 in Health Delivery System

Source: TheStar.com — Authors: Iris Gorfinkel

TheStar.com – Opinion/Contributors
February 29, 2024.   By Iris Gorfinkel, Contributor

Primary care teams are urgently needed to share the responsibilities faced by family doctors and make the most of their skills.

We’ve just told another caller that we’re no longer accepting new patients. It’s been years that our family practice has been closed and we gave up on keeping a waiting list because so few patients leave. It feels terrible to turn people in need away, but our current 11-hour days don’t leave much capacity, even for our families.

How many more Canadians will be forced to scrounge around for a family doctor before real commitments are made to improve this situation? And at what added human costs?

The figures are truly dire. By 2026, an estimated 1-in-4 Ontarians will no longer have a family doctor. Nearly 1-in-3 Quebecers lacks access to primary care and the same goes for the Atlantic Provinces.

Desperate callers implore, “What am I to do?”

We suggest they phone the College of Physicians for a list of family doctors currently accepting patients. We don’t tell them that they’re unlikely to find one and don’t go into the serious health struggles they could face if they can’t easily access primary care.

An unchecked acute abdominal pain might be an appendicitis that ruptures. Untreated high blood pressure could result in a heart attack or stroke. Missed vaccines invite diseases like measles. Losing access to cancer screenings could delay to when they’re no longer curable.

When family doctors like me turn away people in need of care, it leaves emergency rooms and urgent care as the only remaining access point to health care. Yet even if everyone could have access to family doctors, clinicians would need 27-hour days to deliver the current standards of care to each patient, according to a 2022 University of Chicago study.

It’s actually physically impossible for a solo family doctor to keep up with all the needed acute, chronic and preventive care, let alone look after their many results and consult notes while running what amounts to a small business.

Yet, Canada’s primary care model hasn’t changed in the face of this massive increase in workload and complexity. Worse, provincial fee codes for primary care have been in free-fall for decades, quietly dropping well below inflation. Family doctors aren’t provided with pensions, sick leave or paid disability, let alone dental coverage or parental leave.

Is it any wonder that swaths of Canadians can’t find a family doctor?

Primary care teams are urgently needed to share these responsibilities and make the most of family doctors’ skills. A team approach could provide patients with diabetes easier access to a nurse, dietitian and physiotherapist. People struggling with their mental health could more easily access psychotherapy. Nurses could ensure timely access to cancer screening and vaccines leaving family doctors to look after more complex medical issues. The list goes on.

It’s why patients do better under primary care teams than family doctors. Other countries spend 60 per cent more per capita on primary care than Canada employing primary care teams at scale. Yet, the provinces and territories haven’t adequately funded this model of primary care. They’d be wise to heed the advice of the late physician and humanitarian, Dr. Paul Farmer.

“It is very expensive to give bad medical care to poor people in a rich country.”

The cost of not investing in teams is slated to increase over time, along with advances in medicine. Switching to this new model of care is difficult and costly, but the costs of not carries deadly consequences. Funding is a good start, but what’s also needed is a clear vision and a steadfast commitment to reconstructing primary care.

Iris Gorfinkel is a family physician and clinical researcher in Toronto.

https://www.thestar.com/opinion/contributors/i-had-to-turn-another-patient-away-it-doesnt-have-to-be-that-way/article_803a3b0e-d667-11ee-9cc8-6f727c8cca4b.html

Tags: budget, Health, ideology, mental Health

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