Efforts to address Ontario's crisis in primary care have borne fruit but represent only initial steps, according to the Ontario Medical Association (OMA).
The association states that physician burnout, driven by a large administrative burden, is at record levels. Four out of 10 doctors are considering retiring in the next five years.
"There are 2.2 million people in Ontario who don't have a family doctor: an increase of 425,000 Ontarians in 2 years," Andrew Park, MD, OMA president and emergency physician at London Health Sciences Centre in Ontario, told Medscape Medical News. "Everyone, no matter where they live, should have access to team-based primary care led by a physician," he added.
In October 2021, the OMA released its Prescription for Ontario: Doctors' 5-Point Plan for Better Health Care, which recommendeds 87 measures for improving the province's healthcare system.
The priorities highlighted in the Prescription included reducing wait times and the backlog of services, expanding access to mental health and addiction services in the community, improving home care and other community care, strengthening public health and pandemic preparedness, and giving every patient a team of healthcare professionals who are digitally linked.
As outlined in the OMA's newly released Prescription Progress Report 2023, doctors' expertise in finding solutions to fix the healthcare system is being recognized, and the Prescription has contributed to the following improvements:
Wait times are being reduced by moving less complex procedures to community clinics.
Palliative care is being expanded to free more hospice beds.
Patients will have more access to doctors through a practice-ready assessment program for doctors trained overseas.
Ontarians with mental health and addiction conditions will have more support.
"The government is listening to us and has moved on 51 of our recommendations, but there's clearly a lot more work to be done," said Park. "This progress report is focused on the three areas that we think can have the biggest impact on improving the healthcare system overall. These are ensuring that every Ontarian has a family doctor, allowing doctors to be doctors by reducing the administrative burden, and improving community and hospital care."
Bolstering community care means alleviating the burden of the province's acute care hospitals, Park added. Some patients with complex conditions do not need acute care in a hospital and could remain at home with support such as palliative care, personal support workers, physiotherapy, or a dietitian.
"It's really about decentralizing care out of these extraordinarily expensive hospitals," said Park. "Hospitals are very important, of course, but we want to use them at their fullest capacity for what they are really designed for, and that is not to give all care to every person, especially when that care can be provided on an outpatient basis."
Patients and Paperwork
Many factors are contributing to the shortage of family doctors. "People aren't going into the profession of family medicine, because they see it as not being palatable anymore," said Park. "That is understandable, given the environment in which family medicine and family doctors work. A huge deterrent is the crushing amount of paperwork family doctors must do."
In a recent survey by the Ontario College of Family Physicians (OCFP), family physicians reported spending 19.1 hours per week on administrative tasks.
"A lot of times, doctors are doing these tasks at night or at their kid's soccer games, after they put the kids to bed, on weekends. That's all going to translate into less patient care. Some administrative tasks are necessary, and we acknowledge that, but 19 hours is not at all necessary and it's not all relevant to patient care," said Park.
The administrative burden faced by family physicians has gotten heavier over the years, Mekalai Kumanan, MD, chief of family and community medicine at Cambridge Memorial Hospital in Cambridge, Ontario, and president of the OCFP, told Medscape.
"These administrative duties takes up 40% of our working time. That is absolutely astonishing," Kumanan said.
The OCFP is calling for urgent red tape reductions and administrative support to ensure that family doctors have more time to spend with their patients.
"We spend a significant amount of time sending referral forms for each specialist, faxing referrals, writing sick notes, and filling out lengthy insurance forms. Developing a centralized referral system that would help to connect our patients to the right person would take a very time-consuming workload off of the family physician," said Kumanan.
The OCFP also is asking for financial support that would allow family doctors to hire administrative staff. "That would be extremely helpful," said Kumanan. "I see it as a need to streamline the process. Of course, there is always going to be some administrative work, but adopting such measures would free us up to see patients, which is what we trained to do.
"We truly are facing a crisis in Ontario," Kumanan continued, referring to the widespread lack of primary care physicians. "We are seeing a very concerning trend and we know that to increase capacity across the system, we really do need to address the administrative burden that family physicians face."
Park and Kumanan report no relevant financial relationships.
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Cite this: Primary Care in Crisis, Burnout Rampant in Ontario, Says OMA - Medscape - Jun 06, 2023.