As physicians descend on Toronto this week for Family Medicine Forum, these past few months have been demoralizing for family physicians in Ontario.
Unilateral cuts from the Liberal government in January. Unilateral cuts again in October. Sweeping primary care reform being implemented without the involvement of physician leadership. Daily slanderous claims from the government about being overpaid. An active lawsuit against the government. An editorial from the CEO of the Registered Nurses’ Association of Ontario (RNAO) parroting the government’s rhetoric against physicians, in an attempt to argue for higher nurse practitioner salaries. A report today from Health Quality Ontario painting a picture of family physicians providing poor access to patients. And the latest from this week, Health Minister Eric Hoskins has sent an official referral to the Health Professions Regulatory Advisory Council (HPRAC) confirming the government’s intent to allow RN prescribing, and seeking consultation of which model to move forward with.
So to summarize, Ontario family physicians are working for a government that won’t negotiate with us, won’t tell us what they are planning, with seemingly indefinite cuts, with nurse practitioners already demanding a greater piece of the clinical pie, with RNs assuming another portion of our role, and a government that is very friendly to nursing groups.
Feeling alone yet?
We all know that everything taking place around us is absurd. We know that all of the proposed changes will only add red tape and bureaucracy to our health care system, and make an already overly politicized system even more politicized. We know that family physicians are best positioned to lead the primary care system. We understand health policy, we understand what our patients need, and we are always willing to make the sacrifices necessary to make our system more sustainable. But we’re being elbowed out of the picture.
I’m not sure how government spawned the idea that family physicians are an expendable resource. They seem all too keen to parse out all of our skills and responsibilities to other health professionals, leaving us with an unknown role in the future. Unfortunately, physicians have unknowingly been complicit in this transformation, showing a naïve keenness to delegate as many tasks as possible.
But it’s time to re-establish our brand. Time to re-establish the role of the comprehensive family physician: a cost-effective, efficient, skilled, and irreplaceable resource in our health care system. No one can match our abilities. It’s time to start showing that again.
This starts with our relationships with our patients. They need to see us as an integral part of their lives. They need to see our offices like the bar from Cheers. Everyone knows their name, and they feel welcome. Find unique ways to engage them. Provide them superb access. If you are one of the physicians in Ontario who can’t provide a visit within 1-2 days, or who isn’t responding to your patients’ same-day phone calls, I have bad news for you. Your patients see you as very replaceable. Be present in the office. We all need to take necessary breaks from our clinical work, but remember that the more time your office is closed, the more patients begin to find ways of managing without you. And if your patients don’t value you, the government will value you even less.
Broaden your skills. The more talents you can bring to the table, the more value you will have as a family physician in our changing system. Procedural skills, comfort with complex cases, pharmacotherapy management, palliative care, house calls…look at your practice now, and decide how you can comfortably become more comprehensive.
If you aren’t forced to delegate a task, either because of logistics or time constraints, then don’t. Do the little things in your practice that patients still see value in. You can’t afford to be the office manager sitting in the background, while other health professionals get the most face time with patients. You need to foster those relationships, so look for small opportunities with even simple tasks. Give the immunization. Do the pap. Syringe that ear. It may be a financially losing strategy in the short-term, but the goal has to be your long-term connection with your patients, and their sense of value for family physicians.
I don’t know what family medicine will look like in Ontario for the rest of my career. I’d be lying if I said this situation doesn’t frighten me. But the only thing truly in my power is to provide my patients with the best quality care, and to continue to foster relationships with my patients. Even if the government is too short-sighted to appreciate our value, I know that our patients have far more sense, and will advocate for care that they appreciate and can’t live without. It may take years to re-establish the brand of family medicine, but we can’t afford to take our position for granted any longer.