Patient X comes in with Issue Y, and requires a referral to a specialist. But who to refer to?
I think most Canadian patients would be surprised to learn that there are no standardized databases/lists/processes for accessing specialists in a most regions. Our referral patterns are essentially dependent on a combination of specialists we know personally, specialists who have seen our other patients, or specialists we have heard of through word of mouth. I have been working in my community for a decade, and I still come across specialist names that have been apparently working in our community for many years, and I wasn’t aware of them. It’s an insanely inefficient process, and has a negative impact on patient care as their care is entirely dependent on how familiar their physician is with local human resources. I know that there are exceptions to this, as some local specialty groups do provide physician listings, but these are very infrequent, and often only include hospital-based physicians.
Simple solution here in Ontario? Create a program that mandates that any billing specialist (including FP focused practice physicians) must register with the LHIN or LHINs in which they see their patients (MDs who see patients via telemedicine or EConsult can be a distinct list). Regardless of whether they are accepting referrals or not, they should at the very least be part of a directory that is easily accessible to referring physicians. Referring physicians will quickly adapt if the specialist is not accepting referrals, or wait times are long, etc. It would be the responsibility of the physician to ensure that their status and contact information with the LHIN is up to date, as part of the terms in maintaining their billing number. Some of this information is obviously already collected by the CPSO, which should cut down on the work required by the LHIN.
I’m not asking for wait time data from specialists, as I know that will open a controversial and complicated puzzle that will not be easily negotiated. Along the same lines, I don’t think we should create a list of common referral problems that each physician will see, as I think this will be a potentially impossibly complex task to undertake.
But at the very least, we need to know who works in our community. No more hiding in the shadows. Referring physicians are struggling to access timely specialist care for our patients, and one of the first steps to fixing this includes adding some transparency to this process.