Addressing the primary care crisis

In this episode, Dr. David Barber, chair of the OMA’s Section on General and Family Practice and assistant professor at Queen’s University’s department of family medicine, discusses the challenges facing the primary health system in Ontario, along with some possible solutions. He speaks about how family doctors are facing growing administrative burdens and increasing care requirements for patients. That has led to physician burnout and a large number of unattached patients. He explains that taking some of those burdens off the plates of family doctors would allow doctors to focus on treating patients and make becoming and staying a family doctor more appealing.

Transcript

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Georgia Balogiannis:

In this podcast, the Ontario Medical Association looks at current issues of interest in healthcare. Spotlight on Health gives you all the straight talk. We're Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

Physician burnout and lack of access to home and community-based care is at a critical stage in Ontario. In this episode, Dr. David Barber discusses the challenges and some solutions to the primary care crisis. Dr. Barber is chair of the Ontario Medical Association's Section on General and Family Practise and an assistant professor at Queens University's Department of Family Medicine.

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Dr. David Barber: Right now in Ontario we have 2.2 million patients without access to a family doctor, and the repercussions of that are immense. We are in a system where the family doctor is the gatekeeper to other services, and so if there are no gatekeepers then there's no access to the system. As an example, right now in Kingston we had five doctors retire, and so there are 8,000 patients who are all of a sudden left without a family doctor. Because the models of care haven't changed, then family doctors are able to look after fewer patients, and there's also the added burden. 

There's more and more paperwork, there's more information flowing across our desks. It just really impacts our ability to care for the patients. If we could take some of that stuff off of our plates through the use of other health professionals, then we could take on more patients and solve the issue of unattached patients in Ontario — physician assistants, nurse practitioners, but also pharmacists, physiotherapists, dietitians, that can help manage the patients. 

We just need more resources so that we can take on these patients who don't have a family doctor. That's absolutely critical. We can't just all of a sudden magically produce 2000 family doctors, which is what it would take to look after 2.2 million patients and getting worse.

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Dr. Barber: I would say that, on average, the amount of time it takes to look after a single patient has just increased over time. I have a patient who waited two years to see a rheumatologist for some aches and pains. I thought something serious was going on and it was two years. And so for those two years, I'm looking after that patient trying to do what I can do. The mental health burden is extraordinary, and when things get backed up in the system, that falls onto the family doctor's plates. The mental health care, I mean, that's a crisis as well, and despite some more resources that have been put in them we're not near what is needed. 

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Dr. Barber: There's just more of an administrative burden. Family doctors, they need to be taking care of paperwork and lab work and test results that come in, and there isn't the help to take that off of their plates. So we're seeing that burden increase all the time, and so right now the estimate is 20 hours per week. I think when you take the joy out of it, that contributes to burnout. The inability to provide your patients with top level care, family doctors just become less and less happy and they look at other options. People are like, ‘I'm not enjoying this. I can't really help my patients. It's really stressful. I need to look at doing something else.’ 

My own family doctor, he wakes up at four in the morning to start doing paperwork. It's not a good time to be practising family medicine, and we're just seeing the results of that. Probably, I would say that the biggest sort of metric of how we're doing is by looking at the number of medical students that want to practise family medicine. That is dropping. It's at the lowest it's been in decades. What needs to happen is just to take away, somehow, that paperwork, the admin burden, a lot of the bureaucracy. L et family doctors be family doctors and see patients. 

That's what we love doing. That's why we went into this, was to look after patients — because it should be one of the most attractive jobs in the world, in my opinion. So it really is about resources. We need more resources. We need more people around us. There has to be more investment in the system altogether to help remove some of those backlogs and get our patients in to see the specialists so that they can be properly managed and cared for.

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Dr. Barber: We need to look at the options like a single electronic health record for every single patient. So whether you go to the hospital or to the emerge or to see a dietitian or a pharmacist or podiatrist — everybody, all the information is being put into a single record. In the meantime, we need to improve the communication between the systems. The system is really gummed up, and so we have a lot of patients that are in hospitals waiting for a placement to a long-term care home, and that delays surgery. There just aren't open beds in the hospitals and it delays all sorts of care. 

Again, it's not going to be a single solution. I think we do need more long-term care homes, and one of the simpler answers is really to provide care in the community, in the patient's own home. If we can organise that and get nursing care and other types of care into a patient's homes. It's just so expensive to have people in hospitals, it's so expensive to have people in long-term care homes. It can be done a lot more effectively and more comfortably for the patients if the care can be provided in their homes. I mean, that's not always the case, but there's a lot of opportunity for efficiencies and for better patient care there.

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Dr. Barber: How do we encourage doctors to be, practise in the North and stay in the North? I think training where you're training family doctors who are from the North. And the studies show that that actually works in keeping them practising up in the North. The reality is, I mean, practising family medicine in the North is really, really stressful. I mean, I think people forget that really, those communities — the community, the hospitals, the emergency room, obstetrics — everything is run by family doctors. 

So in the North oftentimes it's remote. It is hard to get locums to come in, and so how do you take holidays? How do you take that needed break? And so we need to look at different ways of incentivizing. 

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Dr. Barber: So am I optimistic despite the current problems? Yes. I think the government is open to the idea of more different types of models of providing family medicine to patients. There's a solution that's right in front of us that it’s going to take a bit of work, a bit of time and negotiations, but I don't see why we can't get there. 

I do get the sense there's an appetite. I know that people are really hurting. I get people knocking on my door at my home, neighbours looking for a family doctor, asking me to be their family doctor. It's a real, real problem. So yeah, we need to fix this. But, so, I am hopeful, but we'll get there.

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Georgia Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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