Why you could lose your local family medicine clinic

Dr. Nili Kaplan-Myrth warns of the dangers of the current fee-for-service model of compensation for doctors, which, together with the pandemic crisis, could result in the closing of local family medicine clinics.  
Photo: Tia Photography

By Nili Kaplan-Myrth

“I had no idea,” patients say, when they’ve heard my medical colleagues and me talking about the risk of clinic closures on the radio or read our articles in the papers.

I’m a family doctor in the Glebe. I take care of 1,400 patients, many of whom live in this community. If I’m not your doctor, then one of the 25 family doctors in our group in central Ottawa probably takes care of you, your kids, your parents, your colleagues, your neighbours. You also rely on medical specialists in Ottawa whose clinics may close. If we all close our offices, it will be a crisis for the 12,000 who live in the Glebe.

Here’s a snapshot of family medicine before the pandemic. I’d start at 9 a.m. with my pediatric patients, then I’d see the rest of my patients (infections, injuries, chronic illnesses, addictions, women’s health issues, geriatrics, mental health concerns). I’d end my clinic day, then do home visits with my palliative patients. All of that is integral to family medicine. I’ve sat in people’s living rooms with them as they grieved the death of a family member and stood at their side to welcome babies. I work 50 to 60 hours a week. My commitment to my patients is to maintain a long-term relationship with them, give them a “safe” space, advocate for them.

Since the pandemic began, I’ve been working 8 a.m. to 8 p.m. I phone patients at home to try to address their primary care needs. I also triage and manage symptoms of COVID-19, supporting patients through their isolation. I ration limited PPE (personal protective equipment) to assess infants, give immunizations and do other essential treatments. Patients wait in cars while we screen them. When they leave, I disinfect every surface.

My colleagues and I in central Ottawa are stuck in a fee-for-service (FFS) model of care. Most of us don’t want to be FFS. It’s a model that prioritizes quantity over quality; we have to see enough patients in a day to pay our bills. If patients don’t show up, we don’t get paid. If we get sick or miss work for education, we’re not paid. When we give patients prescription renewals by fax or fill in forms, we’re not paid.

We bill OHIP codes for each visit. When COVID-19 began, new OHIP codes were introduced for caring for patients by phone and video. But even with “virtual care,” our patient volume has dropped substantially. Why? Four reasons: The shortage of PPE; bringing patients into the office is very slow now; many revenue-generating procedures had to be cancelled; and telephone/video communication is frustrated when people don’t answer.

Why are we stuck in FFS? Some colleagues are working in a better model, Family Health Organizations (FHOs). They receive “capitation” payments each month: they are paid by the number of patients registered with them, not by the number of people they see in a day. FHOs provide income stability. In 2015, the Ontario Ministry of Health decided that doctors could only form new FHOs in suburban and rural areas. As a new graduate at the time, there was no option for me to set up a FHO, and all the spots in FHOs in Ottawa were taken.

Why doesn’t the ministry consider Ottawa’s urban populations “in need” of services? Who knows? Thousands of people in our cities don’t have a doctor. In Ottawa, FFS family doctors care for approximately 335,000 patients. Those patients will be left without care if we close our clinics to move out to suburbs or rural areas.

Patients keep asking how I’m doing. I don’t want to freak them out, so I say, “Don’t worry.” But I am worried.

Now you know. What can you do? Write to the Ontario minister of health, Christine Elliott. Write to our MPP, Joel Harden. Write to Capital Ward councillor, Shawn Menard. Make it clear that it would be serious if you lost your family doctor.

Our petition at Change.org to allow family doctors in the city to form FHOs is the easiest way to ensure we don’t close our clinics. Almost 5,000 people have signed it. The challenge is getting the Ontario Ministry of Health to consider cities as important as suburbs. http://chng.it/gH45G7RdM4

Central Ottawa will certainly be “high needs” if 235,000 people find themselves without care. Let’s address this before it is a crisis.

Dr Nili Kaplan-Myrth, MD, CCFP, PhD, is a neighbourhood family doctor.

“If we all close our offices, it will be a crisis for the 12,000 who live in the Glebe.”

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