B.C. vs. Ontario: Why one province's FPs are much happier

I recently read a blog by Dr. Steve Shore, a British Columbian family doctor. We’re both 74-year-old family doctors, but I’ve been far luckier. So let’s compare how and why. For the past 13 years, I ‘ve had access to a very family doctor friendly system in Ontario. It was created by a small-town family physician, Dr. Ruth Wilson in North Bay, population 20,000, 340 kms north of Toronto. It’s called the capitation family health team system. Half the family doctors in Ontario are in it. It works like this: You’re paid a set fee for each patient in your roster every month. You’re paid more for older patients. It costs the same for the government as fee-for-service. Unlike the U.K. national health care system, it doesn’t force you to take any number of patients you don't want to. Read: I'm fed up, and I can't take it anymore! The pay is the same as fee-for-service and the work is less because you only do MD work. You work smarter not harder. In his article, Dr. Shore states he can only get a few days off at a time. I get eight weeks paid vacation and study leave. He is fee-for-service. If he doesn't see the patient, he doesn't get paid. Many small patient problems don't need to be seen by a doctor in person or virtually and can be handled by staff under a doctor's supervision. Dr. Shore also says can’t afford a locum. My practice is covered by a fellow family physician when I am away, ill or on study leave and I reciprocate. We only see three extra patients a day for each other. Emergencies go to the ER, and routine visits like physicals, stable blood pressure, routine prenatal care etc. can wait for the patient's own family doctor. Read: 89-year-old surgical assistant cries foul He says the British Columbia College of Physicians and Surgeons demands around-the-clock coverage for out-of-town patients. Mine doesn’t. My out-of-town patients can go to a local walk-in clinic or ER if an emergency or they can call my office for help. I have patients thousands of kilometres away. Dr. Shore says that specialists dump work back on him. That only happened to me once and I switched specialists. He writes that specialists get him to arrange other appointments for patients. In Ontario, our college of physicians and surgeons made it clear this was the specialist’s responsibility. This is a non-MD task and can be delegated to administrative staff. Dr. Shore says he has to redo the same work over again for no pay if patients want a second opinion from a specialist. I’m lucky because I have an EMR (Telus) that lets me do this with a couple of keystrokes, taking a few seconds. It was invented by a family doctor (my neighbour and friend Dr. Jim Kavanagh) so is very user friendly for me as a GP. Read: We need to teach freshly minted physicians how to pace themselves It also takes Dr. Shore a lot of work to produce charts for patients if they’re transferring to another family doctor. It takes my secretary one second to print the chart or download it onto a thumb drive. Storage is free in the computer and when I retire there are three companies who will store my electronic charts for free. Google medical records storage for your area. I am 99% paperless. Dr. Shore also is driven nuts filling out social services forms. We are paid $100 by the Ontario government to do this. Insurance companies in BC want forms filled out for free. I charge $300 per hour. Most pay and if they don’t I get 50% back as a tax write off for a bad debt. The BCMA should be supporting Dr. Shore in this area. The OMA has a paperwork committee. I agree with Dr. Shore that specialists are taking longer to access. I don’t take ownership of this. I never say I’m sorry unless it’s my fault. I tell the patient to complain to the premier of the province who has control over this, not me. Read: How to best care for super seniors: A portrait of a favourite patient group I also agree with Dr. Shore that the Canadian College of Family Practice is making a big mistake adding an extra year onto the residency program, which is currently two years long. In Cambridge, Ont., we have four family doctors currently taking new patients because we are all on capitation. Google our website at Doctors 4 Cambridge. The more patients you take, the more money you make (to a maximum of 2,000). When we were fee-for-service, we had 30,000 orphan patients. We family doctors love the system so much that few become hospitalists, walk-in doctors, locums or 'boutique' doctors. No one I know has gone back to fee-for-service. It doesn’t work because of older and sicker patients. It also doesn't work with Googling, worried, healthy younger patients. So, Dr. Shore, please move to Ontario. We don't have an ocean, but our Great Lakes are huge and wonderful. We don't have big mountains, but our skiing is still good. We would love to have you and any other B.C. or any global doctors. We have a beautiful province, with wonderful people even though we haven't seen a Stanley Cup since I was 22. This is a system problem not a people problem and the system can be fixed. It was invented by humans and can be changed by humans. What do you dear reader think? Can Dr. Shore and his fellow Canadian family doctors be saved? We need to share ideas with each other. Every province and territory is doing wonderful and innovative things to deliver better patient care and help doctors avoid burnout. Read: How to avoid college complaints

B.C. vs. Ontario: Why one province's FPs are much happier

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