Do it now: OMA calls for more foreign-trained docs, hospice beds and creation of central ambulatory centres

Ontario should license more foreign-trained physicians, move quickly to create integrated ambulatory centres for less complicated outpatient procedures, and add more hospice beds and palliative care services, the Ontario Medical Association stated at a September 15 press conference. “Ontario’s healthcare system is under immense strain as we continue to cope with the COVID-19 pandemic,” said Dr. Rose Zacharias, president of the OMA. “Record numbers of patients sought care in emergency departments this summer, some of our emergency departments had to close on nights and weekends due to staffing issues while the backlog of medical services and surgeries continues to grow. We know we have too many Ontarians without a family doctor.” To address these problems, the OMA wants the province to move immediately on three solutions. The proposed solutions—which were presented at the conference by by Dr. Zacharias and three other Ontario doctors—have been discussed before. But now the OMA is pushing for immediate action. Read: Struggles facing family doctors are real 1. License more foreign-trained physicians through increased residency spots and a government practice-ready assessment program. “We need to look to outside jurisdictions,” said Dr. Joy Hataley, a family physician, anesthetist and District 7 chair at the OMA. “It’s the fastest route to filling the niche and then we don’t compete with (other Canadian jurisdictions).” In seeking to attract more doctors from outside Canada, it’s important for Ontario to be socially responsible and sensitive to the needs of other countries, she added. This might mean looking at countries with an abundance of physicians, or at physicians that have already chosen to come to Canada. Dr. Jim Wright, a pediatric orthopedic surgeon and OMA executive vice president, said there are many internationally-education physicians already living in Canada as landed immigrants but aren’t licensed to practise here. “Many of those physicians, if not all of them, will likely spend the early part of their career in underserviced areas,” he said. “So this return-of-service obligation comes with an ability to work in Canada.” Read: Vitals: Countries with the most foreign-trained doctors 2. Create integrated ambulatory centres for less complicated outpatient surgeries and procedures, backed by a centralized referral system that would ensure demand is distributed among all available doctors in the province. Based on the experiences of other jurisdictions in Canada and in other countries, integrated ambulatory centres can yield 25% improvements in efficiency, said Dr. Wright. “That means for the same amount of money you can do 25% more, or for the same amount of procedure you can do it 25% cheaper,” he said. “We lag many other jurisdictions—including other provinces—in implementing this mode of delivery.” To be effective, these proposed centres would require partnerships with regional planning and Ontario health teams to make sure “patients receive the right care at the right time,” said Dr. Wright. They also need to have a funding mechanism that prevents “low acuity, high remuneration cases going to these centres and disadvantaging healthcare institutions” such as hospitals. Read: A deep dive into the OMA's proposed plan to embrace ambulatory surgery centres in Ontario 3. Create more hospice beds and palliative care services to improve the patient experience, support caregivers and ease the pressure on emergency departments. Dr. Sandy Buchman, a palliative medicine physician, said palliative care can be delivered “very effectively in a community setting, leading to reduced pressure on acute care hospitals. He estimated that 70% can be delivered within a primary care setting, with palliative specialists backing up primary healthcare teams. He also referred to a 2014 report by the province’s Auditor General that pegged the cost of hospital-delivered palliative care at $1,100 per day per patient, compared to $450 within a hospice. Read: Will Ontario’s ‘stay open’ plan mean charges for hospitalized patients who refuse the first LTC bed offered? Shae Greenfield, a spokesperson for the College of Physicians and Surgeons of Ontario, said the college had recently included practice-ready assessments in a proposal to Ontario Health Minister Sylvia Jones. "With government funding and coordination among key system partners, a program could be implemented immediately and begin injecting a new supply of IEPs (internationally educated physicians) into the system as early as spring 2023 and onwards," the CPSO wrote in its recent submission to the ministry. Dr. Alan Drummond, a family doctor and emergency department physician in Perth, Ont., said he doesn't see how boosting the number of residency spots for foreign-trained doctors can fix today's problems. "Tell me how increasing licensing of foreign-trained physicians is going to help our current situation if the focus is on residency as opposed to immediate practising?" he asked. "It has no value, not for today." At the OMA conference, doctors also discussed the concept of a central referral system that would connect patients to the services they need, regardless of their location. When asked if this meant patients could be forced to travel away from home to get care such as surgery, Dr. Wright said the system would be designed so that patients have the option to either travel if they don't want to wait for the service, wait longer to see someone close to home, or even wait to see the doctor they prefer. But Dr. Drummond said this could lead to even more discontinuity in treatment. While some patients may be willing to venture far from home to get surgery, should complications arise after they return home, getting follow-up care from a local provider could be a problem, he said. "Do not be going to your local surgeon because they'll send you back to the surgeon who performed the procedure," he said. "A surgeon is not a surgeon is not a surgeon—there's something to be said about relationships between the doctor and patient." Read: A nurse can't be everywhere': Healthcare staff shortages prompt Ontario ER closures

Do it now: OMA calls for more foreign-trained docs, hospice beds and creation of central ambulatory centres

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