Scribes, centralized referrals and more hospices: Canada’s largest doctors' group sends its wish list to the feds

There’s a lot that needs fixing in what’s lately described as Canada’s broken health system. The country’s largest physicians’ group has three key solutions it wants included in the federal government’s 2023-24 budget. “Our system is in dire need of immediate solutions,” Dr. Rose Zacharias, president of the Ontario Medical Association, said during a Feb. 15 media briefing on the association’s pre-budget submission to the federal government, which had recently announced an investment of $196.1 billion over 10 years—including $46.2 billion in new funding—for healthcare. “Too many Ontarians don’t have a family doctor, so they have trouble accessing the rest of the healthcare system.” Of the nine proposed solutions outlined in its pre-budget submission, the OMA highlighted three it said should be addressed immediately: Reduction of physicians’ administrative burden, the creation of a central referral system and wait-list registry for certain surgeries and procedures, and the addition of more hospice beds and palliative care services in the community. Tackling doctors’ administrative workload is just as important as finding more doctors, said Dr. Zacharias. Lightening the burden of EMRs, charting and forms will help Canada keep its physicians from leaving the country or the profession. Dr. Chandi Chandrasena, chief medical officer at OntarioMD—an OMA-owned subsidiary focused on digital health tools—said introducing more electronic forms can go a long way towards reducing doctors’ administrative work. Read: Ontario willing to accept accountability if healthcare funding increased: Ford Another viable solution is providing medical scribes for doctors— with the integration of artificial intelligence-powered medical scribes an exciting potential prospect for the future. “Medical scribes have been found to improve efficiency,” said Dr. Chandrasena. “Imagine a Siri or Alexa who’s writing the notes while you talk to your patient.” Dr. James Wright, executive vice president, economics, policy and research at the OMA, said having a centralized system for referrals will create greater efficiencies for doctors and, more importantly, improve the patient experience. Too often, family doctors send referrals to specialists only to get a letter back saying the specialist is too busy at the moment. “The centralized system could, instead, take that referral and it will be their job to find the specialist,” explained Dr. Wright. “Family doctors don’t always know who has the shortest wait list, but the referral centre would have access to that information.” Read: All work, no pay: Some Ontario locums frustrated with how long province is taking to pay up The referral centre would, ideally, also be able to triage cases. For example, it may determine that a patient is better off seeing a physiatrist first, instead of a low back pain specialist. “We believe (a referral centre) would substantially improve access for patients and reduce some of the frustration for physicians,” said Dr. Wright. Increasing the number of hospices and community-based palliative care services should also be a top priority in the 2023-24 budget, said Dr. Brian Berger, a palliative care physician leader at Mackenzie Health in Richmond Hill, Ont. “Hospices are great, but there are only around 500 beds in the province,” he said. “Hospices are often forced to turn away patients when their prognosis is too short, so they end up stuck in acute care beds.” This in turn, creates a bottleneck of acute-care patients who can’t get a bed and, consequently, take up room in emergency departments. Read: No evidence enrolled patients subbed ER for virtual family doctor visits: OMA study “About 50% to 60% of hospital patients in their last year of life are occupying acute care beds, even though their acute care needs have already been met,” said Dr. Bergen. “That’s a lot of palliative care patients in acute care beds.” Unlike hospitals, which are largely government-funded, hospices only get about 50% of their costs covered with public money. “So they have to raise money from the community,” said Dr. Bergen. “Some hospices have had to close because they’re in communities that don’t have a lot of money.” The OMA’s full pre-budget submission can be viewed here. Read: 'Disappointed': Physician associations call on gov'ts to step up with more money, more teamwork

Scribes, centralized referrals and more hospices: Canada’s largest doctors' group sends its wish list to the feds

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