Study of family doctors choosing ‘other’ work leaves me with mixed feelings

Last week, a study published in the Annals of Family Medicine revealed what those of us in medicine knew all along. More and more, physicians who are trained in comprehensive family medicine are choosing to do other things.There are a myriad of reasons for this ranging from poor remuneration, lack of respect from government, incredible admin burden and more. But the blunt reality, which is very bad for the people of Ontario, is that despite having enough family doctors, not enough of them are practicing comprehensive care family medicine and more are expected to stop.There was of course, a large amount of press interest in the study, and rightfully so. Probably the best interview given by one of the study’s authors was by my friend Dr. Kamila Premji (who is brilliant) and can be listened to here.I was fortunate enough to be asked about this issue last week on “Toronto Today” with host Greg Brady. As I explained to him, I personally am left with decidedly mixed feelings about the report.The hopeIt’s not like people haven’t been talking about this for a long time. Heck, I wrote about how Ontario does NOT have a shortage of family doctors, just over a year ago. I pointed out that family doctors were leaving to do other things then.But now that there is a comprehensive study done on the matter, maybe, just maybe, the bureaucrats at Ontario Health will finally do something positive about the matter. (I won’t bet the mortgage on it, but there is a teensy little bit of hope).The frustrationIt’s precisely because people have been talking about this for such a long time that I was also frustrated that this issue hasn’t been dealt with yet. Dr. Premji herself warned about this issue years ago. My friend Dr. Mathew (another doctor much smarter than me) pointed out how the system has been deteriorating since 2012. Dr. Nadia Alam, a former president of the Ontario Medical Association (also a dear friend much smarter than me) wrote in 2018 about the fact a crisis was coming in Family Medicine. And yes, a certain grumpy, miserable and cantankerous old bugger wrote back in 2017 about the need to support family medicine and warned that the shortage of comprehensive care family physicians was going to get worse if nothing was done.All of these doctors were ignored. When Dr. Alam wrote her blog, “only” 800,000 people in Ontario didn’t have a family doctor. Today, we are at more than 2.5 million.Thinking about how much better off we would be if the bureaucrats at Ontario Health hadn’t unilaterally ignored these doctors makes my blood boil.The fearThis brings me to my biggest fear in all this. When I look around at some of the Ontario Health staff and see some of the reports, decisions and directions given by various committees, panels and departments of Ontario Health, I see a lot of the same old names and faces.The same bureaucrats that ignored Dr. Alam and others for over a decade, and have made bad decisions and recommendations ever since, are still in charge. Many have been promoted. All of them are going to retire with full pensions. And yet now, they will likely be tasked to find a solution to the very mess that they failed to foresee and, in many cases, aided and abetted in creating.To expect the same people who consistently and repeatedly made wrong decisions over the past ten years to suddenly not make a mistake with the next set of decisions is surely the definition of insanity.What’s next for family medicine in Ontario?As I think most of us know, Dr. Jane Philpott has been tasked by Ontario Premier Doug Ford to lead the new Primary Care Task Force. Her stated goal is to ensure every resident of Ontario has primary care within the next five years. She has a strong relationship with Dr. Tara Kiran, one of the more visible authors of the study on family doctors. Both seem to be working closely together.Both of them seem genuinely passionate in their support of family medicine. They also understand the foundational importance of family medicine in a strong health care system. I believe they both have the desire to fix this crisis as soon as possible. We should all want them to succeed, because success means a healthier population for all Ontarians.But . . .To date, I haven’t seen in either of them the necessary willingness/ability/chutzpah/brass to tell off our woefully incompetent bureaucrats at the Ontario Health and tell them which direction we need to go in. As I mentioned above, we just cannot rely on the advice the bureaucrats are giving anymore, nor the processes they have put into place.For example, it’s been known for more than 15 years now that our healthcare IT systems are completely disorganized and don’t talk to each other. The situation is so bad that healthcare is the ONLY major industry in which fax machines are still used. It’s so wasteful that it’s been estimated that we could save $2.1 billion dollars a year if we unified our health IT systems. (Which ironically is about how much Dr. Philpott has been given to fix the family medicine crisis).Recently, Ontario Health announced that it would develop an electronic referral system to get rid of faxes. Sounds great. But unfortunately, a deep dive of their plan suggests that each of Ontario’s more than 180 health teams will have to pick their own software. This means you could have a situation for someone like me, who has patients from two different areas, being forced to use two different electronic referrals systems. This will do absolutely nothing to reduce my admin burden, the same admin burden that the study’s authors admit is driving physicians away from comprehensive family practice.The family medicine crisis desperately needs to be fixed in Ontario. It will take a combination of a seamless electronic record system, processes in place to reduce paperwork, increased pay for family doctors (including pay for admin work and retention bonuses) and, yes, teams where the family doctors guiding them. But I don’t think any of that can happen until we clean out the bureaucrats at Ontario Health.Dr. Sohail Gandhi is a former president of the OMA and opinions are his and not necessarily the opinions of the OMA Board. This article is a reprint from his blog site: justanoldcountrydoctor.com.

Study of family doctors choosing ‘other’ work leaves me with mixed feelings

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