Opinion: What you need to know about family medicine and why you could lose care

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

I’m a family doctor down the road from you. I take care of 1400 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.

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, I’d do home visits to 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 newborns into their lives. I work 50-60 hrs/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 COVID-19 pandemic began, I’ve been working 8 a.m. to 8 p.m., phoning patients at home, trying to address all their primary care needs, and also triaging and managing symptoms of COVID-19, supporting patients through their isolation. I ration limited PPE to assess infants, give immunizations, and other essential treatments. Patients wait in cars while we screen them. When they leave, I disinfect every surface.

My colleagues and I who work 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 patients ask for prescription renewals by fax, to 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 dropped substantially. Why? 1) PPE shortage. 2) Bringing patients into the office is very slow now. 3) Many revenue-generating procedures had to be cancelled. 4) Telephone/video is frustrating when people don’t answer!

Why are we stuck in FFS? Some colleagues are work 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/rural areas. As a new graduate at the time, there was no option for me to form 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 docs care for approx 335,000 patients. Those patients will be left without care if we close our clinics to move out to suburbs/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’m worried.

This is our petition, to allow family doctors in the city to form FHOs (the easiest way to ensure we don’t close our clinics). Almost 5000 people have signed it. The challenge is getting the Ontario Ministry of Health to consider cities as important as suburbs.

This was our discussion with two MPPs, if you’re interested in learning more: