Rekindling Reform-Health Council of Canada Report
I would think that the report from Canada's Health Council released today has no hidden surprises for most of the readers of this blog.
The first paragraph of the media release:
"Despite the nationwide commitment to build real and lasting change and the infusion of billions of dollars brought about by the 2003 Accord on Health Care Renewal, progress falls short of what could, and should, have been achieved by this time, says the Health Council of Canada's latest report to Canadians, Rekindling Reform: Health Care Renewal in Canada, 2003-2008."
Jeanne Besner, Chair of the Health Council of Canada says, "As we reflect on the speed and direction of health care renewal, we find the glass is at best half full."
This is a curious statement amidst the cheerleading that goes on in health care transformation these days. With so much political need for short term wins it is rare to hear such honesty. Many of us working within the system understand the predicament but unfortunately much of the public is led to believe that the current transformation is going to solve most of our problems...and there are even some, both public and political, who still deny there are problems.
We can't fix the problems if they cannot be identified or spoken about.
Change has occurred in some areas as identified by the report:
1. Major purchases of medical equipment and information technology have boosted the number of services delivered.
2. Some jurisdictions have improved the way waiting lists are managed and provide wait time information.
3. Most Canadians have better access to health information and advice through telephone help lines.
4. Some Canadians have better access to publicly insured prescription drugs and to primary helath care teams.
In other respects progress so far is not cause for celebration:
1. Catastrophic drug coverage and safe prescribing lags.
2. Home care is inadequate.
3. Aboriginal health has not improved significantly.
4. Primary Interprofessional team access is uneven, not comprehensive or available when patients need it.
5. Electronic health records and IT are not on track to meet the goal of having 50% of Canadians with and EHR by 2010.
According to Dr. Besner, "Governments promised to eliminate inequities and ensure all Canadians have equal access to the same services, such as primary health care, home care and prescription drugs, regardless of where they live in the country. Governments must renew their commitment to nationwide change."
I can say that the "nationwide change" that Dr. Besner refers to must be bigger than the transformation we have seen in Ontario. The inequities in Ontario, as far as I can tell, are growing more significant with the transformation strategies. We have have-not patients on more levels than we've ever had before to my knowledge. We have more hospitals with varying degrees of support and we have a growing need in many areas that are unlikely to met with more government money or government spear-headed change.
If we are to address the growing numbers of patients with diabetes, cancer, and other chronic diseases as well as acute events such as pandemics, bacterial outbreaks of various kinds and more social needs than in the past, government will not be able to manage alone.
We know this already with private foundations and philanthropy that continues to grow across Canada to support our public institutions.
If we are to truly transform and create renewal of our health care system, its institutions, and its providers while simultaneously introducing and managing new industries such as genomics, patients will need to understand the urgency of the situation and understand their own leadership potential. Gone are the days when a few elite leaders existed to organize the masses. Patients must be seen to be leaders themselves and empowered with the ability to manage their own health care.
This will not be achieved in a top down approach driven by government need to micromanage and control. In my opinion sustainable renewal can only be achieved through the acts of individuals in many, many capacities from volunteer work, to mentoring, to community patient leaders.
The process must be driven by patients and to achieve this the politics must be uncoupled, at least in part, from the provision and transformation process. I'm not certain our politicians have the stomach for this and so politicians and our governments will continue to promise what they cannot deliver. Perhaps the courts will need to do this job.
At least the Health Council of Canada is able to admit that the government is not delivering...a step forward and for me another drop in the glass.
Merrilee Fullerton
49 Comments
Reader Comments (49)
Was it renewed?
"In theory there is no difference between theory and practice. In practice, there is..."
"The future ain't what is used to be."
"There are some people who, if they don't already know, you can't tell them."
" We made too many wrong mistakes."
"You can observe a lot by just watching."
"You got to be very careful when you don't know where you're going, because you may not get there."
To be fair, the powers that be have taken some of his advice to heart, such as "When you come to a fork in the road, take it".
The one thing that they should realise is that "In baseball [managing the health and welfare of the citizenry] you don't know nothing".
For us at the grass roots "It's deja vu all over again."
At various stages of this electronic health record saga, I've heard (for a long time) it's SSHA, then Canada Infoway, and now e-health Ontario.
Unfortunately the e-health portal doesn't currently fill me with confidence:
http://www.health.gov.on.ca/ehealth/
Mind you, I have to say, I don't believe the EHR will be the savior of public healthcare in Canada, but it wouldn't hurt (if we can afford it).
I'm just happy I know enough (not much, mind you) about technology to be able to maintain my own EHR!
The plain business case is that the number of potential customers in all of Canada, that is hospitals, doctors, and clinics is not sufficient to keep the industry of providers of software in busines. there are perhaps 30 providers of electronic software for various clinical situations. They are expensive and labour intensive to design , test, sell and support. There are perhaps 16 major porviders in Ontario, of whom, 7 or 8 have met the conformance specs with MOH. That is they can talk to the OHIP computer in some way.
There are not enough docs clinics etc in need of EMR solutions to keep them all in business.
So they will drop out, amalgamate etc over the next while in order to keep in business.
A decision was made, early in the process to allow choice in terms of product believing that the docs in Ontario would adopt the solutions faster with a choice in product over a ministry imposed single solution.
And we have a patchwork of products for emr's which will allegedly all communicate with one another (that being one of the standards) but which will do different things in terms of supporting primary care management of chronic disease states for instance.
And only the alphabet groups get ministry fincancial support for the computerization. And many of the hospital systems are "legacy" systems and cannot support outreach to their communities.
And in my little shop I spend hours entering data and dollars on paper for the paper less solution. And I absolutely refuse to emply scanning gnomes to scan all the paper that still comes in the mail.
so I have a hybrid system. And it is true that the computer rememebers eveything better than I do in my advanced state of decrepitude. But I have spent hours and hours putting it all in in the first place.
And it is not always clear to me that my time is best employed as a data entry clerk
But the information in the system must be as precise as one can make or the whole idea is defeated.
So what I am trying to say is that emr is very much a mixed blessing, and one that has a long way to go before the benefits are to be fully realized.
I think that the younger generations of patients will have a better handle on how to manage their own EHR/EMR.
Ontario/Canada could wait to be late adopters again and save themselves plenty of cash.
On the other hand, it is a trendy thing to mention and it will undoubtedly get lots of press.
It is also interesting that the Family Health Teams are going to get some kind of funding to provide Telemedicine.
Interesting times as the inequalities grow.
(1) A huge amount of money was dispensed by the feds to get this up and running in the provinces.
(2) At the provincial level, physicians who already were, or were about to contract into, primary care reform (acronym practices), were offered capital and operating incentives to set up the EMR.
(3) SSHA was contracted by the province (in consultation with the OMA, I think), to be the entity that set up the e-highway and secure electronic sockets along which information would travel from the MOHLTC to the practices, and, if the SSHA internet/email system were being used (I think this is called One-Mail), and, in the case of networks, from one place to the other. SSHA in turn subcontracts to local carriers like Allstream, Rogers, etc. for the actual connections and conduits.
SSHA pays for the secure socket or switch in which your system resides and all associated set up and operating costs. In our case, this is a T-1 which forms a kind of "cloud" over the five distributed sites of the FHO. Our servers are located in Kingston General Hospital, and each site retrieves its data on a daily practice basis from KGH within that secure environment.
We opted not to go with SSHA internet/email because it is a bad system. We get our internet/email through KGH, and pay an annual per user cost of $125 for MS Office Professional which gives us all our word-processing, spreadsheet, and relational database software in addition to MS Outlook which we use for email.
(4) OntarioMD was set up by the Province as the overseer of fund distribution to the physicians; it is a creature of the OMA to whom the money was turned over for administration by the MOHLTC. When certain criteria are met, the capital and operating funding is flowed to the physicians. It only lasts for a contracted period of time, in our case, three years.
(5) So SSHA delivers the electronic pathways and conduits for the EMR, and the physicians with their funds deliver the setup and use of the EMR in practice.
(6) I guess you want to know on whose desk the buck for delivery rests in the corridors of power. I don't think I have answered that for you, but it probably resides within the MOHLTC as much as anywhere.
(7) I have not kept up with eHealth as a concept or in practical terms, but your questions prompt me to do this over the week-end.
(8) As for the Infoway, you can subscribe to their newsletter through their site to see what they think they are doing this week at the macro level.
(9) I myself am micro, and that's enough for me.
Does this help?
It is one big fog for me so I'm glad to see that others are making sense of it.
Many thanks Hayseeds.
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http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20080605/breast_cancer_080605/20080605?hub=Canada
British Columbia's Fast Track screening and diagnosis program sends abnormal screening results directly to a diagnostic facility, which then calls the woman directly for an appointment. By bypassing the family doctor, wait times have been cut by more than half.
http://www.health.gov.on.ca/english/public/ministry/about_mohltc/ehealth.html
I think Hayseeds has it correct.
SSHA is creating the backbone.
MyDoctor.ca is funded in conjunction with CMA/OMA & goverment dollars to provide a secure email set up.
Each clinic picks their EMR and can get incentives for converting.
There are various ways host the server for your EMR -- for discussions go to Michelle Grievers EMR -- she's blogging about a conversion and which server system to use.
OHIPster is looking for a personnal health record (PHR) like Google Health. Each of the EMR's is responsible for creating a portible file. Microsoft Vault & Google Health are the big providers of the PHR right now (I think). At the Cleveland Clinic certain records are made available to a PHR once the patient agrees -- but the EMR has to make the files transferrable. It's 5 years out still for small clinics I think.
As far as ROI for EMR it's very hard to quantify. If you make use of the electronic scheduling the pay back is there but without careful management in can actually slow things down because of constant log-in/log-outs. One of the problems with an off-site server is frequent disconnects. There are some good studies out there on the ROI (none of which I've attached but I can swear I remember reading about them).
Not sure what that adds to the converstation. As far as the buck goes -- without the backbone x-rays, lab results, etc... won't be transferrable. But for clinic EMR's it's up to each clinic but there are plenty of incentives out there to convert.
Going back to the original health canada report the logic is that with EMR clinic wait times, hospital wait times can be better evaluated and services better distributed. They also think EMR itself will increase the velocity of care (I don't agree with the assessment or at best it's a 5-10% difference). Part of the concept is greater central control of health distribution. I guess the LHIN's are supposed to take care of that :-)
For a better assessment of how healthcare is going take a look at the CPSO 2007 survey.
http://www.cpso.on.ca/Publications/2007%20Reg%20Stats%20and%20Survey.pdf
10% of primary care docs are accepting new patients (up from 9.4% as the government spins it) with about 82/10,000 FD's.
Good discussion -- thanks. Ian.
www.waittimes.blogspot.com
Better when strings are attached
From Thursday's Globe and Mail
June 5, 2008 at 7:46 AM EDT
Five years ago, the first ministers jubilantly declared that they had saved the health-care system. There would be easy access and quality care for all, along with $36-billion over five years from Ottawa. A year later, the former federal Liberal government sweetened that pot, adding another $41-billion over 10 years while raising health-care transfers by 6 per cent a year.
In a report released yesterday, the Health Council of Canada concludes that those deals led to very little reform. The provinces took the money, and spent it. And the feds foolishly kept no leverage to make sure it was well spent.
Did these measures lead to better access or to quality care on a broad basis? "In short, the answer is no," the report says. "The glass with which we toast this fifth anniversary is at best half full." It's a brutal 44-page diagnosis from a council that, ironically, was created with that 2003 deal in order to track governments' progress in fixing the system.
The list of broken vows is long. The deal stipulated that there would be catastrophic drug coverage by the end of 2006, protecting Canadians from financial hardship. That is in limbo today. There would be short-term, publicly funded home care. That has been set at two weeks of coverage, which doesn't help many people. Provinces have made uneven and far from comprehensive progress in primary care delivery, and still do not work together to meet work-force challenges.
There's more. Provinces are "not on track" to meet the goal of ensuring that 50 per cent of Canadians have electronic health records by 2010. (Denmark has put almost everyone online.) There are still long waits for care in many areas. (The United Kingdom has solved this problem for many services.) Most provinces do not even clearly account for how the federal money is being spent.
The report's bottom line is that Ottawa has funded the purchase of better equipment, and prodded some provinces into better managing some wait lists.
But if some Canadians have better access to services, drugs, home care and primary care, it's a matter of being lucky enough to live in the right places, because governments are not working together on those challenges. Some advisory committees have even been disbanded.
What are the lessons? Next time, the federal government should better define its goals, attach strings to its funding and encourage governments to collaborate. Otherwise, as the council tartly notes, taxpayers could end up funding the status quo, instead of reform. This wisdom comes five years too late.
http://www.theglobeandmail.com/servlet/story/RTGAM.20080605.wehealth05/BNStory/specialComment/home
It seems to me, the organizations involved in the EHR are either private software companies trying to make a buck, or levels of government that are acting as 'facilitators', whether it's SSHA with their VERY expensive private network, or Canada Infoway funding an Alberta initiative here, and a New Brunswick one there.
The EHR really must span all provinces/territories, so it really must be driven by the feds - no matter what anyone says, they are the ultimate source of funds. We can't have Alberta implementing (which I think they have already) an EHR that's quite incompatible with one implemented by Ontario (well I suppose we don't have to worry about that for awhile).
We need Infoway to step up to the plate, say this is what the thing is, this is how you interface with it, and provinces, physicians, CMS vendors, hospitals, labs, pharmacies, the general public either tie in or don't tie in (at their peril).
So Infoway defines the thing, and becomes the custodian of the EHR data, sort of like a federal SSHA (or what we EXPECTED SSHA to do).
Ain't gonna happen, huh?
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June 6, 2008
Medical risk for rural patients?
OMA concerned about number of 'nurse-led' clinics with limited access to physicians in under-serviced areas
By CHRISTINA BLIZZARD, TORONTO SUN
...cut...
Smitherman dismisses the docs' concerns.
"I feel that is actually territorialism," he said in an interview this week.
"There are many models of practice that can enhance access to family health care for Ontarians and as a government we are very committed to examining them and to implementing them," Smitherman said, adding that "billions" of dollars from the health budget go to pay for doctors.
He says the doctors can't have it both ways when they complain there is a doctor shortage.
"If you want to argue, as the physicians do, that there is a shortage of doctors, and we all agree that it takes quite a long time to make a new doctor, is their alternative to say, 'don't take advantage of the skills of these health care practitioners, let the patient wait?'" he asked.
Fluorodeoxyglucose-positron emission tomography (FDG-PET) is a nuclear medicine imaging technology whose use in the detection and evaluation of infections is an emerging indication. FDG-PET is currently used in the diagnosis and management of cancers, heart conditions, and neurological conditions............
There is no Canadian guidance on the use of FDG-PET in infections at the present time.........Assessments of cost-effectiveness and of the possible impact on resource allocation and wait times are also required.
As for independent nurse led clinics, and Ian may disagree with me, these will be quite expensive and are not likely to be able to provide care to large numbers of patients as family doctors have been able to do in the past.
Certainly, as more complex chronic conditions become much more common, physicians could certainly use the help.
But if family doctors go the way of the dodo bird over the next 20 years we will be left with a more expensive system in my opinion with many layers of providers and the primary care level with significant overlap which will be inefficient and not terribly productive (both of which we need in the face of workforce shortage).
Although physicians working in teams could all be very fine, independent nurse led clinics will be the death knell for family practice and for the efficiencies associated with it.
As family medicine is divided up between pharmacists, midwives (who are going to be given well baby care as well as deliveries and obstetrical care), independent nurse led clinics, social workers, chiropractors etc. who is going to want to be a family doctor? Not too many.
Does the government really know what it is doing by killing off a very efficient and productive form of delivery of primary care?
"It's a delicate balance: Sure, we want to increase access to health care, but not if it dilutes quality of care. Nurses play a vital part in health care -- as a team. You can't replace a doctor with a nurse."
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http://www.thestar.com/News/Ontario/article/438541
The NDP are renewing their calls for Ontario's ombudsman to oversee the province's hospitals following the death of a politician's elderly relative who contracted C. difficile.
The pharmacists are supposed to have a private room for these "counselling" sessions but clearly in the big smoke this is not happening. As one patient said to me, "do you think I even want to go into a closed room as a female at 0200 hours with some strange guy I have never met."
It is clear many of these IMG pharmacists have not had any sort of training in basic patient interviewing skills.
Ministry looking at allowing druggists to prescribe medication to ease pressure on health-care system
June 02, 2008
Chinta Puxley
The Canadian Press
Ontario patients could soon get drug prescriptions from their local pharmacist as the governing Liberals look to join other provinces and expand the prescribing powers of pharmacists, nurses and other non-physicians.
Despite concern from doctors, Health Minister George Smitherman is asking for advice on who should be allowed to prescribe drugs and whether nurse practitioners – who have some prescribing power – should be able to write prescriptions for a wider array.
"I think it's an appropriate thing to take a look at. Obviously, it's got to be done with ... an abundance of caution on behalf of patients but also recognizing that, for patients, it can be a matter of extraordinary convenience," Smitherman said.
The Ministry of Health is quietly commissioning a study which would examine whether those who have prescription authority now – such as midwives, optometrists and nurse practitioners – should be able to prescribe more classes of drugs. The study would also look at whether pharmacists could ease pressure on the health-care system by writing prescriptions.
Alberta expanded the role of its pharmacists last year, allowing them to prescribe some drugs, give drug refills and inject vaccinations.
New Brunswick is moving forward with legislation that allows pharmacists to refill prescriptions without a doctor's consent, alter the prescription if necessary and write prescriptions for minor conditions. Manitoba is also moving toward a system which would give pharmacists not only the authority to prescribe drugs and order tests.
Having prescribing pharmacists would help take the pressure off clogged emergency rooms and doctors' offices, argues the Canadian Pharmacists Association. Pharmacists already diagnose and recommend medication for ailments like coughs, colds and diarrhea.
But Brian Day, head of the Canadian Medical Association, said today's pharmacy training doesn't prepare graduates for patient examination and diagnosis. And, he added: "To say this is an answer to the doctor shortage is ludicrous. The answer to a shortage of doctors is to produce more doctors."
http://www.thestar.com/printArticle/435214
Thanks for this Canary.
"extraordinary convenience" at what cost...hmmmm
If "extraordinary convenience" was the driving force behind health care transformation then private care should have taken a more prominent role years ago but not so....guess why....it is about funding.....
Someone should ask the docs in Espanola why they no longer want to supervise any foreign medical grads. Once bitten, twice shy.
Ontario to clear way for more foreign-trained MDs
Jun 06, 2008 05:53 PM
Maria Babbage
THE CANADIAN PRESS
The province will introduce changes within weeks that will break down regulatory barrier s and allow more foreign-trained doctors to work in Ontario, Health Minister George Smitherman said today.
The legislation will move on a government report that outlines ways to increase the number of foreign-trained doctors practising in Ontario to improve access to health care, he said.
"That story about taxi drivers and pizza drivers, we're a bit hooked on telling that story as if that's the plight of every foreign-trained doctor," Smitherman said.
"But I think it's really important to acknowledge that in Ontario, 25 per cent of all the doctors that we have are foreign-trained. So we're doing a better job."
Smitherman is mulling recommendations that include putting doctors who are already practising in countries with a comparable health-care system directly into practice and creating a transitional licence that would permit a doctor to practice with supervision while completing their training.
The licence could help specialists whose talents aren't always recognized because the focus is on a "broader array of things that they would have learned years and years ago," he said.
"This is about transitioning those specialists into opportunities without having to go through residency, and they would be supervised by existing physicians in those environments," Smitherman said.
The bill will be introduced before the legislature breaks for the summer, but likely won't be passed until it resumes in the fall, he said.
In the meantime, the government will work with the College of Physicians and Surgeons of Ontario – which regulates the profession – to draft the new regulations, Smitherman said.
College registrar Dr. Rocco Gerace said the college already issues restricted certificates, which allow doctors to work while under the supervision of another physician.
"We have a host of doctors out there who have gone through a process recognizing their ability and, over a period of time, are under some remote supervision just to make sure someone's looking in on them," he said.
Of the 3,279 certificates issued by the college last year, 1,403 went to international medical graduates and 1,155 went to Ontario grads.
"Whatever we do, we have to be assured that we do it in a way that maintains the standard that doesn't put the public at risk," Gerace said.
Dr. Haibo Xu, a family doctor who received his medical degree in Beijing, came to Canada in 1999 and is only now heading out to start up his own practice in Dunnville, Ont., a small rural community near Niagara Falls. The 32-year-old plans to start working in July once he has completed his residency training.
"The frustrating part of the application was the number of examinations you have to take," he said.
The province has since eliminated some of those repetitive examinations to simplify the process, he added.
What the province needs is more residency spots, which isn't addressed in the report, said Progressive Conservative health critic Elizabeth Witmer.
"Great at announcements, but they never have a plan of action, they never have any time lines and you never know when they're going to achieve and really make a difference in the lives of any people," she said.
The Liberals say they increased the number of residency training position to 200 from 90 in 2004.
Currently, more than 5,000 foreign-trained doctors are practising in Ontario and 630 others are in residency training, according to the Ministry of Health and Long-Term Care.
Yet 850,000 people in the province still don't have a family doctor, according to a recent report by the Ontario Medical Association.
The province is short about 2,500 doctors about 2,600 physicians currently working in the province are over the age of 65, the report noted. If those physicians decide to retire, Ontario would lose about 10 per cent of its family doctors and about 13 per cent of its specialists.
they are, says George..
Society gets the health care they support. Want point of entry care / family health care and want it from anyone who will provide it, conveniently with or without an MD?
Nurse practitioner or international medical graduate. He can't see the difference, can you?
When prescription is no longer restricted to MDs, and the universal health record is open to all, there will be a dog pile of point of entry providers. When the family doctor is no longer required to refer for specialty acute care, the family medicine model of care delivery will be extinct at OHIP.
If Canada Post could not guarantee 90% on time delivery, it just changed the benchmark for "on time". Don't meet the current credentialing process, change it. He can't see the difference, can you?
So, moving into the summer months (and thus no action time for central):
1. We have successfully introduced new layers of health care providers whom we can budget: nurse practioners, midwives, so to come PA, new hordes of IMG doctors - this plan is very good.
2. We have created our centres of excellence - where we have provided ta funds, not based on medical excellence - but based on political excennence. All centres are run by our appointees - under our rules.
3. We can, by the appropriate use and distribution of tax resources, calm any action points that cause us short term embarassment.
4. We have create a work force of "barefoot doctors (and alternative workers)" on the front lines to deal with much on the unneeded care, and centres of excellence to deal with the more complicated, serious issues.
5. We have established that we know best for you, and we can deliver what the public wants.
6. We have created successfully, the LHINs - they take the heat, we call the shots without direct access by the public.
7. The new graduates have been "transformed".
8. Top down management works!!
Does anyone know of any statistical information the LHIN's might have which enables one to determine directly or indirectly whether specific social agencies, or social service agencies as a sector, have or have not kept pace with some benchmark of progress? I am speaking of those SSA'a that receive small amounts of MOHLTC dollars targeted as things such as seniors' needs.
Ottawa poor on health care
BRIAN P.H. GREEN
Dr.
June 9, 2008
Thunder Bay, Ont. -- It's clear that $77-billion didn't buy the change in health care it might have (Better When Strings Are Attached - editorial, June 5).
But to say that federal taxpayers were let down by provincial mismanagement is absurd. They are also provincial voters, taxpayers and patients, quite capable of calling their provincial governments to account.
But your solution is truly laughable: more conditions, better oversight by Ottawa. This is the same outfit that oversees aboriginal health.
http://www.theglobeandmail.com/servlet/story/LAC.20080609.COLETTS09-5/TPStory/Opinion/letters
On another note, here is an Ottawa Citizen editorial that makes me want to weep. This editorial is inflammatory at best and if the media keeps up this nonsense and the public swallows it, they will surely get what they deserve.
Nothing will be gained by dividing up primary care and selling it off the the lowest bidder. Primary care by physicians will die to be replaced by multiple layers that will cost even more...then the media can start blaming the nurse practitioners I guess.
Well, the public is going to learn the hard way.
I would have written a letter to the editor but it doesn't seem to make a difference. Better to focus on my book.
http://www.canada.com/ottawacitizen/news/editorials/story.html?id=5bb20e9a-2aab-4472-beb6-aa86b09c5ca1
There you have it, receiving care from a doctor is "clogging" up the works. Having a lesser qualified person must then be "unclogging the pipes".
When did over qualification become the problem?
It is not the minor problems or script refills that are clogging up doctors' offices. In fact, these are pleasant encounters most of the time which help to balance out the chronic conditions and other more complicated problems.
Parceling off these minor problems to other providers separate from family physicians will only create more layers of care with less continuity....and likely at a greater cost....but as always, the bureaucrats know best...just like the medical school cut backs in 1993...all righty then.
For about $20 one would enter the local pharmacy for any kind of respiratory ailment and a injection of penicillin was given by the pharmacist. Every new Mexican patients says this is standard operating protocol down there. Only if the pharmacist's treatment failed did you bother seeing a physician.
Of course I had to laugh when one Mexican mother told me she got fed up with the expensive pharmacist consulting fee and outsmarted them by keeping her script and writing on the back what each diagnosis was for the particular drug dispensed. That way she cut out the pharmacist consult such that when her next kid had a sore ear she pulled out the amoxicillin script, when a diaper rash the cortisone/canestin script, and so on. She showed me about a dozen different diagnoses for common childhood ailments and the scripts she would present to the pharmacist. Apparently the script date didn't seem to matter and the pharmacist would dispense whatever you "wanted" as long as you knew what to ask for. They did draw the line at narcotics though and this required a fresh script from a pharmacist or physician.
I can see we are going to slowly evolve in this direction where the pharmacists and NPs become the primary care point of entry, and only after a few unsuccessful kicks at the can will the patient reluctantly come to a physician for a second opinion.
And in this day and age why would a bright student want to become a family doctor?
education certificate holders, rose from 20,053 to 22,725. This is an increase of 2,672 physicians (13%).
Source: OPHRDC “Physicians in Ontario” Annual Reports.
But the population rise from 9.1 million in 1996, to 12.8 million in 2006 was 23%. Hmmmm, seems to be a gap that is increasing
Ontario has a net increase of only 30 additional Neurologists over the last 8 years. Of these, one-half came in 2001. We believe this explains some of the recent OHIP utilization data.
http://www.aoneuro.on.ca./Political/CrisisinNeurology.pdf
There are many, many reasons why medical students are not choosing family practice. When government and the "experts" figure that nurses can provide equivalent treatment it's time to get out....I wonder if this is going to be "Barer-Stoddart" Part II with an equally poor outcome.
Anybody notice how well government did at containing costs by limiting the number of doctors? OOooohh Yahhhhh....hold on to your patient gowns...its going to be a rough ride.
Instead...there will be more layers in the health care bureaucracy with all the negative sequelae that implies.
Retirement from this top heavy health [care] light [ and dirty] looks increasingly attractive...best get one of those international health insurance plans that will allow one to be assessed by competent medical practitioners as opposed to the danger of being 'cared for' [an oxymoron?] by this H[C]L[&D] system's 'team' of quacktitioners and doctor wannabes in increasingly pathetic H[C]L[&D] facilities.
" .... the investment to establish a team-based primary care system is substantial, and it could take a generation to fully evolve, Padmos said."
She was on the cusp of the FHN rollout in 2002, which had a target of 80 per cent of family physicians within two years.
Horse of a different colour now.
Unless there is room for innovation and profit, we will see more women taking up family practice, ultimately making significantly less than male physicians in other areas and the nurse practitioners who seek to be independent practitioners will become the "pink ghetto" workers of primary care....not much different from bank tellers (who have mostly been replaced by automated tellers)..Interesting future in primary care awaits!
Perhaps they don't mind or just don't see it coming. Doris Grinspun has been fighting hard to break into the medical realm with nurses and she might end up accomplishing only the creation of nursing positions that require more work and responsibility without much increased pay benefit.
Wouldn't that be ironic....to end up back where the nursing profession started after so much energy expended to get nurses into primary care.
Here's the release from CNW on the new data from the NPS.
http://www.newswire.ca/en/releases/archive/June2008/11/c2478.html
Yes, interesting times.
So the move to NPs, PAs, teams, etc. is more out of necessity (and to influence public perception) than anything else.
The ones being squeezed are the FFS-only GPs and the ER docs that are seeing more and more of the chronically ill. For most of the rest (ie. in an alphabet group) times are good, with more carrots to be expected, retroactively, this November.
The plan is good.
Alternative funding/providers are more "expensive" on a per unit cost - but the need for control exceeds the cost. Once control is obtained, the costs can (will) be brought down to a more acceptable cost per unit. Physicians on FFS are too independant of the needed control, and must be brought into the fixed budgetable line that is needed to maintain tight fiscal control by the ruling party.
It's nearing the end - the new contract will close out the options and the next contract will be easy to budget. All in under 25 years. Quite an accomplishment.
And certainly alternate funding agreements, and capitation rates can be adjusted, but so can Schedule of Benefits rates.
You're jumping the gun on this - the November agreement will just be another small step - FFS has a way to go yet. If it's a generation, as Ruth Wilson has suggested, that'll take us to 2020 at least.
Agreed the FFS issue will be around for a while - it's not worth the politcal fight to bring it publically up.
However, the next contract flips pass the point of no return. After that, it represents an option that new graduates won't try - thus it's toast.
Then we're ALL toast.
As it stands, although medical students choosing family medicine has risen slightly recently, some numbers indicate that only about 7% are EVER planning to do comprehensive care. The others are doing obesity clinics, sports medicine, eating disorder clinics etc.
There are many, many options for "family medicine" residents not just comprehensive care.
One issue is lifestyle but the other is simply government intervention in way too much of comprehensive care these days....quotas for this and for that before you can get the carrots....professionals don't necessarily want to work like that. OK if you are trained as a clerk I think.
Orthodontists have figured out how to use assisants rather well and profitably. Problem with government established FHTs is they take away from innovative minds and motivation to be more productive. THis is a very big issue.
Why government won't consider FFS docs within FHTs or other structures amenable to using PAs and NPs and office practice nurses is absurd.
The "experts" are going to be wrong again and when they've managed to drive away the really productive and innovative minds from family medicine they will wonder why patients can't get access to a primary care doctor anymore.
It will be interesting to watch how this plays out....a slow motion train wreck..and of course the politicians will only listen to the "experts" who have done such a great job so far. NOT.
Can't remember any positive achievements from his mother during her three year reign between 1987-90...of course she was followed by the even more disastrous NDP minister of health who gave that final push to Ontario Health care over the cliff and into its present abyss.
Let's hope that he doesn't listen to his mother's advice....but it is unlikely.
there is an old Norwegian saying "no matter how bad things are, things can get even worse"....we are about to experience that phenomenon.