Ontario Government to Family Doctors: The Beatings Will Continue Until Morale Improves

That we have a family medicine crisis in Ontario is indisputable. That the numbers of family doctors leaving comprehensive care family medicine continues to rise and is expected to leave over 4 million people without a family doctor in the next couple of years is irrefutable. That the need to recruit and retain comprehensive care family doctors has never been more urgent especially as competition from provinces like British Columbia, Manitoba and others increases is unquestionable.

All of this is self evident to anybody following health care.

Except of course, the Ontario Government, and their Ministry of Health Bureaucrats. As far as they are concerned, now is actually the perfect time to attack family doctors. Because, you know, the way to improve burnout, morale and encourage them to take on new patients is to ambush people who are already under siege with overwhelming workloads.

Here’s what happened. About 6,000 family doctors in Ontario practice under what is called a Family Health Organization (FHO) model. Think of it as a base salary plus performance bonuses. As part of working in that model, the family doctors have to sign a contract agreeing to deliver a basket of services, including, a certain amount of after hours care.

Because we have so many rural areas in Ontario, where family doctors do a whole bunch of other work (emergency department, hospital on call, palliative care, long term care on call and more), there is a provision in the contract that says if you have X number of family doctors doing this kind of work already, then the amount of after hours care you provide as a FHO can be reduced. There’s a somewhat complicated formula but that doesn’t really matter – it’s the principle that counts. Essentially, if you are already doing after hours work – then you are not asked to do more after hours work.

Unless of course you are a Ministry of Health bureaucrat, taking the guidance of your bellicose negotiations team that said there was “no concern” about a shortage of family physicians. This allows you licence to use a stick against family physicians.

Then, you send letters to 75 FHOs telling them they are not meeting the terms of their contract, based on made up metrics. The letters (I’ve seen a few of them) all allege that the doctors in the FHOs are not living up to the terms of their contract.

Let’s be 100% clear on this. If a physician signs a contract as part of a FHO, they should hold up their end of the bargain. You should read the contract, go in with your eyes open, and make sure you are capable of meeting all of the terms that you agreed to.

BUT.

It appears what the Ministry is arbitrarily and unilaterally determining how to decide if a physician is meeting the terms. For example, one FHO letter I saw suggested that that FHO was not performing as well as its “peers” and was therefore targeted. Two things though. First the Ministry unilaterally decided who the peers were. Second, performing up to the standards of your peers was not part of the original contract.

Another letter I saw alleged that the doctors who do call for their hospital or their nursing home, don’t qualify because……they don’t bill enough for going into the hospital. The ministry unilaterally decided that in order to claim after hours work, you couldn’t just be on call, but you had to keep going into the hospital when on call, a certain number of times (this number was never up for discussion before).

I’ll use myself as an example. Last Wednesday I was on call for my hospital. I got three calls (one at 4:00 am!) and managed all the patients over the phones. I DID perform the task I agreed to (being on call). But the bungling bureaucrats won’t acknowledge that. They want me go to the hospital (even if I can handle it over the phone) and then bill OHIP for the service (which would drive UP the cost!!) to be recognized – a decision they seemingly made on their own, without consultation.

My two loyal fans and one non-fan regular reader know that I’ve long maintained that Star Trek is a far better franchise than Star Wars. But in this case, I will concede the Ministry’s actions are most appropriately compared to this fellow:

Normally when a government changes the terms of an agreement unilaterally, one would expect the Ontario Medical Association to step in and advocate for their members. However, the response from the OMA, in a letter sent to all its members was, frankly, pathetic. The letter basically told doctors to “notify the Ministry” about the circumstances around your group. Try to reason with Darth Vader as it was. No dedicated email or legal team staff member either. Just contact the general help email.

I guess specialists who had expressed concerns on Social Media about too many family doctors on the OMA Board have nothing to worry about. Clearly the OMA, between allowing the across the board increases to the arbitration award this year and not dedicating resources to tackle this issue cares nothing about family medicine. (They talk a great game on social media, but it’s the actions that count).

I imagine the issue will eventually sort itself out after many rancorous meetings and back and forth – all of which will take up physicians time and prevent them from doing minor and inconsequential things like, say, seeing patients. The Ministry will continue to claim that we have more family doctors than ever before – but let’s face it, if they keep behaving like this, those doctors won’t practice comprehensive care medicine. It just seems so ridiculous, and indicative of a Ministry that truly doesn’t understand or value family medicine.

And that should frighten the general public more than the Death Star ever did. (Drat, made ANOTHER Star Wars reference).