Health – justanoldcountrydoctor

Lettre ouverte au premier ministre François Legault

L’honorable François Legault, député
Premier ministre du Québec
Édifice Honoré-Mercier, 3e étage
835, boul. René-Lévesque Est
Québec (Québec) G1A 1B4

Monsieur le Premier Ministre,

Vous ne me connaissez probablement pas, et vous vous demandez sans doute ce qui m’a poussé à vous écrire une lettre ouverte. J’ai pris cette décision après avoir fait une entrevue à la radio avec Greg Brady, dans son émission Toronto Today. Durant l’entrevue, Greg m’a demandé de commenter la chicane entre vous et les médecins de votre province. Il a mentionné que, dans les dernières semaines, 263 médecins québécois ont fait une demande de permis pour pratiquer en Ontario.

Je ne prétends certainement pas être un expert du fonctionnement du système de santé au Québec. Je ne me permettrais pas non plus de dire que je comprends toutes les subtilités du projet de loi 2, la législation que vous avez déposée et qui met vos médecins en colère. Et non, je vais le dire d’emblée : je ne sais pas comment se déroulent vos négociations avec les organismes représentant les médecins du Québec (la FMSQ et la FMOQ).

Mais je peux vous dire que mon tout premier billet de blogue (dans le Huffington Post) était une lettre ouverte adressée à l’ancien ministre de la Santé de l’Ontario, le Dr Eric Hoskins. J’avais écrit ce billet parce que son gouvernement parlait d’imposer des mesures unilatérales contre les médecins (ça vous rappelle quelque chose?). Dans ce texte, j’avertissais le Dr Hoskins que des actions unilatérales allaient engendrer le chaos dans notre système de santé :

On ne peut pas retourner à un système où trois millions de personnes et plus n’ont pas de médecin de famille, ou encore à des délais pour consulter un spécialiste (déjà trop longs chez nous) qui deviennent carrément intenables.

J’avais aussi prévenu qu’il y aurait un prix politique à payer en allant de l’avant de façon unilatérale, et que cela nuirait aux libéraux lors de l’élection de 2018. Vous savez peut-être qu’ils ont été complètement anéantis à cette élection-là. Même si une bonne partie de leur défaite s’explique par l’impopularité de la première ministre Kathleen Wynne, je maintiens encore aujourd’hui que les libéraux auraient au moins pu conserver leur statut de parti officiel s’ils n’avaient pas magané le système de santé à ce point.

La raison pour laquelle j’ai pu écrire ces avertissements avec autant d’assurance — et avoir raison au final — ce n’était pas de la clairvoyance de ma part. C’est simplement que j’ai suivi le conseil de Santayana :

A picture of George Santayana, Spanish American philosopher with his famous quote "Those who don't learn from history are doomed to repeat it"

Ceux qui ne peuvent apprendre de l’histoire sont condamnés à la répéter.

Regardez : je comprends que les détails précis des politiques et du projet de loi que vous déposez ne sont pas identiques à ce que le Dr Hoskins tentait de faire. Mais au bout du compte, le message est le même : votre gouvernement affirme qu’il sait mieux que tout le monde comment gérer le système de santé. Vous n’avez pas besoin de l’avis ni de la collaboration des médecins. Vous allez imposer les changements que vous voulez.

Je vous encourage à retourner lire la lettre que j’avais envoyée au Dr Hoskins. Je lui avais souligné qu’il répétait les erreurs (les gestes unilatéraux) du gouvernement néo-démocrate de Bob Rae dans les années 1990. Ils ont détruit le système de santé avec ces actions-là et ont été balayés lors de l’élection de 1995, sans jamais reprendre le pouvoir depuis.

Jetez un œil au gouvernement progressiste-conservateur de Jason Kenney en Alberta, en 2019. Ils se sont mis en guerre avec l’Alberta Medical Association en 2020. La seule façon pour eux d’éviter une défaite à l’élection suivante a été de sacrifier leur chef, Jason Kenney. (Oui, c’est vrai que le mécontentement lié à sa gestion de la pandémie a joué — mais l’essentiel, c’est qu’il n’y avait rien pour le sauver. S’il avait gardé un système de santé fonctionnel…)

Vous en voulez d’autres? Regardez le gouvernement de Gordon Campbell, en Colombie-Britannique. En 2001-2002, ils ont unilatéralement déchiré une entente d’arbitrage conclue entre le gouvernement et les médecins. Cela a été suivi par des années de conflit, un recours fondé sur la Charte (que le gouvernement a perdu), du tumulte politique, un vote de grève des médecins et une majorité gouvernementale passablement réduite. Finalement, devant un système de santé en déroute — un échec dû à leur propre arrogance — le gouvernement a dû conclure une entente avec les médecins en 2002, puis en 2006, rétablissant l’arbitrage exécutoire dans des conditions jugées très généreuses à l’époque.

Comme je l’avais dit au Dr Hoskins, le message est simple :

Tout gouvernement qui agit unilatéralement court le risque de perdre des médecins.

Et quand ça arrive, le système de santé en souffre. Les patients en souffrent. Les délais augmentent. Les soins se détériorent. Et dans ces situations-là, les gens ne blâment pas les médecins. Ils blâment les politiciens.

En bref, un gouvernement qui impose des mesures unilatérales aux médecins fait du tort aux patients de sa province et paie toujours un prix politique. Au final, il finit toujours par payer plus cher que s’il avait tout simplement négocié de façon juste avec ses médecins dès le départ.

Écoutez : je n’ai pas d’intérêt particulier pour vous ou votre gouvernement. Ça m’est complètement égal que vous gagniez ou non la prochaine élection. Mais mes collègues médecins, je m’en soucie. Et je sais qu’ils sont très, très fâchés (et avec raison). Je me soucie aussi des citoyens du Québec, et je sais qu’ils vont énormément souffrir de vos décisions. En ce moment, 28 % de la population n’a pas de médecin de famille. Imaginez ce qui va arriver si 263 quittent. Et pensez-vous vraiment qu’un médecin sensé voudra venir pratiquer au Québec quand votre gouvernement agit de cette façon?

Croyez-moi : si vous ne changez pas de cap immédiatement et si vous ne recommencez pas à travailler avec vos médecins, les dommages causés à votre système de santé — et aux gens que vous êtes censé servir — seront immenses.

Et si vous ne me croyez pas, relisez la citation de Santayana.

Cordialement,

Un vieux médecin de campagne

Dear Specialist, You’re Awesome, but PLEASE STOP Calling Me A Provider

To my specialist colleagues,

In over 30 years of family practice, when I have been uncertain about a diagnosis you’ve been there. When I needed some advice on best treatments, you’ve been there. You’ve helped me and my patients, and you deserve many many thanks for that.

As with all things, there have been some ups and downs over the years (we really need to talk about the “go see your family doctor to have your staples/sutures removed” thing). Perhaps it’s because I work at a fairly small hospital with generally collegial colleagues, but I genuinely have positive feelings about our relationships and interactions.

There is, however, one thing that is starting to creep in to the vernacular that needs to be addressed before it goes too far. I’ve noticed it increasingly in reports from specialists. It seems to be particularly endemic in notes from the Emergency Medicine specialists and younger specialists.

It is the unfortunate tendency to use the highly offensive and derogatory term “provider” when referring to the family physicians. As in “the patient should follow up with their primary care provider.”

A couple of months ago, I attended the biennial menopause society update (yes, the same one where I discovered family physicians were giving up). At one of the small breakout groups, I happened to sit with a couple of my specialist colleagues. We were talking about how to handle various clinical scenarios, when I noticed both of them using this abhorrent term.

My personal observation (and I suspect I’ll get in trouble for saying this, but I’m going to say it anyway), was that the two of them looked like they weren’t even born when I entered medical school. It’s a credit to them just how involved they were in their hospital and community and patient advocacy at such a young age. As I understand it, they had been told that “primary care provider” was the appropriate new terminology to use.

I don’t really fault them. They were not aware of the negative connotations involved in that term or how objectionable it was. In fact, I credit both of them with being very open to change when I spoke to them about this.

What exactly is the problem you may be wondering? What’s the big deal about using the term provider?

Because language matters. Words matter. Definitions matter. Just as it is highly reprehensible and dehumanizing to use the word “client” when referring to a patient, it’s pretty offensive to use the term “provider” when referring to a family physician.

The term “physician” has meaning. It denotes a person who is entrusted to help you heal. It signifies a sacred bond between the healer and the sick that dates back to Hippocrates. It infers respect and dignity. It attributes professionalism, honour, and morality. It automatically speaks of the implicit trust that patients have.

The term provider, in health care, is egregious and appalling. To quote an excellent article by Jonathan Scarff:

“The word provider does not originate in the health care arena but from the world of commerce and contains no reference to professionalism or therapeutic relationships.”

He goes on to state:

“This terminology suggests that the clinician-patient relationship is a commercial transaction based on a market concept where patients are consumers to be serviced”

I could not agree with him more.

One of the things that the bureaucrats who run health care have long resented is the respect that physicians have from patients. Despite all of the attacks against physicians on social media, and even from official government types like RFK Jr in the States, physicians consistently continue to be shown to be among the most respected professionals out there (yes we are behind nurses). We receive these high rankings based on the proven belief that we are honest and adhere to ethical behaviours and high standards.

I firmly believe this is why bureaucrats have tried to bring in new terminology to describe physicians. They know that if we speak out against their brilliant ideas to “fix” health care, physicians will inherently get more trust than bureaucrats. I’ve seen the resentment of physicians first hand at a bunch of bilateral meetings between the OMA and the Ministry of Health. Trust me, it’s there, both implicitly and in some cases, very explicitly.

So the bureaucrats, under the guise of “inclusivity” or “patient centredness” or some such thing, are now introducing the term “provider” to diminish the significance of our roles. Their goal is to curtail our value in the eyes of the public, so when we call out their (many) mistakes, there will not be implicit trust in what we say. Think about it, which sentence below has more impact:

“Ontario’s providers speak out against government’s health proposal “

“Ontario’s physicians speak out against government’s health proposal”

Get the point? I beseech my specialist colleagues to not fall into this trap. Being a physician (as you know) is a sacred responsibility that all of us take seriously. We routinely make life altering suggestions to patients, and have a strong bond with them. Our role in their lives is not a commercial transaction. We do not treat patients as consumers who need to be managed. As the Section of General and Family Practice points out:

This term (provider) devalues the training, expertise, and vital role we play as physicians in the healthcare system. Family physicians are not providers; they are physicians.

So I ask you my specialist colleagues, the next time you write an Emergency Department note, or a consult note, be mindful of what you write. Recognize and respect the value of the person you are sending it to. Ignore the bureaucrats self serving machinations when they try to change the terminology.

Tell the patient to follow up with their FAMILY PHYSICIAN. (Except for the staple/suture removal – you can do that yourself).

Yours truly,

An Old Country Doctor

Expanded Scope of Practice Will Ultimately Hurt Patients

On October 1, the CBC published an article on how a program to expand the scope of practice of pharmacists in New Brunswick completely fell apart and was cancelled. There’s a litany of reasons why the project died. But the ones that stood out for me were (italicized quotes are lifted from the CBC article):

the project promoted a “a convenient new option” as opposed to to focusing on quality health care first
the project’s hypothesis – “..every patient getting care at a pharmacy would take pressure off the public system — remained unproven..”
there is a lot of focus on the fact that pharmacists need to be able to order bloodwork
There is significant mention of the role of Perry Martin, a paid lobbyist for Shoppers Drug Mart pushing for this change. There’s also this line – “the pilot pharmacists were being deluged with patients prescribed point-of-care tests by Maple, the private company operating the eVisit virtual care service.” Curiously, even though Maple referred patients to Shoppers Drug Mart pharmacies, there’s no mention of the fact that Shoppers Drug Mart invested $75 million into Maple. One would think that if company “A” invests in company “B”, and then company “B” sends business to company “A”, and company “A”makes money from the government for that business (though public health insurance), that should get a mention.
The provinces physicians feared duplication of tests and fragmenting of care
There was significant push back to the statement that letting pharmacists treating minor illnesses led to a 9.2% drop in Emergency room visits in Nova Scotia – “Health officials checked, however, and concluded the drop was because of a combination of several initiatives.“
Unsurprisingly, the government noted “an Ontario report that surveyed pharmacists who complained of corporate pressure to hit quotas and revenue targets“
Most importantly to my eyes: “Nicole Poirier, the director of primary care, pointed out the report contained “no conclusive findings” that it reduced pressure on the public system, and did not show better health outcomes for patients.“

I bring this up because in Ontario, we continue to fail to heed these warning signs. On Sep 17, the Ontario government announced plans to consider expanding the scope of practice of many allied health care professionals (AHCP).

It’s not just this report from New Brunswick that should raise concerns. There has been a growing body of evidence over the years about how the idea of offloading “minor” illnesses to non-physicians doesn’t achieve the benefits intended.

For example a three year study of expanding Nurse Practitioner (NP) autonomy in US Veteran’s Health Administration hospitals found that:

There was a 7% increase in immediate costs to patient care, and an overall 15% in costs for caring for patients when one included downstream costs. This was attributed to NPs taking longer to evaluate patients and ordering more tests.
Sub optimal triage of patients was also noted leading to things like under‐admission when needed (leading to worse outcomes and later, costlier interventions) or over‐referral/overuse
Patients under NP care had worse decision‐making about hospital admissions and increased return ED visits (which cost more)

It’s not just studies that are opposed to scope expansion that have expressed concerns. In Australia, a generally favourable report to having AHCPs work to their full scope of practice, still mentioned the significant need for training, regulation, and funding to support safe expansion. The training part is important because contrary to what’s being put out, many AHCPs are not trained to recognize a potentially serious issue from a minor one. (You don’t know what you don’t know). The same report also mentioned significant concerns about more fragmented care, waste and higher long term health system costs.

Another generally supportive of scope expansion of NPs study purports to show that NP delivered primary care for patients with multiple chronic conditions show similar outcomes to care delivered by family doctors. BUT, a deep dive into the study showed that the models studied often included physician-NP teams, or limited scope expansions. They did not always include fully independent NPs. Training, team collaboration, and oversight often remained intact.

With respect to AHCPs expanding their scope of practice in general, a number of concerns need to reviewed.

First is antibiotic stewardship. This is a big problem as overprescription of antibiotics is increasingly resulting in more and more virulent and drug resistant strains of bacteria. As I’ve pointed out before – CANADIAN provinces which allow pharmacists to provide antibiotic prescriptions- have a higher per capita rate of antibiotic prescriptions than others. That’s just reality.

Secondly the reality is that AHCPs will over order diagnostic testing, particularly if they “are not sure” about the diagnosis. We saw that with the Veterans Hospital study above. We will see that if, as suggested, AHCPs will be able to order more and more tests.

Thirdly, there is going to be an increase fragmentation of care. Whether one looks at Japan, Norway, Great Britain, or really any other country, it’s been repeatedly shown than having a consistent family doctor will result in better health care outcomes and reduced costs to the health care systems. Central to this is the family physicians ability to provide a medical home where all of the patients information can be consolidated at one spot, and their ability to help patients understand and navigate health care.

In Ontario our system is so disjointed and disorganized that it is not possible for all of the testing/prescribing done by allied health care providers to get to the family physicians easily. This very quickly will lead to fragmentation of care and will eventually come back to hurt patients. To their credit, both OMA Past President Dr. Domink Nowak and current President, Dr. Zainab Abdurrahman have repeatedly pointed this out.

Finally one thing that has not been discussed is the liability concerns. I don’t see any of the people talking about expanding scope of practice acknowledging that there will be increases in the cost of liability insurance. We’ve already seen in the US that NPs have had increased lawsuits against them. I’m positive that this will happen to other allied health care professionals if these changes go through.

It’s fair to note that much literature also finds benefits (e.g. improved access, equivalent outcomes in many primary care settings, especially for chronic disease management), and some cost savings under certain models. The risk is that decision-makers may generalize from settings where allied expansion worked well under supportive conditions to settings where such supports are weaker. Which appears to be where we are heading in Ontario.

All of which means we should expect a newspaper report in about 2029 showing that expansion of scope of AHCPs has not shown the expected results. Say, isn’t that about the time of the next Provincial Election?

It Appears Family Doctors are Giving Up…

Recently, I attended the Menopause Society’s Biennial National Scientific Conference. I’ve long felt that medicine as a whole has done a poor job on women’s health issues, and wanted to learn more about what I can do to better help my patients. The conference itself was packed (over 600 attendees). Half of them were family doctors like myself. As with all medical conferences, not only did I get the chance to learn some valuable information to benefit my patients, I got a chance to network with colleagues from across the country.

Sadly however, a rather large number of family doctors I met were in a similar state of mind. They were tired, burnt out, and were actively exploring ways to stop practicing family medicine. In short, they were all giving up.

A dear friend of mine is taking 6 months off her practice to re-evaluate her work (despite having helped countless numbers of people over the years). Another physician has found happiness working part time at a specialty clinic and occasionally doing locums (vacation relief work). Another is actively looking to find someone to take over his practice. Another is simply going to close her practice after two years of trying to find someone to take over. Another…….ah, you get the point.

About one -third of the family doctors I spoke to were all at some stage of quitting family medicine. Given that Canada has 6 million people without a family doctor – which is already a disaster- it’s safe to say our health care system won’t survive if this happens.

About the only part of the country where family doctors seemed to want to carry on was Manitoba. They cited a new contract that fairly compensated them for their work, and a reasonably positive working relationship with the government. I guess that’s why Manitoba set a new record for recruiting physicians last year. Paying people fairly and working with them co-operatively will attract new talent? Who knew?

(As an aside, Manitoba is also the only province I am aware of that has a specific billing code for counselling women on issues related to peri-menopause and menopause).

But I digress. The question becomes why are so many family doctors planning on giving up? I would suggest it’s a host of issues. There is an increasing level of burnout in the profession. It’s primarily driven by by the administrative workload which has gotten out of hand. For example, I recently went on vacation to Manitoulin Island, and while waiting for the ferry, I couldn’t help but pull out my laptop and check my lab work and messages. I knew that if I didn’t check my labs every day, the workload on my first day back would be crushing.

Me in my car, waiting to get on the Chi-Cheemon ferry to Manitoulin Island, checking my labs and messages on my Electronic Medical Record (dummy chart on screen)

There’s also the constant delays in getting patients tests and referrals to specialists. The most common message I get from my patients is something along the lines of “I haven’t heard from the specialist/diagnostic test people yet, do you know when it’s going to be?”

And of course there is the ever present “But my naturopath told me you could order my serum rhubarb levels for free” and “I did a search online and it told me I need a full body MRI”.

The worst part of it of course, is that the family doctor becomes the brunt of the frustration and anger that patients express when the health care system doesn’t live up to their expectations. I had to tell three patients (while I was on vacation) that, no, I couldn’t do anything to speed up the specialist appointment. Four more were told that I had in fact called the pharmacy with their prescriptions – and I had the fax logs/email logs to prove it. And so on…

So what can be done?

In the absence of anything else of course, the first thing is to pay family doctors more. Recently, the Ontario Medical Association (OMA) and the Ministry of Health (MoH) have rolled out the “FHO+” model of paying physicians. There is a slight bump in pay (about 4% for the next fiscal year over this year). There is also an acknowledgement that administrative work needs to get paid and some other tweaks. It’s perhaps a start, but in the current system, a 4% raise will not stop the haemorrhaging of family physicians.

What really needs to happen is for Ontario to forcibly, quickly and rapidly move to a modernized, province wide electronic medical records system. I’ve been talking about this for years and years and even presented on this to eHealth Ontario (in 2018!). But I have not been able to explain it as well as my colleague Dr. Iris Gorfinkel did in her recent Toronto Star Op-ed. (It’s a really good read and I encourage you all to read it). To shamelessly quote her:

“A fully integrated, province‑wide, patient‑accessible electronic health record system should no longer be viewed as a luxury, but an essential part of the solution to Ontario’s existing crisis…… It would free family doctors to do the work only we can do.”

Secondly, we need to rapidly move towards team based care with family physicians as the lead of the team. While the MoH is announcing teams proudly in the hopes of connecting patients with doctors, the rollout seems kind of uneven. They amount to a call for proposals as opposed to a specific evidence based structure of how these teams should run. There’s also no specific role guarantees for family physicians in these teams (beyond saying they are important). The process seems slipshod at best.

Finally, at the end of the day we must not shame or diminish those family physicians who have given up. Many of them have spent years, if not decades fighting for better care for their patients. The fact that the unrelenting bureaucracy of our cumbersome health care system finally got to them and made them give up should be cause to shame the people in charge of health care, not the individual physicians.

Let’s hope that message gets across.

Patient Accountability ESSENTIAL for Health Care Systems

Canadians want a high functioning health care system. This requires (but is not limited to):

appropriate funding
a seamless electronic medical record
strong support for Family Doctors (the back bone of a high functioning health care system)
a “Goldilocks” level of oversight to ensure the needs of Canada’s diverse areas are met
and much more

But one essential feature that is not talked about nearly enough is patient accountability.

Doctors diagnose and treat patients. More of us (thankfully) are also discussing proactive measures to prevent people from getting sick (appropriate screening, lifestyle tips, advice on menopause/andropause etc).

BUT patients also bear a vital responsibility in their own health outcomes. When patients are accountable—meaning they are informed, engaged, proactive AND use the health system appropriately—health systems perform better. In contrast, passive, non-adherent patients who misuse health care will strain health systems.

What exactly is patient accountability? Partly it’s the degree to which individuals take responsibility for managing their health. This encompasses adherence to prescribed treatments, lifestyle choices, attending medical appointments, following preventive care recommendations and so on. Certainly patients who adhere to current guidelines for, say, diabetic care, will have fewer complications and wind up in hospital less and use health care resources less overall. This is why investing in proactive teaching for diabetics has been shown to not just improve health care outcomes, but also the cost to the health care system.

Patient accountability cannot exist without adequate health literacy. Patients must understand medical terminology, navigate health systems, and assess risks to make informed decisions. Without health literacy, patients cannot be expected to manage their care effectively. A diabetic patient who learns to read food labels, monitor blood sugar, and adjust insulin levels exemplifies accountability in practice. When one looks at just how disjointed our current health care system is, it is clear we have much work to do to improve health literacy amongst our patients – and that dollars spent to promote this, will be money well spent.

But patient accountability also refers to how patients use the health care system. Our health system is under pressure from growing demand, finite resources, and rising costs. Patient accountability plays a pivotal role in mitigating these challenges.

Non-adherence to treatment alone is estimated to cost billions annually in avoidable hospitalizations, emergency room visits, and disease complications. For example, failure to take antibiotics properly can lead to resistant infections requiring more intensive care. Likewise, patients who frequently miss appointments or use emergency departments for non-urgent needs place undue strain on systems designed for more acute care.

By contrast, when patients manage minor issues at home, access preventive care on schedule, and comply with physician recommendations, they reduce unnecessary utilization of high-cost services. This not only frees up resources for patients with more serious needs but also ensures that funding is directed toward value-based care rather than avoidable interventions.

During my time in practice, I have only seen one government paper that talked about patient accountability – the (in)famous Price-Baker report of 2015. Written by lead authours Dr David Price and Elizabeth Baker, and including luminaries like Dr. Danielle Martin on their expert committee, one of it’s ten principles stated:

“The system is built on joint accountability: Each primary care provider group is responsible for a given population and their primary health care needs. Both provider groups and citizens are expected to use the system responsibly.”

Since then of course I have yet to hear Drs. Price/Martin or any of the other authours talk publicly about patient accountability.

How does this work in other countries?

In Finland, patients are told they have the right to good care that respects their opinions and ensures that there is informed consent with treatment. This onus is on the doctors. BUT, Finland also puts accountability measures on the patients in the form of user fees. They are generally nominal, but they are there, and I would suggest, serve to make patients think about whether they are using the health system wisely.

In Norway a similar concept applies. Health care is heavily subsidized by public health insurance. However there are user fees up to a prescribed annual maximum (currently around $250 if I’ve done the currency conversion correctly). After that, all your health care needs are covered (nobody goes bankrupt if they get cancer).

Then we have the Netherlands. There you are required by law to purchase health insurance (there are many providers apparently). There are various packages from basic to more comprehensive and the costs vary. There is also, unsurprisingly, a deductible, known as Eigen Risico, which you have to pay, before your insurance kicks in. It’s mandatory.

I picked these three countries as examples because not only do have a reputation for providing excellent health care, but because they are often talked about in glowing terms by the two physicians who seem to be driving the change in Primary Care in Ontario, Dr. Jane Philpott (Chair of Ontario’s Primary Care Action Team) and Dr. Tara Kiran (principal investigator for the ourcare.ca project)

Dr. Philpott frequently mentions countries like Finland/Norway, not just in her book (Health for All) but in various interviews. Dr. Kiran has frequently mentioned the Netherlands. They have generally spoken in glowing terms about how well the health system works in those countries and how almost everyone has a family doctor there.

I’ve also never heard them talk about how those countries require patients to be accountable for how they use the health care system.

Currently, our health care system is poorly rated compared to its peers. Canadians want, and deserve a better system. But in order to get that, we need to recognize that preserving our health care system is a shared responsibility. Despite what the politicians say, you should NOT be able just to walk into a health care facility and automatically expect it to be perfect. Rather, we should all recognize that we taxpayers own the system. As owners, we have a responsibility to use it fairly, wisely and appropriately. And yes, that means putting in mechanisms like deductibles to ensure people think about how they use health care.

Or we can carry on with a health system in a perpetual state of crisis. The choice really is up to us.

Primary Care Reform Needs More Than a Phone Call

Dr. Madura Sundareswaran once again guest blogs for me. She’s a community family physician who’s resume is too long to print here. She helped found the Peterborough Newcomer Health Clinic and is a recipient of the CPSO Board Award which recognizes outstanding Ontario Physicians. I happen to think she is one of our brightest young leaders.

I was feeling incredibly optimistic after Friday’s SGFP report, which articulated the importance of family physicians in addressing the current primary care crisis. But that hope was abruptly crushed by a recent email I received from Ontario Health East. Ironically, it serves as a prime example of how health systems transformation continues to follow a top-down approach with little regard for the realities of primary care delivery.

In its latest communication to its members, Ontario Health East outlines a two-step strategy for clearing the Health Care Connect waitlist.

Let’s talk about the good first.

Given that the Health Care Connect waitlist has been largely stagnant, the proposal to verify and update the list is reasonable and welcomed.

In its latest proposal, Ontario Health East also commits to providing “interim services” for patients who are not immediately matched to a family physician or primary care team. This is great – and arguably where the new “Care Connector” portfolio should focus. Why? Because this is what many Ontarians need right now: assistance navigating our complex healthcare system without a family doctor.

Now, the not-so-good.

A large part of Ontario Health’s plan is to connect with every primary care clinic in the OHT to determine available capacity. If I am reading this correctly, they want to cold call every primary care clinic in the region and ask if they are accepting new patients. Are they aware that people have been trying to do this for years…?

To their credit, Ontario Health has expressed a commitment to support capacity-building. They’ve emphasized exploring “creative ways” to expand capacity at the individual clinician level — but this language effectively masks the absurdity of the underlying ask. The expectation appears to be that family physicians, already working at or beyond full capacity, can somehow stretch further, simply by reimagining how we work — all while receiving little to no additional resources.

To their credit, Ontario Health has expressed a commitment to support capacity-building. They’ve emphasized exploring “creative ways” to expand capacity at the individual clinician level — but this language effectively masks the absurdity of the underlying ask. It assumes that family physicians already working at full capacity, can somehow stretch further, by simply reimagining how they work — with little to no additional resources.

I’d like to apply the trending analogy of comparing our healthcare system to the public education system.

Imagine 30,000 children in your community suddenly need a place in schools – all at once. Instead of building new schools, adding classrooms, increasing the budget for school supplies, or hiring new teachers – the plan is to call each teacher and ask if they can “accept a few more students.” Not just one or two students– try about 100 each. Now teachers, please brainstorm how you can better meet this need (on your free time, of course).

Parents and teachers – would you allow this to happen?

The dilution of services is not the solution to this primary care crisis. This government’s current focus is entirely on numbers – with little regard for the quality of care being compromised in this process. What happens when each of us have 100 more patients with little to no additional support?

Less time for direct patient care as we dedicate more time to an overflowing inbox.
Longer wait times to see your family physician.
More strict enforcement of rules like “one problem per visit.”
Even fewer family doctors choosing to practice family medicine. More choosing to leave or retire early.

Some argue that teams will offset this burden. Full disclosure: I do think teams can help. But whose responsibility will it be to create medical directives, identify how the teams can best work, and continue to engage in quality improvement and assurance as this new process evolves? Family physicians. Back to the classroom analogy – it doesn’t matter how many other support staff you hire, a classroom of 130 students needs more than one teacher.

This proposal assumes we haven’t already asked—more accurately, begged—family physicians to take on more patients. We have, many times. And with limited success. And before I’m criticized for being negative or dismissing innovation, allow me to share my own experience.

In 2023 I founded the Peterborough Newcomer Health Clinic with the intention of supporting newcomers to Peterborough transition to the Canadian Healthcare system. In this process, I follow newcomers for 6-12 months after which I personally cold call family doctors and primary care nurse practitioners to see if any of them will accept my patients after I have done a great deal of work completing intake assessments and consolidating all previous health records. I have already brainstormed and implemented strategies to make the transition as easy as possible. Have I successfully attached my patients? Rarely. Many of these patients remain unattached.

This is just one story. Many in our community — advocacy groups, primary care providers, and local organizations — have made similar efforts with limited success. And let’s not overlook the fact that this proposed model of attachment completely ignores the issue of inequitable access for marginalized populations (another post for another time).

As I sit here on a Sunday, preparing to enter the week without sounding like a “grumpy physician,” here are my final thoughts.

In this race to reach 100% patient attachment to primary care; we must advocate to ensure that this is not done in a way that dilutes existing resources, compromises existing access to care and devalues family physicians who are currently working at full capacity. We need to protect our existing workforce and support sustainable growth. I encourage every user of our publicly funded healthcare system to advocate for this.
Family physicians – I urge you to continue to advocate for better remuneration and exercise caution when pressed to roster more. Please remember that our contracts exist with the Ministry of Health and Long Term Care. When new opportunities arise – exercise due diligence to ensure that what is being asked of you aligns with the policies of your own practice/organization and the CPSO.
Rushed, expensive, and poorly planned reforms that focus on quantity, not quality is not good for patient care. Failing to address the core issues with primary care – demonstrated by fewer and fewer family physicians choosing to practice comprehensive, community-based family medicine – is resulting in top-down, expensive, and band aid solutions to the primary care crisis. It edges on careless spending on taxpayer dollars. We should advocate for a system that prioritizes sustainable, safe and equitable care – not just a solution for tomorrow.

Disclaimer: The views expressed in this piece are my own and do not necessarily reflect those of any affiliated organizations or institutions.

Survey on Delayed OHIP Payments

NB: The following is a guest blog, written by the (anonymous) author of the survey I referenced in, “Will the OMA Learn Lessons from OHIPs Latest Attack on Doctors?“. While it’s true these surveys tend to attract negative responses by their nature, the rather large number of respondents (especially compared to some of the OMAs own Thought Lounge surveys), suggests the OMA really needs to pay attention to the extreme dissatisfaction this issue has caused. My thoughts follow at the end.

The purpose of this survey was to highlight to the OMA the need to take this issue more seriously and to outline the impact the delayed payments had on members. The OMA’s response to this has been tepid. At the time the survey responses were collected, the payment timeline for November and December, 2024 retroactive pay was set as November, 2025. This was changed to August, but this does not alter the fact that the MOH has repeatedly delayed payments for physicians over the years.

Even with a signed, public agreement, the MOH has not managed to uphold its obligations, yet the OMA seems resigned, on behalf of its members, to accept whatever delays happen, based on whatever excuse the MOH provides. The members are not the cause of the MOH’s problems, yet they pay, over and over, for these deficiencies.

The survey results are summarized below. As a practicing physician, my time is at a premium, so I utilized AI to summarize the main findings of the survey.

Technology willing, the full survey results are here. Survey Monkey dashboard is here.

AI-Generated Summary of the Full Survey Document:

The survey responses reveal widespread dissatisfaction among Ontario physicians regarding delayed payments, systemic issues in healthcare administration, and inadequate advocacy by the Ontario Medical Association (OMA). Key themes include the impact of late payments, financial hardship and impact to personal finances.

Many respondents reported being unable to meet financial obligations, pay taxes, or fund discretionary purchases due to delayed payments. Some had to take on debt or cancel planned expenses like maternity leave benefits, vacations, or home down payments.

Clinic Operations:

Clinic owners faced cash flow disruptions, inability to pay staff, and delayed renovations. Others mentioned the administrative burden of tracking payments and rejected claims.

Mental and Emotional Toll:

Physicians expressed feelings of moral injury, frustration, and discouragement, with some considering early retirement or leaving the province entirely. The delay has eroded trust in the Ministry of Health and the OMA.

Lack of Accountability:

Respondents described the Ministry as untrustworthy, disrespectful, and adversarial, with unilateral decisions that breach agreements. Many called for interest payments on delayed funds and legal action to hold the Ministry accountable.

Systemic Issues:

Complaints included outdated payment systems, rejected claims, and lack of transparency in billing processes.

Weak Advocacy:

Many respondents felt the OMA failed to advocate strongly for physicians, with delayed and insuﬃcient responses to the payment issue. Some called for legal action, media campaigns, and stronger negotiation tactics.

Loss of Trust:

Physicians expressed frustration with the OMA’s perceived lack of power and transparency, with some questioning the value of membership dues.

Declining Appeal to Practicing in Ontario:

Many respondents are considering leaving Ontario or medicine altogether due to poor compensation, lack of respect, and systemic challenges. Some noted that other provinces offer better pay structures and support.

Family Medicine Crisis:

Respondents highlighted the lack of investment in family medicine and primary care, with concerns about burnout, scope creep, and inadequate funding.

Rejected Claims:

Physicians reported valid claims being rejected by OHIP , causing financial losses and administrative burdens.

Delayed Payments:

Delays in flow-through funding, parental leave benefits, and relativity-based fee adjustments were frequently mentioned.

Outside Use Penalties:

Respondents criticized penalties for outside use, especially when patients sought care elsewhere due to hospitalizations or urgent needs.

Recommendations for Advocacy:

Demand Accountability:

Push the Ministry to honour agreements, pay interest on delayed funds, and improve payment systems.

Increase Transparency:

Advocate for clearer communication about payment timelines, rejected claims, and billing processes.

Strengthen Negotiation:

Take a more aggressive stance in negotiations, including legal action and public campaigns to highlight the Ministry’s failures.

Support Physicians:

Address broader issues like rejected claims, outside use penalties, and inadequate funding for family medicine and specialists.

Conclusion:

There have been severe financial, emotional, and operational impacts of the delayed OHIP payment. There is an urgent need for the OMA to advocate more forcefully with the Ministry of Health to address late payments and systemic issues affecting Ontario physicians. Physicians are calling for immediate action, including interest payments, stronger advocacy, and accountability from the Ministry of Health and the OMA. The dissatisfaction expressed by respondents highlights the risk of losing physicians to other provinces or professions if these issues are not resolved.

An Old Country Doctors Thoughts:

While the above was written by my colleague, my personal thoughts on the survey is that I’m not really surprised by the results. I try to “keep my ear to the ground” so to speak, and there is a broad level of dissatisfaction with how the MOH repeatedly gets away with violating its own signed contracts, and the frankly abject level of incompetence at the MOH. The incompetence is unfortunately, not limited to just their payment systems/processes, but also how they run health care in general.

I’m also not surprised by the negative comments towards the OMA. Admittedly (as mentioned before) these surveys tend to cater to negative responses. However, there is a real sense of defeat on the ground about how physicians are being treated by the current government (protracted arbitration, stupid statements about the family physician shortage, and more). My sense is most physicians are resigned to defeat and are disengaging from health care – which is bad for the whole health system.

It does not help frankly, that a few short days after being told physicians would not get paid on time, OMA CEO Kim Moran was quoted in an Ontario Government News release on Primary Care saying:

“Ontario’s doctors are encouraged by this announcement and look forward to working with government to ensure that every Ontarian has access to a family doctor. We will do everything we can to accelerate this goal by collaborating with Deputy Premier and Minister of Health Sylvia Jones, and the lead of the Primary Care Action Team, Dr. Jane Philpott. It’s a long road ahead but this is a positive step forward to protecting Ontario’s valued health care system.”
Kimberly Moran
CEO, Ontario Medical Association (OMA)”

A very well respected physician from another province told me after seeing this: “It’s a bit pathetic. Screw us over and we’ll still be nice to you”. Personally I think Ms. Moran should look up “Stockholm Syndrome“.

I’ve repeatedly said you cannot have a high functioning health care system without happy, healthy and engaged physicians. These survey results suggest that that isn’t the case in Ontario.

Dear Sylvia Jones, Here’s How to Make Health Care More Convenient…

Congratulations on winning the last election and being re-appointed health minister. The health ministry is the toughest job in government. I sincerely mean now, what I wrote before, that all of us should hope you are successful. Ontario deserves the healthiest possible population.

Of course, that still won’t stop me from giving you advice (whether you want it or not)……

I’ve noticed that you place a really high value on making sure that health care is “convenient.” Your government even calls the overall program “A Plan for Connected and Convenient Care.” Your talking points in the press always mention “convenient.” Even the second major outline for health care uses that word.

I would suggest that rather a lot of your health care platform is based on making people happy by giving them what they want and making things easier for them. For example, your boss, premier Doug Ford, when talking about the expanded scope of practice that allowed pharmacists to prescribe treatments for minor ailments focused almost exclusively on the fact that it was one of the most popular things your government has ever done. The public was satisfied, so it must be a good thing.

Now I appreciate that you don’t have a health care background. If you did, you would know, that convenient health care, and patient satisfaction in health care, actually have a negative correlation with health care outcomes. Essentially, when patient satisfaction with the health care system goes up, the health care outcomes get worse. A study published in Medscape showed that focusing on patient satisfaction lead to 12% higher hospital readmission rates, 9% higher health care costs and 26% higher mortality rates.

Basically, focusing on convenience and satisfaction in health care costs more, makes people sicker and kills more people.

However, at this point, I doubt that I can get you to shift away from this philosophy. So I have an idea that will make health care much more convenient for people. Something that will reduce the amount of travelling back and forth that people do, and will allow them to quickly and easily get their health care needs taken care of in one spot.

It’s time for you to amend or revoke regulation 114/94 under the 1991 Medicine Act. This prohibits physicians from selling medications to patients. My sincere thanks to OHIPs former lawyer, Perry Brodkin, for pointing this out to me on X.

How will this be convenient? Well, right now, when a patient goes to see a physician for, let’s say high blood pressure, the patient will get assessed by their family doctor, and based on their medical history, an appropriate medication will be chosen for them. They will then drive to the pharmacy with that prescription. The pharmacy will take however long it takes for them to fill out their prescription, and after a period of waiting, the patient will get their needed medication.

By allowing physicians to have their own dispensary, a patient will now go to the physician’s office, and if a prescription medication is deemed necessary, they can just purchase it from the physicians office right then and there. It saves them an extra drive, and perhaps even parking lot fees depending on where they go. This will, of course, be extremely convenient for the patient.

What’s that you say? Isn’t this a conflict of interest? I mean, if a physician is now able to sell the drugs after making a diagnosis, wouldn’t it encourage physicians to prescribe more medications?

Um, can I ask why that didn’t seem to bother you when the pharmacists were allowed to expand the scope of their practices by you? Pharmacists now make an assessment for certain minor illnesses, get paid to do that by the government, determine what in their opinion the right treatment is, and then sell the patient the drugs at a profit. (This is what naturopaths and some chiropractors do as well, but that’s a whole other story.)

What’s that you say again? Pharmacists have to abide by a certain code of conduct from their college. They are bound by their code of ethics to act in the best interests of their patients. Um, ok. You do know that physicians also have a college that we answer to, right? You do also know that physicians also have a code of ethics? That we all took an oath to do no harm to our patients?

Might I ask exactly what the difference is between these two scenarios?

Of course, while most patients would be happy for this convenience, I imagine not everyone will be happy. I suspect (Shoppers Drug Mart bigshot) Galen Weston would be quite annoyed if you did this. But hey, look at the bright side, at least you won’t have to deal with some miserable crotchety old country doctor spouting off in the media wondering who exactly the health minister was in this province.

Galen Weston, of Shoppers Drug Mart and Loblaw fame.

Look, at the end of the day, for me, it’s health care outcomes that matter the most. I want patients to have the best possible results for themselves and health care as a whole in Ontario. But if you are going to insist on “convenience” then at least do it in a way that’s fair to all of the health care professions.

Change or amend the 1991 Medicine Act to make life a little easier for the patients.

Yours truly

An Old Country Doctor

P.S. While you’re at it, don’t forget to direct your OHIP Bureaucrats to not seek repayment from Dr. Elaine Ma. Don’t think doctors in Ontario have forgotten about this situation.

Unrelenting Bureaucracy is Killing Health Care (and Canada)

Canadians are currently dealing with the dizzying spectacle of Donald Trump’s tariffs against our country. On again? Off again? Delayed? Doubling? I’ve personally gotten seasick trying to keep up with whatever tangerine Palpatine is thinking.

U.S. President Donald Trump – aka the Tangerine Palpatine

However Canada’s response to this (and the nonsense about us becoming the 51st state) has frankly been quite lacking. Yes, it’s great to see Canadians being able to fly the flag with pride, especially after the miserable co-opting of the Canadian flag by the freedom convoy types, who likely themselves were Donald Trump supporters. (How’s that working out for you guys now?) Yes #elbowsupCanada is a wonderful approach to take and a great mantra going forward, particularly with how intertwined hockey is with our nation. (Quick reminder: Not only do we win Olympics, we win Four Nations Cups as well).

BUT, for all the outcropping of (absolutely warranted) national pride – our governments – outside of launching retaliatory tariffs, haven’t done anything to fix the systemic problems in our economy. For example, getting rid of domestic trade barriers and having free trade between provinces would provide a boost of up to $200 billion dollars to our economy, but seemingly no action on this yet.

Even more importantly and what’s long overdue, is an absolutely necessary look at the bureaucracy and impediments that many businesses face in trying to contribute to our economy. Let me talk about a personal experience (and no disrespect intended to the good people on staff in my township).

About 10 years ago, our community had clearly outgrown the medical centre. Some poor sap was put in charge of expanding it. (Guess who.) I had to deal a myriad of problems of putting an addition on our medical centre. Here’s a couple of examples of what I dealt with.

As per policy, the township requested that we provide an engineered site plan. The reason for this was to assess water drainage requirements. While on the surface this makes sense, all the engineered site plan was going to tell us what size of culvert to put on our property for water drainage. The estimate for the site plan was about $15,000.

A sad, lonely culvert, passing its life away draining water…

However, it turns out there were only two sizes of commercial culverts for our project. A big one and a small one. The big one cost $500 more than the small one. Being well-versed in the obstinacy of Ontario Health’s bureaucrats, but somewhat naive in the inflexibility of municipal bureaucrats, I offered to simply put in the bigger culvert right from the start in exchange for waving the engineered site plan.

Those discussions went as well as my less naive readers will expect. The site plan wound up costing $17,000, and it told us that we had to put in the big culvert.

Want more? The township requested a $250,000 letter of credit or certified cheque prior to approving the expansion of the building. My initial reaction was somewhat negative to this request, but upon reflecting, I did realize that it made sense. The request was put in place in case a builder started a project, ran out of money before they finished the project, and left a hole in the ground. The money would then be used to pay to clean up the mess they made.

I still grumbled about the fact that the township was making long term doctors who were clearly invested in the community do this, but I have to concede that it was fair.

The bank informed me there’s some complex fee formula for a letter of credit – and it would have cost $5,000. I asked them for a certified cheque, and it turns out banks don’t do that anymore. However, they were willing to issue a bank draft and the fee for that was $50. Obviously, I got the bank draft instead.

When I went to the planning office however, I was told this was unsuitable. The contract we signed specifically asked for a Letter of Credit or Certified Cheque and I had presented neither. Therefore we had not met the terms of our contract and the project would come to a halt. The staff person did offer to take this to the planning committee, and six weeks later they decided this was ok.

Is this me just griping? Nope – in fact his is happening all through health care and businesses in Canada. I recently spoke to the owner of a Nursing Home. His home had been approved on a “fast track” for a new build based on the dire shortage of nursing home beds in Ontario. I asked when the facility would be built and he just laughed. Apparently “fast track” means that there will “only” be 30 months of paper work (!) before the shovels go in the ground and he hopes it will be completed in 5-6 years!! I’m guessing this “fast track” must be on Toronto’s Eglinton LRT line….

A sad, lonely train on Toronto’s much, much, much delayed Eglinton LRT line

Want more? Just look at the saga of my local hospital, the Collingwood General and Marine. We’ve known for almost two decades that it’s far too small for the community. Heck the community has been asking for a new hospital since the early 2010s and finally got approval on phase 1 (of 5) in 2016. And 9 years later (!) we are at phase 3. The “hope” is that the new building will open its doors in 2032 – 16 YEARS after it was absolutely clear a new hospital was needed immediately.

This problem is not restricted to the health care sector of course. The Financial Post had a piece in 2019 (!) about how these rules are affecting multiple industries. Not only are we not building critical infrastructure in a timely manner because of an inability to cut the bureaucratic bloat, but it’s stifling private businesses as well. The Canadian Chamber of Commerce pointed out that the “ease” of doing business has gone from fourth in the world in 2006 to 53rd now, and this impedes economic growth and investment.

New Prime Minister Mark Carney is off to Europe this week to build trade and strengthen relations. Nothing wrong with that, we need reliable trade partners in the future. BUT, we face an unhinged, hyper volatile situation with our neighbours to the south RIGHT NOW. It seems to me there is no better time than now to drop intra Provincial trade Barriers and right size the bureaucracy allowing for businesses to grow and thrive more easily in Canada. As for health care, the right time was 10 years ago.

Health Care in the Ontario Election: Lots of Sound Bites, No Strong Policy

Last week, I had the opportunity to talk to Greg Brady, on his 640 am radio show, Toronto Today. The episode is on Spotify and, if you are in need of a great cure for insomnia, you can catch me starting from about the 19:30 mark:

Six and half minutes is not enough time to discuss health care in Ontario. Neither is a 1,000 word blog, but that won’t stop me from trying to expand on some of my thoughts.

The first and most prevalent thought I have is disappointment in ALL of the political parties for how they have addressed health care so far. Everyone on the front lines of health care has known for a least a decade that we need bold transformative changes in how health care is run and delivered in Ontario. Probably all of Canada.

And yet, the four would be Premiers all fail to outline a plan for such transformation. Instead, they have all resorted to that age old political vote grabbing stunt of saying “Let’s just throw more money at the problem” without actually reminding you that the money is going to come from YOUR pockets and is going to be, frankly, poorly spent.

The Conservatives hired Dr. Jane Philpott to oversee a spend of $1.8 billion in a plan to connect everyone with a “primary care provider” in the next few years. As I’ve written before, that plan, through no fault of Dr. Philpott, who I have a great deal of respect for, is doomed to failure.

The Conservatives did not start the downfall of family practice in Ontario (that was the miserable Eric Hoskins/Bob Bell duo during the wretched Kathleen Wynne years). But they sure haven’t done enough to fix the mess they inherited. Economist Boris Kralj, PhD, recently showed in the Medical Post that Ontario lost 238 family physicians in 2022/23 – the biggest loss of any province.

The Liberals for their part want to spend 3.1 Billion dollars. At least they promise everyone a family doctor and not a “provider” (and yes, there IS a difference, a BIG one between the two). However, their plan amounts to spending $1.3 billion more than the Conservatives. Spending more without changing things seems naive at best.

The NDP promise to recruit 3,500 more doctors, promise family doctors for everyone, cut red tape, establish a “Northern Command Centre” for health care (that’s actually a good idea) – all for the low low price of only $4.1 Billion dollars, a billion more than the Liberals.

The Green Party promises are actually the most detailed I could see, including lots of goodies, like recruiting more doctors, building more nursing homes, increasing nursing student spots, hiring 6,800 personal support workers and more. There is only one thing missing from the proposal (at least on their website). How much this will all cost YOU, the taxpayer.

Ontario spends $81 billion in taxpayers dollars on health care. Rather than look to see if that money is being spent wisely, and looking to transform health care, all the political parties are simply giving us sound bites. They promise to spend $83-$85 billion on the same failing system, without looking at changing things. Because spending more inefficiently will surely fix things.

OK Smart Guy – What do YOU Think Should Be Done?

Glad you asked dear reader, glad you asked. At an absolute minimum I’m looking for a party that has the political courage and wisdom to do the following three things.

First, A complete hiring freeze on all bureaucrats in health care, including not replacing those who retire, or leave for other reasons.

Currently Ontario has 10 times as many health care bureaucrats per capita as Germany. That’s too many. This means that any meaningful suggestions for change have to go through so many bureaucrats that the whole system is plagued with paralysis by analysis. Time to trim the fat.

Second, ensuring one, and only one, patient app that every resident of Ontario has, which will have access to all their health care data, and allow them to share this with the health care specialist or facility of their choice

Ontario is a digital health nightmare. Your health information often times can’t be shared if you go from one hospital to another, or one doctor to another. There are multiple inefficiencies and unnecessary repeat tests because of this mess and it should never have been allowed to occur.

It would be too expensive and too time consuming to force every health care facility to use the same electronic medical records system. What can be done however, is to force all the systems to integrate with ONE patient app. This will ensure a common standard, and moreover will allow a hospital you happen to be in, to access your out patient information (with your permission) which just doesn’t happen now.

Third, ensuring strong family physician representation at the board level of the Ontario Health Teams.

There is a lot of talk about the benefits of team based care. As someone who views one of his proudest achievements to be the founding Chair of the Georgian Bay Family Health Team, I would agree with this. The current plan for Ontario Health Teams does have merit. BUT, in order for these teams to succeed, they need strong family physician leadership at the GOVERNANCE level. That’s right, you need to put doctors (and more than just a token one) on the Boards of these teams and ensure the teams are led by them – for best clinical outcomes. I don’t see that in the plans.

Final Thoughts

My usual followers will know that I generally vote on the conservative side of the political spectrum (de gustibus non est disputandum). However, I’ve been frankly disappointed that the current Conservative government has been anything but conservative. Sadly, the other parties are really not offering the kind of transformative solutions we need in health care either. I firmly believe that we should all vote in elections, and I certainly will, but for now, call me an undecided old country doctor.