Called FHO+, the proposed deal<\/a> recognizes the behind-the-scenes work of family doctors and will compensate them for clinical administration, such as charting and filling out forms.\u00a0\u00a0<\/p>\n\u201cIt\u2019s a model that we hope will encourage more doctors to go into providing this critical cradle-to-grave care,\u201d Barber said.<\/p>\n
Why he is sticking with family medicine<\/p>\n
\u201cIt\u2019s where we can have the biggest impact. Keeping people healthy, keeping them out of hospital, doing a lot of preventative care, catching diseases early so something can be done about them \u2026 It\u2019s nice making a positive difference in somebody\u2019s life.\u201d<\/p>\n
Dr. Rosemarie Lall<\/p>\n
![\"Rosemarie](\"data:image\/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAQAAAADCAQAAAAe\/WZNAAAAEElEQVR42mM8U88ABowYDABAxQPltt5zqAAAAABJRU5ErkJggg==\")
<\/p>\n
\u00a0Dr. Rosemarie Lall.<\/p>\n
Giovanni Capriotti for the Toronto Star<\/p>\n
A family physician for more than 30 years, Lall works in a family health organization in Scarborough that cares for roughly 10,000 patients. Lall\u2019s own roster of patients is more than 1,500 and is considered on the larger side for a family doctor, which she said is typical for an older physician. \u201cData shows when an older doctor like me retires, you need three new doctors to replace us.\u201d<\/p>\n
In a family health organization, doctors are paid through capitation. This means doctors receive payment from the government determined by the number and complexity of patients on their roster. In this model, doctors can also bill OHIP for some services. Lall said she typically grosses $6 for every patient she sees on top of her baseline payment.\u00a0<\/p>\n
The rising cost of running a practice is most pressing for Lall. She and the other doctors in the family health organization pay a portion of their earnings to support the practice.\u00a0<\/p>\n
Expenses include everything from snow removal ($2,000 a month, from November to March; though Lall has bought a plow to save money) to office and medical supplies, such as toilet paper, paper clips and cleaning products ($700-$800 a month).\u00a0\u00a0<\/p>\n
The family health organization has 16 full- and part-time staff, whose salaries cost the practice roughly $35,000 a month. The computers, software and program support needed to run the organization\u2019s electronic medical records for their patients costs almost $1,600 a month (including $320 for the software that handles the faxes electronically).<\/p>\n
At the height of the COVID-19 pandemic, when costs rose without a corresponding increase in revenue from the government, Lall said she had to put $20,000 of her own money into the practice to keep it afloat.\u00a0 \u00a0<\/p>\n
Administrative pain point<\/p>\n
\u201cThe increasing medicalization of forms that require a physician evaluation and sign-off is taking time away from patient care,\u201d said Lall, adding that filling out forms consumes an ever greater part of her to-do list. \u201cLet me practise what I\u2019m trained for. I didn\u2019t go into medicine to do paperwork.\u201d<\/p>\n
Searching for patients\u2019 medical records also takes up a large chunk of Lall\u2019s time. If one of her patients goes to a Muskoka hospital for care, for example, she doesn\u2019t automatically receive notes or results. \u201cMy system doesn\u2019t talk to that hospital\u2019s system; we\u2019ve got to track it down,\u201d she said,\u00a0noting this means logging on to other platforms for information. \u201cIf you do five extra clicks to get information on a patient, for 25 to 35 patients a day, that\u2019s a lot of extra time from my day.\u201d<\/p>\n
Writing notes following a patient\u2019s exam was among Lall\u2019s most time-consuming tasks, seeping into evenings and weekends. Since June 2023, Lall has been using an AI scribe to summarize her patient visits, which she reviews and edits to ensure accuracy.<\/p>\n
\u201cIt\u2019s been life-changing,\u201d said Lall, an early adopter of the technology. Though she pays $135 a month for the tool, Lall said it\u2019s worth it. \u201cIt has decreased my charting time to a fraction of what it used to be. On really good days, I\u2019m done my notes by the end of my workday.\u201d<\/p>\n
Why she is sticking with family medicine<\/p>\n
Even after three decades, Lall enjoys the daily challenge of solving patients\u2019 health problems. Hearing a patient say \u2018Thank you for being my doctor; thank you for being there for me\u2019 remains the best part of her job. \u201cYou\u2019re not just a heart, you\u2019re not just a big toe or your blood sugar result. People appreciate that whole-person care.\u201d<\/p>\n
<\/p>\n
Dr. Madura Sundareswaran, a family doctor in Peterborough.<\/p>\n
Supplied<\/p>\n
In practice for six years,\u00a0Sundareswaran works in a family health organization in Peterborough, where she provides comprehensive primary care to 760 rostered patients. She is also the founder of the Peterborough Newcomer Health Clinic, a pilot project that helps newcomers and refugees transition to the Canadian health-care system. In this role,\u00a0Sundareswaran looks after 50 to 100 patients who don\u2019t have immediate access to primary care.<\/p>\n
Like most family doctors,\u00a0Sundareswaran points to the rising cost of overhead without the proportional rise in wages. She said family doctors under most payment models, including family health organizations and fee-for-service, effectively subsidize 30 per cent of a patient visit\u00a0\u2014 a cost not often factored in payment from the government.<\/p>\n
\u201cEncompassed within that single visit is the overhead cost of the day-to-day operations: the staff, the rent, the supplies\u00a0\u2014 everything from the pen that we use to the crinkly paper on the bed,\u201d\u00a0Sundareswaran said.<\/p>\n
She wants people to understand that doctors even incur costs of medical supplies, whether that\u2019s purchasing the plastic speculum required for cervical cancer screening, or buying the syringes and needles for vaccines. \u201cEven the fridge to properly store vaccines, we need to buy and maintain it.\u201d<\/p>\n
Rather than forcing doctors to find efficiencies or cut overhead costs, the focus needs to be on increasing compensation for family physicians who provide comprehensive care,\u00a0Sundareswaran said. To back up her point, she said data cited by the College of Family Physicians of Canada shows that family doctors provide about half of all medical services in the country, but account for just 5.7 per cent of total national health spending.\u00a0<\/p>\n
\u201cThat has to be factored in when we\u2019re trying to recruit doctors to do longitudinal, comprehensive family medicine,\u201d she said. \u201cWe\u2019re up against jobs in hospitals or emergency departments, where there is no overhead. Our pay has to reflect that difference.\u201d<\/p>\n
Administrative pain point<\/p>\n
Sundareswaran\u00a0is working with colleagues in Peterborough on a project that\u2019s asking local family doctors to pinpoint specific tasks leading to administrative burden and burnout. One that keeps popping up, she said, are those that \u201cneedlessly increase our cognitive load and strain.\u201d<\/p>\n
A patient\u2019s discharge summary from hospital is one such task. While critical for a family doctor to review,\u00a0Sundareswaran said reports are now dozens of pages long, often with inconsistent formatting, making it both time-consuming and difficult to identify the patient\u2019s plan.<\/p>\n
\u201cIt used to be that we got maybe one or two pages, and we could scroll to the bottom and easily say \u2018Yup, this is what is needed,\u2019\u201d she said, noting these reports contain test results, diagnostic imaging summaries and notes from different physicians. \u201cNow, we might get a 30-page document, and you\u2019re filtering through it and there\u2019s this constant fear that you\u2019re missing something.<\/p>\n
\u201cThis is a new problem. We\u2019re getting so many reports, and so many FYIs, and so much information \u2026 we\u2019re burying important data in thousands and thousands of documents.\u201d<\/p>\n
Ensuring family physicians feel their expertise, skills and leadership is respected and valued would go a long way in convincing doctors to keep providing comprehensive care to patients,\u00a0Sundareswaran said.<\/p>\n
\u201cMy colleagues are dropping like flies; they\u2019re leaving practice because they\u2019re not feeling valued,\u201d she said. \u201cThere is a lot that\u2019s complicated to fix (in family medicine). But something that the government and the public can do is help us feel valued.\u201d<\/p>\n
Why she is sticking with family medicine<\/p>\n
\u201cThe longer I\u2019m in practice, the more I value the patient-physician relationship,\u201d she said, adding that research shows patients have better health outcomes when they have a strong relationship with their doctor. \u201cBeing an important part of people\u2019s health-care experience, I really do value that.\u201d<\/p>\n
<\/p>\n
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