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Team-based care needed to solve shortages

October 17, 2022   ·   0 Comments

By Mark Pavilons

Not having a family doctor could very well mean the difference between life and death.
What’s desperately needed is a team-based care approach to health care in this province.
Bolton physician Dr. Michael Gagnon explained Ontarians are suffering from the lack of proper care, largely due to a lack of general practitioners. The latest data indicates that 1.8 million residents are without a family doctor, and another 1.7 million are served by GPs who are 65 or older. When these doctors retire, it will leave a huge gap in the system, something Dr. Gagnon called “crazy.”
There are many reasons for the shortage, and one is the fact more physicians than ever before have retired in recent years, with few ready to fill in the gaps. Dr. Gagnon also noted that new medical school graduates are leaning towards specialities, and not general practise, further compounding the shortage.
Sure, there will be more specialists on the horizon, but Dr. Gagnon pointed out that’s a seven-year process, not an immediate one.
Further, to make general practice more attractive for new doctors, it has to be less stressful.
“The base of the pyramid of health care is the family doctor,” he said. “Without those, the whole thing collapses.”
He pointed out he personally receives upwards of three calls per day from people looking for a physician. He knows of only one doctor in Bolton who is currently taking on new patients.
The family doctor is the “quarterback” for the system and as a primary point of contact for patients, can help treat, monitor and identify illnesses. Without a physician, people are going untreated with many illnesses and diseases. What happens is they get sick and end up in hospital ERs. The hospitals are therefore becoming the de facto primary care locations.
“That doesn’t work,” Gagnon observed, adding this adds to wait times and ends up costing the health care system more money.
One solution within our grasp is a team-based approach. Family doctors, supported by a network of specialists, can diagnose and treat patients more efficiently.
The example Dr. Gagnon used is mental health, which has seen a tremendous rise over the past couple of years. If his “team” included a social worker, for instance, he would refer several patients a week, freeing up his appointment schedule for other patients.
The incidence of mental health is reaching alarming rates and Dr. Gagnon estimates he sees 3-4 mental health cases per day – an unprecedented rate.
It was a “perfect storm” of factors that have led to this increase. The stresses of the pandemic, along with job security and social anxiety have all come together to weigh heavy on people. But COVID-19, Gagnon notes, definitely pushed people over the edge.
The team approach means using resources – especially physicians – wisely. He suggests if the government invests more in this team care idea, all of the parts can become more efficient and work together to lessen the burden.
He estimates that only 25% or so of Ontarians have access to team-based care. If this system removes just one person per week from emergency rooms, it pays for itself, he said.
Physicians are also burdened by paperwork and Dr. Gagnon says it works out to roughly a 1:1 ratio – for every hour he spends with a patient, there’s one hour of paperwork.
Also, given the lack of physicians all around, specialists, too, are overburdened. Dr. Gagnon said it’s not uncommon for him to have to refer a patient three times before a specialist agrees to see them.
Every minute spent bogged down in the process takes away from patient care.
“A central referral service is necessary and the OMA is apparently working on a process, like some places have for mental health,” Gagnon said. While we’re “getting there,” he said, he notes that it needs to happen now.
The government needs to look at the data to realize the system is costing lives. Dr. Gagnon said diseases like cancer are being diagnosed later than ever before, largely due to the doctor shortage. Delays caused by COVID have made matters worse and he sees it every day in his palliative care role.
“There’s a huge inequity in health care,” and we have to expand the team-based care approach, so that everyone can have a primary care provider.
Hopes are representatives of the College of Family Physicians (OCFP) can meet with Health Minister Sylvia Jones to find some reasonable solutions.



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