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There is no doubt that your access to health care is deteriorating. If current trends continue, I foresee the extinction of family based medicine within the next 50 years. The system is molded by consumer trends spurred on by Ministry decisions. I do see the day coming when the needs of the time-strapped patient will be met by an array of impersonal technicians whose task will consist of screening minor ailments around the clock in large factory-like settings. Developing Family Health Groups is the latest answer to squeeze more water out of a dry mop. Although well intentioned, it uses the same brush for every color. In a place like Peel, even though I reluctantly joined the FHG, I really see no advantage to my patients. Even I am confused about how it can apply here in a beneficial form.
FHG was a model designed to provide better access to care for patients in smaller communities. When I first heard of the concept, admittedly I was interested. Yet I was somewhat confused because local physicians implemented the basic elements contained in the model years ago. Take, for example, access to a group doctor after hours and on weekends. More than a decade earlier, a large group of family docs in the Credit Valley area got together to address the issue. The idea was to set up a clinic where patients could go in the evenings and on weekends, see a familiar face, not wait hours and the treatment information would be sent to their own doctor. Neither the hospital nor the ministry would co-operate or help fund such a venture. The hospitals in our region proudly bear the term "community" but they have all "forgotten" to set up family practice centers. This determined group of family docs went on to form an after-hours clinic with their own funds and still take regular turns working there, significantly relieving emergency wait times.
The FHG model requires doctors to form groups. They would be provided with integrated computer technology to share and exchange important medical data. A nurse practitioner would be on hand to help with patient problems supposedly freeing up more time to do direct patient care. I was surprised to learn that it offered nothing to clear up backlogs of patients awaiting services and tests, made no attempt to update the antiquated office technology used on patients or update skills. Worst of all, it continued to function on a fee-for-service basis restricting what and how much can be done for a patient. To qualify, I had to agree to see emergencies in the clinic after hours, cover hospital patients, be on-call, etc., etc. All the things I have been doing for years. One of my pet peeves in medicine is the lack of computer based information sharing. There are databases available to instantly track where you drive to, whom you talk to, how much tax you pay, where you spend your money, and whom you owe a debt to, but no ability of notifying me that your child had a drug reaction, your husband had a heart transplant, or whether or not your grandmother obtained the medications I prescribed. The vital info rarely made it to the chart because people rarely know where to send it, and rely on the pony express. Native Americans originated the current info gathering system available to docs. It is called "word of mouth" or "show and tell." You walk in, show the scar and tell the doc what procedure you had. This frustration results in the "what's the use?" attitude. Hoping to improve this situation was a major reason for my agreeing to be part of the FHG.
Most patients in these parts will notice little change. What existed before has been re-invented and now exists in two forms. The computer based medical information sharing is still on the "drawing board." The nurse practitioner turned out to be a 1-800 number to somewhere. I have no clue as to who is on the other end and I cannot see how they can know anything specific about your health. So now you have two 1-800 numbers to call in the middle of the night before heading to the emergency.
What about the "more time for medicine" part? I got a little worried when two days after signing, seven large boxes of forms arrived. Now, what physician likes mounds of paperwork? I am sitting on two of them while writing this. Upon further investigation, I learned that the Ministry really wasn't sure who my patients were despite having the ability to track visits for the last 18 years. They felt that the patients should all register now that I am an FHGer. "Surely, you must know who my patients are?" I inquired, "They are the ones who book appointments, see me regularly, we are like family." They must all be notified that I am an FHGer, came the reply. Furthermore, I too had to sign each and every form. So that "extra" time is now productively spent explaining why we all have to sign more forms. Notice that "paper" is still the operative word. Smells like rostering to me. But there are bonuses in this system. Even though most of us docs are hopelessly over our capacity limits, I can earn a bonus for crowding my practice even more. Some patients decline to sign the form and admit that they are double doctoring, but only for convenience sake, they say. Other bonuses include a 10 percent raise for doing only certain things after hours. So I wonder who is left to do all the non-compensated, technically referred to as "humanitarian services," after hours. I now add a fifth uncompensated night call schedule to the life of my family's disrupted sleep pattern.
So, if your doctor is an FHGer, relax, because not much will change provided you are a regular patient. You still get the same lengthy waits for tests and specialists, and get to be examined by the same old equipment. But people who think they have a doctor but have not seen him or her in years may be the ones left out in the cold. My advice is to sign up as quickly as you can, because the model does not recognize how bad the shortage truly is, nor does it recognize the levels of burn-out factor in the remaining docs!
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