Family Health Teams – Ideal or Extravagant?

Family Health Team Halton HillsSome patients get special care in Ontario. Twenty percent of patients have priority access to extra, insured services with very short wait times. Government apparently spends 60% more for the privileged care. If you roster with a Family Health Team, you could get some too.

In Family Health Teams, social workers handle mental health concerns.  Pharmacists review complex medication lists and track INRs if required.  Dieticians help with diabetes, high cholesterol or obesity. Nurses offer smoking cessation programs where they counsel, support and follow patients trying to quit. And much more.

Family Health Teams (FHTs) include family doctors, nurse practitioners, nurses, social workers, dieticians, pharmacists, support staff, administrators, other professionals and sometimes part-time medical consultants.

The Ministry of Health website says:

Family Health Teams were created to expand access to comprehensive family health care services across Ontario. Since 2005, 184 Family Health Teams have been operationalized through five waves of implementation, with the last 50 implemented in 2011/12. There are currently over 3 million Ontarians enrolled in Family Health Teams in over 200 communities across Ontario.

Getting a spot in a FHT feels like flying first class: privilege, access and priority.

Family Health Teams have complex needs. A few of the issues include:

  • An additional layer of bureaucracy
  • Staff reporting changes (to admin vs. MD)
  • Sharing resources can cause strain – especially if FHT has multiple sites
  • MD leadership is largely unpaid
  • Multiple meetings
  • Complex governance: especially if aligned with hospitals, LHINs and teaching programs
  • Complex legal issues and contracts
  • IT infrastructure and maintenance
  • Attempts to contract MDs to another bureaucracy
  • On-call requirements
  • Continual checking and oversight of scheduling and care
  • Monitoring of staff activities
  • Patient complaint processes
  • Quality committees
  • Forms committees

Bureaucratic Method

Like many issues in health, everyone agrees on the general outcome. We all want high quality care designed around patients’ needs. But we disagree on how to get it done.

Politicians believe in bureaucracy. They place their faith in central control. They can take credit for projects that they control from the top. Politicians need special projects like FHTs to demonstrate how they’ve added value to healthcare.

Bureaucrats believe physicians are mostly incompetent at managing primary care. They interpret doctors’ pleas for necessary services as greedy requests for more income. Bureaucrats think they can arrange better healthcare than doctors, if they manage and control it themselves.

We already have government owned, staffed and managed practices in Ontario. There’re called Community Health Centers. They work very well in specific communities but seem too expensive to offer everywhere.

FHTs provide an attractive way to offer care. No one debates that. If we spend 60% more for any service, we expect some improvement. We need to ask whether we could get the same or better outcomes for the same investment.

A Better Way

Nothing beats the efficiency and personalized patient attention offered in a small clinic. Even large clinics function best when broken into teams or pods so staff can develop relationships with patients and with each other. Primary care is a service, not a product. Great service is personalized, local, prompt and meets individual needs.

Instead of building bureaucratic monoliths, governments should consider giving extra funding to family doctors. Let small teams of physicians show how funding changes outcomes from a baseline. Let them hire and build allied teams. Government could reward high performers with even more funding for new, creative solutions.

Politicians give family doctors low fees and then complain about less than ideal care. Those of us working in FHTs love them but know they’re probably too expensive to offer everywhere. Instead of trying to reinvent primary care, politicians might consider letting front line professionals prove how well they can provide care free from bureaucratic baggage. I suspect it would improve patient care for much less cost.

photo credit: haltonhillsfht.com

Grassroots Activism: Time to Demand Justice?

Je suis charlieDoctors take buses to protest outside parliament. Noisy physicians crash a local political meeting. Doctors hand out flyers at a shopping mall, scuffle with security and get on the evening news.

Grass roots activism sends chills into both sides of a political war. It’s messy and carries huge reputational risk. It might back fire. It’s often crude and unsophisticated.

Activism is not about riots, and doctors cannot strike. The occupy movement used professional demonstrators funded by partisan organizations to drive a political message. They did not grow on local individuals and families standing shoulder to shoulder against injustice.

Organizations prefer thoughtful, coordinated media-based campaigns. They show the other side that you can mount a sophisticated attack. Media campaigns often work very well.

But what if media has no interest in being convinced of your message? What if journalists fundamentally disagree with your position?

What if your audience cannot understand what you’re saying? What if a campaign drags on, year after year, same old thing?

What if the public doesn’t care?

Grassroots Activism – Features & Benefits

1. It gives people something to do. When citizens get oppressed, they go through shock, disbelief, anger and depression. But eventually, many of them will look for ways to fight back. They need something to do.

2. Grassroots activists welcome sacrifice. They volunteer. They believe in their cause. They use personal funds. They enlist their families into the movement.

3. It focuses an issue. It does not try to deliver a complex intellectual message. Activism sharpens discussion onto a single injustice. It’s gritty, emotive. It speaks to people’s hearts. This is wrong! You cannot treat people this way! Simple messages empower activists, recruit members and resonate with the public.

4. It’s time limited. Movements wrap up when they achieve success. People go back to their families, on with their lives. Movements that spawn reactionary organizations never hold public sympathy for long; they get old, stale.

5. Activism rests on the value of individuals. At its heart, activism relies on free people speaking out. A free and democratic society demands that people get active in the face of injustice. Leaders offer information and support but not control.

6. Grassroots activism does not worry about compromising political relationships or contracts. It puts truth before partnerships, justice before political control. Political leaders can join movements but do not define them.

7. Activism works when the courts cannot help. The law has limits. It’s shackled by process like any other political system and often impotent in the face of abhorrent oppression.

8. It is diverse. Everyone can join. I am Charlie enlisted millions who had never heard of the controversial French tabloid. People from every group in society can stand shoulder to shoulder against injustice. It’s not a strike but a social movement.

9. Grassroots activism works. Oppression persists when one group benefits from taking advantage of another. Entire systems survive on institutionalized trampling of particular groups. Such a system will not change on its own. It cannot. It needs to keep squeezing one group to stay alive. Only activism can challenge a dysfunctional system.

Imagine this:

A government signs an agreement with a group of workers. When the contract runs out, politicians decide they want to pay less for more work. They need the work done so politicians make it illegal for the labourers to work anywhere else, illegal to strike, and refuse to negotiate a new contract. The politicians cut pay with legislation. In fear, the workers make peace by signing a terrible 2 year contract.

Two years later, the politicians want to pay the workers even less. They say the workers are greedy. Politicians blame workers for finding tricky ways to make supplies even more expensive.

The politicians pretend to negotiate with the workers for a whole year but say the same thing in nearly 100 meetings. Finally, the politicians offer the workers a massive pay cut. They threaten, “Take it or we’ll legislate an even bigger cut!” On top of that, politicians promise to make workers pay for all the increasing costs of supplies and new projects.

The workers refuse. The government delivers their threat. The media yawns. Lawyers shrug with elbows bent and hold out empty hands, “I’m sorry, but there’s nothing we can do!

If something like this happened, would it warrant outrage? What would you do about it?

[photo credit: cnn.com]

Income Disparity: Why Media Loves MD Incomes

wolf of wall streetJournalists know that envy sells papers, and people can’t resist a bit of wealth porn (see Super Rich or Super Angry). But publishing doctors’ incomes also serves a deeper purpose. On average, doctors’ billings prove that some workers earn more than others. Physicians’ incomes demonstrate that income disparity exists, and publishing them presupposes the gap warrants discussion. Except for ardent capitalists, salacious CEO incomes give most of us pause. But is income disparity intrinsically bad?

Beyond envy and idle curiosity, income comparisons rest on the belief that all workers should earn a similar wage. Some people think that skilled workers who contribute more to production should be paid more. Marx disagreed. He saw factories automated to increase profits for owners while decreasing wages for labourers. He believed income disparity to be evidence of capitalist corruption, and many still agree with him.

We miss the point when we debate whether incomes are fair. If we accept the idea that wages should be set in comparison to other wages, we presuppose Marx was right. He believed that all work had intrinsic value that should determine wages. Capitalists believe that demand for a product or service should determine income. If a particular skill or service is in high demand, then wages for that skill will be high.

If we agree that all income disparity is inherently bad, we accept a core tenet of socialist ideology.  Our country grew strong on democratic capitalism. We did not become prosperous by pursuing socialism.

Prosperity allows us to create some socialized services. But we must not confuse socialized medicine with socialism.

Within socialized medicine, every worker labours for an income, for profit. Highly trained professionals earn more than those with less training and responsibility. Healthcare wouldn’t exist if it weren’t for intimate ties with industry to build, supply and service institutions. Socialized medicine is not the same as statewide socialism.

Income equality stands at the pulpit of socialized medicine to preach socialist ideology. Most people agree with helping those who cannot help themselves. But this does not require socialist economics. Socialism has been tried and failed repeatedly over the last 100 years. It refuses to die. If we accept the belief that all income disparity is bad, we lose the debate about doctors’ incomes before it begins.