Some 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
When I saw a sole practitioner my office appointments were short and convenient. Now that I am in an FHT they are convoluted. I rarely go there so I see a different team member every time. I have to discuss not only my existing problem but my history and explain my personal philosophy of treatment. (For example…when I bring my kid in for otitis media we are already long past the “watch and wait”. We did that before we came. I sometimes have to put my foot down and demand to see the team leader who does know me.
My mother was in a teaching unit. Every two years she was assigned a new resident. She was thrilled! She had LOTS of thing that needed investigating! But of course there was never anything wrong. She was able to effectively manipulate this system for at least four years…maybe longer. All the while there was a persistent decline in her cognitive function. Family brought this forward many times and were told to butt out by the resident because mom didn’t want us involved. Had there been continuity of care over those four years by a sole provider I am sure her dementia would have been diagnosed much earlier and a lot of unnecessary and expensive work ups avoided.
Thanks so much for reading and commenting, Kathleen.
You articulate exactly what I’ve heard so many patients try to say, but you nailed it. Discontinuity and waste pile up like lint under a couch unless there’s incentive to remove it. Tackling waste means talking about performance. People perform, so if we are serious about performance, someone must talk with the performers. But people hate being asked about their performance. Leaders find it too painful to bother. So waste continues to pile up like lint.
Our state run system does not have the levers necessary to drive efficiency. Bureaucrats can only increase oversight, add more management, but that only increases cost and waste. Workers slow down wondering how every move will get critiqued.
Unfortunately, those of us on the inside risk being labelled as malcontents when we identify opportunities to improve. We’ve locked ourselves in an impossible situation in Canada. There’s hope for change, but it will be uncomfortable.
Thanks again for taking time to read and share your thoughts!
Warm regards,
Shawn
You nailed it. I got out of a CHC(‘bureaucratic monolith’)and will never ever go back to being a salaried doctor. Even though I loved my work serving vulnerable priority populations and felt privileged to enjoy what I did, the micromanagement from administration was mind boggling . The waste that happens in these CHCs( tiers of bureaucracy,meetings discussing changing of light bulbs , doctors being told to take minutes of 2 hour long meetings) is totally amazing. Ms Tetley (on the Agenda) with that holier -than -thou exhortation to docs to join CHCs was way off the mark. Thank God 95% of family docs have got it right !!!
Thanks for your comment, Asfa!
You said everything I tried to say but in one, condensed paragraph. Well done! Bureaucracy begets more bureaucracy, meetings, forms and audits. The system has become unhinged from its only reason to exist, the patient. The situation in Ontario follows directly from the ideology driving the government. It believes government does good, and more government does even better. Bigger, better bureaucracy should deliver improved results. When will we wake up and admit the ideology does not work? It’s a utopian dream; we must change course.
Thanks again for sharing your comments!
Shawn
Totally agree CHC’s are a waste of money, all the high paying management team salaries could be used more constructively.