PEM Freeze and Lease Fiasco Continued

In our previous Bulletin to you, we brought to your attention two important developments, which are of serious concern to us all:

• The freeze on new physician registration in Patient Enrolment Models (PEMs), and

The leasing matter remains unresolved and exposes us to potential increases in OMA dues and/or cuts to OMA programmes. However, the OMA recently announced that the freeze on new physician enrolment in PEMs has been lifted. Unfortunately, we believe this announcement is critically misleading for the reasons outlined below.

On May 14, 2009, The OMA President's Update announced that the Government has lifted its sudden freeze on physician entry into Patient Enrolment Models. The freeze on Family Health Teams (FHTs) continues. Although this as been hailed by the OMA as significant progress in resolving this contentious issue, a careful analysis of the announcement clearly shows that while the freeze on the other PEM's has been lifted, the freeze on the formation of FHOs has not been lifted at all.

As of now, you may form a new CCM, FHG or FHN, but you may not form a new FHO , but only apply to join an existing FHO, creating a backlog of applications and delays which the government has already acknowledged. Why is this so important and what are the implications for you?

For the majority of you who have not formed or transformed your practice group into a FHO, you may still not do so, and there is no indication as to when this situation will change. As many of you may know, the FHO has turned out to be a very popular model for physicians – including new physicians – because of the practice-style and financial advantages that it offers. There is now a long list of applications to form a new FHO, as well as the long lineup to join the limited number of existing FHOs.

If, for example, you are presently in a FHG and wish to transform into a FHO, you cannot do so. How then will you attract new physicians to join your group or retain the existing ones? This will prove very difficult, as you cannot compete with established FHOs which were fortunate enough to form before the freeze. The result is a very uncertain future which makes it very difficult to make any plans and investment decisions. It may also drive new physicians away from Ontario, since their practice opportunities will now be severely limited.

What in effect is created by the present freeze on new FHOs is a two-tier system for family physician compensation , with those in existing FHO being rewarded while most of you will likely be relegated to the "have-not" category.

Moreover, because the FHO is a very popular PEM, the freeze also put in question the entire commitment of the Government and the OMA to the Patient Enrolment Models of practice, which they have so ardently touted. If the Government has come to the conclusion that it may not be able to afford a capitation approach now or in the future, they should not resort to creating two-tier inequities in dealing with this problem, but rather look at new ways of funding health care in Ontario.

As for the OMA, it should highlight the continuing freeze on FHOs as a serious problem rather than burying it, as in the latest President's Update. We expect our representative body to represent our interests and demand an immediate lifting of the freeze on new FHOs.

We urge you to become involved in this matter, since it has serious implications for your professional futures. You can contact the OMA and simply inquire if you are now able to form a FHO. Or you can also write to the OMA President, Dr. Suzanne Strasberg, voicing your concerns. We urge you to do both, and to do so as soon as possible. If you wish, you may use the letter at the bottom of this Bulletin and fax it to the OMA at the fax number provided.

Douglas Mark MD, President
and the Board of the Coalition of Family Physicians of Ontario

Join, renew, give feedback, make political action & legal challenge contributions online at www.cofp.com

THE COALITION OF FAMILY PHYSICIANS OF ONTARIO

45 Sheppard Ave E, Suite 900, Toronto, Ontario, M2N 5W9

Tel.: (416) 412-1474 Toll Free Tel.: 1-866-495-4346 Fax: (416) 412-7297 Toll Free Fax:1-866-495-4349

In your recent OMA President's Update dated May 14, 2009, you state that the temporary hold on primary care models has been removed. However, on my reading of the update, it appears that while individual physicians can again move to existing FHOs, groups of physicians who would like to form or transform to a new FHO may still not able to do so.

I am very concerned that I may not be able to form a new FHO, and would like a clarification of this information.

Are groups of physicians permitted to register for a new FHO and have their applications processed now?

If not, then how could the freeze be considered to be substantially lifted, given that the FHO is a popular model for physicians applying for new patient enrolled model (PEM) registration?

And if I cannot form a new FHO, how can I compete with established FHOs and attract physicians to join my group?

I would greatly appreciate your prompt attention and response to these important matters, since they greatly affect my future career decisions.