To All Ontario Family Physicians                                November 23, 2005

Don't be Fooled by Political Rhetoric

Family Physicians Understand ‘Which Way the Wind Blows'

Dear Colleagues,

Prevailing winds have the potential to alter one's course; it can be difficult to steer in the right direction. In the context of Ontario's changing medical climate, physicians can sometimes feel overwhelmed by political bluster. Now, with the increasing daily pressures of practice, physicians must demonstrate solidarity and find the means to enable and support each other. Physicians and patients will depend on this.

Indeed, the pressures within family practice are growing, including increasing government involvement, patient expectations and expenses of practice without significant offsetting improvements or compensation.

The March 2005 agreement between the Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care (MOHLTC) provided some improvement for family physicians that chose one of the favoured models. By lobbying the Ontario government with our March 2003 Comprehensive Care Networks (CCN) funding model, the Coalition of Family Physicians of Ontario (COFP) laid out the groundwork and template for the Family Health Group (FHG) concept. At the same time, the OMA Section on General and Family Practice (SGFP) Executive Committee lobbied the OMA and negotiating team for the 2003 “Re-opener” Agreement with its similar Physician Coordinator Care Model (PCCM) that provided more professional freedom then their predecessors, Family Health Networks (FHNs).

Solidarity requires that no physician or their patients be left behind. There remains a need to support Fee-For-Service (FFS) physicians and indeed all physicians in a tangible way.

Many physicians who choose FFS have sound reasons for doing so. Their decision should not preclude them from receiving full support from their representative bodies. FFS physicians were essentially ignored in the last agreement, but this does not mean that ways to support them, along with other family physicians, cannot be found if there is incentive to do so.

In fact, from his October 25, 2005 “Inside Out” letter, Dr. Val Rachlis, president of the Ontario College of Family Physicians (OCFP), recently admitted that there is no evidence to support the belief that interdisciplinary team care is necessarily superior to care provided by family physicians. An extensive review of the literature also revealed that the problem was not with FFS itself, and that it was overwhelmingly clear that there is no scientific basis for including or excluding any family physicians regardless of their system of remuneration from involvement in quality care, enhanced care, or team-based care.

It is also clear that Information Technology (IT) funding is not intended for all physicians; only specific groups, such as Family Health Networks, are or will be entitled to receive this support. Equal treatment across all physicians and their patients, not just those in certain models of care, is absolutely necessary for any transformation of the healthcare system.

As the Ontario government's health care transformation agenda blows across the landscape, physicians must find ways to have input and alter the course within their own practices for the benefit of their patients. Ultimately, it is patient care that will be improved by enabling family physicians to find solutions to their day-to-day concerns. The Coalition of Family Physicians of Ontario understands that the solutions to health care problems are related to affordability, accessibility and sustainability – and not simply to “efficiency”.

All is not calm within the rostering models of family practice, either; there is still need for improvement. The complexity of the last agreement has exposed problems associated with timely payment of Q codes and premiums leading to frustration for some physicians. How can an agreement reached through negotiation allow one party to delay meeting its contractual commitments? How can this be rectified and how can physicians be helped to endure such prolonged delays to their income?

Issues concerning revalidation, the implementation of the Cory Report, the wait-times fiasco, the media's willingness to impart negative commentary about physicians, and the 2003 Re-opener, among others, are but a small sample of what physicians will face in the next few years; a potentially overwhelming and daunting prospect.

The Coalition believes in supporting family physicians, enabling them to participate in preventing the erosion by the transformation agenda of control over their practices, of their earning power and dignity.

All family physicians must be supported if the public's needs for health care are to be met. Improved morale amongst physicians is crucial to improve health-care delivery for all patients.

Although change in medicine and family practice is inevitable, it is important to remember that physicians do have the ability to modify its course and its impact. This can be achieved with solidarity, support for each other and sustenance for all family physicians.

Or as someone once said, “We cannot direct the wind, but we can adjust the sails.”

And that we will.

Sincerely,

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

The Coalition of Family Physicians of Ontario
4190 Finch Ave E, PO Box 27033, Toronto, Ontario, M1S 5C2
Tel: (416) 412-1474 or 1-866-495-4346   Fax: (416) 412-7297 or 1-866-495-4349