| To
All Ontario Family Physicians
November
30, 2005
A
Balanced Approach
Transforming
the Government's Transformation Agenda
Dear
Colleagues,
Moving
forward with transforming the health-care system requires
a balanced approach. We can appreciate positive change, but
we must remain vigilant for pitfalls while advocating for
solutions that will lead to improvement for both physicians
and patients alike.
The
Coalition of Family Physicians of Ontario has identified significant
areas of concern, such as the failure to include physicians
in the development of Local Health Integration Networks (LHINs).
With new Ontario legislation, LHINs will become operational
without significant input from physicians, who are the core
of a functional health-care system. In Alberta, where regionalized
health-care delivery was initiated years ago, physicians were
initially excluded from the planning process. Years later,
this was acknowledged as a serious mistake .
The Coalition hopes that Ontario can learn from Alberta's
mistakes, and closely consult with its physicians before it
decides on how its health-care system is transformed. Thus
far, we have been ignored.
Similarly,
the governance structure of Family Health Teams (FHTs) remains
vague, but will play a major role in the future delivery of
health care. The potential blurring of the roles of physicians
and those of allied health-care workers is real and very troubling.
For example, will physicians still be able to advocate on
behalf of their patients when the Ministry of Health and Long-Term
Care controls the funding of FHTs and their non-physician
workers? Frankly, what is at stake here is the protection
of our professional freedom from the vagaries of government
fiscal policies.
Furthermore,
while FHTs and other "aligned"
capitation models such as Family Health Networks (FHNs) and
Health Service Organizations (HSOs) will provide a variety
of exclusive government-funded services, the same services
will not be offered to those in other delivery models. This
two-tiered approach creates major inequities for both patients
and physicians alike, all the while using public funds to
do so. For example, the funding for information technology
(IT) – a sensible transformation ingredient – is shaping up
as a colossal financial fiasco, as was recently exposed by
the media, which revealed that millions of dollars have been
wasted thus far. Equally troubling is that IT funding is not
planned for all physicians, but only for those in the capitation
funding models favoured by the government. We believe that
there will be few winners here, least of all the physicians
and patients of Ontario.
It
is also important to keep in mind that all of the current
health-care transformations are being planned in the present
delusion of a universal one-tier system. However, this very
approach is being increasingly challenged both in the courts
and in other provinces. As a result, we are likely to see
major changes in the near future. The Coalition believes that
rather than avoiding this debate, we should start examining
alternatives to the status quo open-mindedly, and adjust our
views accordingly. Sitting on the fence on such issues will
simply leave physicians out of the mainstream of change by
default, as Canada's health-care system undergoes a fundamental
shift. We welcome the debate and plan to fully participate
in it.
At
the heart of the debate is “choice” for both patient and physician.
Physicians
must be free to choose their own practice model. Governments
throughout Canada are also choosing their particular favourites.
In Quebec, for example, the Liberal government will not appeal
the Supreme Court of Canada's Chaoulli-Zeliotis decision.
They stated that they instead plan to expand and collaborate
with the private centres to improve their existing system.
Family
physicians everywhere are under increasing pressure to provide
additional services to patients that governments cannot afford
to cover and patients demand. However, the provision of these
additional services brings with it significant financial and
practice demands that physicians must somehow cover.
Physicians
should be free to choose how to respond to the needs of their
patients. Instead, our present system applies a centrally
planned top-down approach to family practice and dictates
which needs will be met and how. In fact, the same government
bureaucrats who created the health-care problems and doctor
shortages that plague us today are now pushing unproven and
untested family practice schemes for tomorrow. It should come
as no surprise that interest in family practice as a career
choice is at an all-time low. It has been replaced by mistrust
and pessimism for the future of family practice in the context
of punitive financial and practice constraints.
The
only hope for this sorry reality is two-fold:
-
Proper funding of family practice
services that allows physicians to choose their remuneration
model without being financially or otherwise punished for
their choice; and
-
Allowing physicians to choose
the scope of their practice and the full range of services
that are increasingly demanded by their patients, who would
in turn be responsible for any extra costs incurred for
these services.
Such
changes can only lead to improved provision of health care
and at the same time safeguard professional satisfaction.
This will provide for the recruitment of new physicians and
the retention of many who are considering relocation, changing
their scope of practice, or early retirement.
The
debate and action has already begun across Canada. More changes
will soon follow, and the groundswell can no longer be legislated
away.
It
is absolutely essential that the grave, realistic concerns
facing family physicians today must be given front-and-centre
stage during this time of increasingly rapid change. Only
an objective and educated perspective can provide a workable
path forward. The Coalition of Family Physicians of Ontario
plans to be at the forefront of the coming changes and to
lead its members in the planning for a sustainable, affordable
and effective health-care system. We have done so for nearly
10 proud years, and will continue to do so in the future.
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 |
