Back to Media Releases

VOLUME 38, NO. 01, January 8, 2002

Will Blue RIO scare MDs away from family med?

Critics argue contract being pushed through too quickly

By Matt Borsellino

TORONTO – The Ontario Medical Association and its nemesis, the Coalition of Family Physicians of Ontario, are battling about the controversial new primary care reform initiative.
   The 3,000-member coalition contends the primary care reform contract known as Blue RIO is a bad deal for patients and family doctors, and has been pushed through with unseemly haste.
   The OMA and the recently established Ontario Family Health Network are battling back by sending leading proponents of the changes to talk to doctors about the deal.
   The coalition is a watchdog group, formed several years ago by doctors disgruntled with OMA policy-making.
   "(The contract) radically changes the patient-doctor relationship and may be perceived by some to improve accessibility and quality of primary care, but it will not resolve the key reason for reduced accessibility, namely that there aren't enough doctors and there is dwindling interest in the practice of comprehensive primary care," said coalition president Dr. Doug Mark.
   "We believe (this) will scare away people from family medicine at a time when the exact opposite is needed. . . . We're not opposed to change as long as it's for the better. This is not."
   The Blue RIO template, named after the OMA-designed Rurality Index for Ontario, will pass legal responsibility for provision of care from government to local family health networks or group practices, COFP officials contend. Also, the technology being used, which Dr. Mark says is "the engine needed to power primary care reform," might not provide patient-record confidentiality and be costly for doctors.
   The deal, distributed for consideration to 600 family doctors in northern and underserviced areas in November 2001, will make doctors responsible for "huge" legal and administrative burdens, according to the coalition.
   "We are 100% in favour of any proposal to more adequately fund our devalued work. However, we absolutely do not support any contract that puts family doctors at legal and/or financial risk," Dr. Mark said.
   Doctors signing the agreement will also be responsible for ongoing costs beyond the $100 million set aside by the province to get reform off the ground, Dr. Mark added.
   The coalitionplans to query family doctors across the province later this month, and will likely ask if there should be a referendum on both the rural and urban versions of the contract.
   Both the OMA and the coalition use the Canadian Medical Protective Association to illustrate their points.
   The template has no detrimental impact on a physician's relationship with his or her patient, states a letter sent to OMApresident-elect Dr. Elliot Halparin by Dr. John Gray, CMPA secretary-treasurer and CEO.
   "A patient injured by a physician in relation to the practice of medicine could still bring proceedings in tort, contract or breach of fiduciary duty. Such claims are typically the subject of assistance by the CMPA and the fact the physician is providing those services in a family health network should not alter the nature of those claims nor the scope of assistance," says the letter.
   But the CMPA's assessment isn't clear-cut. The template "creates obligations between physicians involved in a family health network and the ministry, which could be a separate source of liability if the physician were to be in breach of the agreement," according to Dr. Gray's letter.
   The CMPA doesn't usually assist members in administrative or business matters that "do not relate to the practice of medicine."
   Another cause for concern, critics say, is an assessment of the template by the OMA's legal department. The opinion by OMA general counsel Jim Simpson mentions internal governance problems with pilot project sites running for more than three years and raises concern about what happens when the number of doctors in a network falls below the minimum of five stipulated in the contract.
   Three of the OMA's biggest guns—Dr. Wendy Graham, chairwoman of its primary care policy and planning committee; board chairman Dr. Larry Erlick; and Dr. Kathryn Lockington, chairwoman of the section of general and family practice—spoke at a recent conference on primary health-care reform summit.
   Dr. Lockington said physicians "are interested in working collegially with other care givers as long as they are not paid through physician dollars."
   Dr. Erlick expressed optimism for the template. "Many of the primary services family physicians provide, and this is becoming an ever-shrinking amount, can be provided by nurse practitioners working in collaboration with family physicians."
   But he admitted: "It is not known which reforms work well, under what circumstances and at what costs. We need evidence and evaluation based on principles that apply to the unique health-care delivery environment in Ontario."