Media Release

FOR IMMEDIATE RELEASE

COALITION OF FAMILY PHYSICIANS OF ONTARIO RELEASES "SHELL REPORT"; PROMINENT LABOUR LAWYER RECOMMENDS FAMILY PHYSICIANS NOT TO EMBARK DOWN "FHG" ROAD

(July 23, 2003, Toronto, Ontario) - Dr. Douglas Mark, President of the Coalition of Family Physicians of Ontario (COFP), announced today that the Coalition is releasing the "Shell Report." The report, prepared by one of the country's most prominent labour lawyers, Brian Shell of Shell Jacobs Lawyers, Toronto, is the first true independent comprehensive legal analysis of the new Family Health Group (FHG) contract, which was negotiated by the Ontario Medical Association (OMA) and the Ministry of Health and Long-Term Care (MOHLTC) in April.

"We're very grateful for the excellent work that Mr. Shell has done on behalf of the Coalition," Dr. Mark said. "I believe that all of us - family physicians and their patients alike - owe him a huge vote of thanks for pointing out the many pitfalls - legal and otherwise - inherent in the government's new FHG scheme."

For his part, Mr. Shell said that his report - read along with the footnotes contained within as well as the documents and legal sources referred to - should cause all family physicians contemplating the FHG structure to reconsider and re-evaluate. "I have concluded that there are very serious concerns that all Ontario family physicians should consider before embracing the FHG concept and reorganizing their practices," he said. "I cannot recommend that any family physician should rearrange his/her practice and working life into a FHG, as the 'structure' is currently available. There are simply too many pitfalls, unknowns and uncertainties. Moreover, the consequential anxiety for patients and the liabilities that the FHG presents should cause all Ontario family physicians to pause in the hope that the concerns and problems can be addressed and resolved by further discussions that involve family physicians and their advisors."

Mr. Shell then went on to say that while the interests of the Ministry may be met through the FHG concept, the interests and economic needs of family physicians are not. Furthermore, it is far from clear that the interests of patients are protected. Nor is it clear that the FHG concept is really intended to be a cornerstone of primary care reform, and not an interim measure on the way to some other concept more akin to the Family Health Network (FHN) concept than a fee-for-service compensation arrangement.

"Indeed, I am of the opinion that the FHG concept puts the family physician in an untenable appearance of or an actual conflict of interest position vis a vis his/her patients, " Mr. Shell continued. "This conflict of interest can only be resolved by full disclosure by the family physician to his/her patient of the details of the FHG and of the arrangements for service delivery, including full disclosure of the issues pertaining to confidentiality of the patient's medical records, as well as the economic incentives afforded to the family physician - the 'rostering' bonus and the other premiums offered for special categories of patients. Full disclosure by FHG members is likely to cause many patients to refrain from becoming FHG patients."

Mr. Shell further explained that he cannot recommend nor does he believe that family physicians are willing to engage in any effort that may be seen by their patients to be coercive. A family medicine delivery concept like the FHG that uses the family physician as the "salesperson" and may subtly insinuate a degree of coercion - "Join our FHG or I cannot continue to be your doctor" - abuses the family physician and the patient/citizen. In addition, the minimal economic benefits that the FHG concept offers to the family physician will be reduced by the refusal of many patients to be rostered under present circumstances, in light of existing uncertainties, and because of the substantial transaction and administrative costs associated with FHG membership. Additional obligations about office hours and after hours services, including weekend and evening office hours required for FHG member physicians, are neither clearly articulated nor very attractive.

Mr. Shell concluded by recommending that family physicians consider the range of obligations they assume under the FHG Agreement, and the attendant risks and impact on their practice and personal lives. The patient disclosure issues alone are so substantial, Mr. Shell warned, that it would be "foolhardy for family physicians to ignore the concerns and expose themselves to legal challenges, professional humiliation, disputes with their FHG partners and colleagues, and complaints directed at them by their own patients and by the additional regulators."

"In view of the myriad of difficulties that the FHG construct presents to family physicians who may be considering this form of practice," Mr. Shell said, "I do not recommend that any family physician in Ontario embark down the FHG road as it is currently paved. It will be a very bumpy road and it leads to an uncertain destination for the physician and for his/her patients."

Dr. Mark echoed Mr. Shell's advice, saying, "Clearly, we are living in dangerous times - both family physicians and their patients - thanks to a government that doesn't listen and a representative association that doesn't seem to care. We urge our members - and, indeed, all family physicians - to stand up to both the government and the OMA and say 'No thank you' to a FHG that is neither ripe nor sweet."

At the same time Dr. Mark released the "Shell Report," he also reminded everyone that the Coalition will be conducting a referendum on FHGs and other issues of importance to family doctors sometime this summer, with the results being announced shortly after Labour Day.

The Coalition of Family Physicians of Ontario, representing front-line providers of health care, is a grassroots organization dedicated to the provision of top quality health care to the people of Ontario. We strive to protect the rights, freedoms and independence of family physicians of Ontario and to continually improve the health-care system. To learn more, or to download a copy of the "Shell Report," please visit the Coalition's Web site at www.cofp.com.

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