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Primary
Care Deal Must ‘Survive on Its Own Merits
by
Matt Borsellino, National Editor of the Medical Post
The
following Editorial appeared in the July 30, 2002 issue of
the Medical Post
COFP Challenged on PCR by Medical Post
It's time
for certain people to do their business or get off the pot—and
in the case of primary care reform, those people are members
of the Coalition of Family Physicians of Ontario. The coalition
earlier this month announced a provincewide membership drive
and heightened public relations strategies for family physicians
at "critical crossroads" with government. But it
must be cautious that its energetic opposition to the Ontario
Family Health Network (OFHN), a deal implemented by the province
and approved for distribution by the Ontario Medical Association,
doesn't backfire and cost the group credibility and political
capital.
The coalition,
a yelping watchdog since Ontario unveiled primary care reform
in the mid-'90s, complains there's no real need for it. It
feels an average annual payment per rostered patient of $97
is far too little. Its survey of member views about the model
produced clear-cut opposition. It wants a provincewide, integrated,
telehealth service and less bureaucracy. It's clearly at odds
with OFHN chairwoman Dr. Ruth Wilson.
The coalition
has some legitimate axes to grind. Its members justifiably
fear further government intrusions into the way 10,000 family
doctors practise and an exacerbation of widespread GP shortages
since the deal caps at 2,400 patients per doctor before a
50% discount is instituted.
FHNs, or
family health networks, ("fins" to those in the
know) are groups of at least five doctors working together
with other health professionals to provide accessible, co-ordinated
care and after-hours service to enrolled patients through
on-call arrangements and telephone health advice, Dr. Wilson
said during a recent visit to OFHN's Kingston base. FHNs ask
network doctors—who join voluntarily—to offer enrolment
to all current patients and provide 24/7 care.
In a pointed
comment, Dr. Wilson said that the issue has been overtaken
by politics. There are only two sources for that: the coalition
and OMA section on general and family practice. The current
heads of both, Drs. Doug Mark and Tom Weinberger, vocally
oppose the reform model, questioning its monetary aspects
and complexity. In oft-quoted analysis, they've said it would
take an office administrator with talents worth $80,000 a
year to take full advantage of the deal's terms.
It's been
difficult for Dr. Wilson to dig her way out. Only 55% of the
annual incomes of FHN doctors, she noted, will come from capitated
payments, and the coalition has excluded numerous other incentives
(see story on page 29).
In fact,
according to OFHN's workbook, widely distributed to help candidates
determine if potential incomes will match current ones, GPs
with rosters of just 600 patients doing mostly office-based
work can make a respectable $105,000 a year. As of June 21,
634 doctors had requested an OFHN-supplied revenue impact
analysis. If they haven't done so already, coalition officials
should avail themselves of the service. Further, provincial
computers are programmed to recognize automatically incentive
payments once stated requirements are met, Dr. Wilson added.
The battle
lines are now clear, and it's time for a "war" that
should be fought not with rhetoric, but by the decisions of
GPs in the field. To her credit, Dr. Wilson looks forward
to the outcome, saying the deal "should survive on its
own merits." Exactly.
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