Critics say comments will only escalate problem of deteriorating working conditions

By Matt Borsellino (Medical Post)

TORONTO – Detractors are describing as "irresponsible" a suggestion by the Coalition of Family Physicians of Ontario arising from an increasingly combative campaign against deteriorating general practice working conditions.

At a Queen's Park news conference, coalition President Dr. Doug Mark and Vice-President Dr. Chris Pinto advised GPs across the province to "explore options in more hospitable practice jurisdictions." Family practice in Ontario, they added, is under severe strain, and they believe planning for the future is "virtually impossible due to system instability."

The coalition also issued an "orange" advisory code—designed along the lines of the terrorist alert system in the U.S. rather than any intra-hospital emergency scale—to signify a degree of overwork and stress they consider one step below a code red. That's the point where the system completely collapses into untenability.

Backlash from the comments was almost immediate. Though aware of the dire circumstances now facing family medicine in Ontario, Dr. Scott Wooder of the Hamilton Academy of Medicine told his local newspaper the remarks would "escalate the problem . . . not really do anything to solve it."

Dr. Wooder said it's irresponsible to urge students, residents and family doctors to move to what might be perceived as greener pastures. Still, he also said he believes significant changes are needed so family practice is sustained.

Dr. Larry Erlick, facing one of the first controversies of his young term as president of the Ontario Medical Association, seemed equally irate. "The coalition's doom and gloom messages are stale dated," the Scarborough-based GP said in an interview.

"They don't have any solutions. All they have is rhetoric. We have the answers, and many of them are in the 're-opener' (a recently reached, year-long deal with the province). We know what the problems are, and we're dealing with them. They don't want to consider what we've accomplished, and that's a disservice to hardworking (GPs) across the province."

Dr. Erlick also noted he represents the 24,000-member OMA which has a section of general and family practice with 8,000 members. The coalition claims membership of about 3,500.

When told he probably won't win any citizenship awards from the provincial Tories for his remarks, Dr. Mark responded the current government isn't about to win any accolades from Ontario's family doctors.

"We're disappointed by their response to the situation," he said. "They've ignored plans by both the coalition and (the OMA's) section on general and family practice. We need to make the public aware of what's happening and keep them aware."

Dr. Mark said there's already a significant number of GPs leaving either Ontario or their clinical area of practice "trying to look for other sources of income."

Medical politicians and government policy-makers across the country welcome the prospect of an exodus of GPs from Ontario. Ontario leads all provinces in average provincial gross payments to GPs, according to 2000/01 data from the Canadian Institute for Health Information. Both OMA and coalition officials put Ontario's GPs average net incomes at about $100,000.

The coalition news conference was organized in the wake of the OMA's recent $330-million, year-long agreement with the province. This extra money was negotiated as part of the OMA's four-year, $4.5-billion-a-year contract with the province. In this, the fourth year of the the contract, there is a provision for a re-opening of the contract to take into consideration changing situations.

The "re-opener" establishes a new fee-for-service-based plan known as family health groups (FHGs) to supplement an existing capitated plan known as family health networks (FHNs).

"Inexplicably, the OMA board signed the 2003 're-opener' . . . with the Ontario government days before OMA council was due to meet in late April," Dr. Mark said. "The OMA economics department provided the board with an analysis of the agreement, but the board prohibited prior release of this document. . . . Council had no meaningful opportunity to discuss this entirely new model."

The re-opener provides only marginal incentive for established fee-for-service practitioners to continue providing comprehensive care, and "will not reverse the profound lack of interest in family medicine by medical students," Dr. Mark said.

The economic analysis, Dr. Erlick noted, was approved by the board then sent for approval by council, the OMA's parliamentary decision-making body, before any outside distribution.

"There was no effort to try to hide, deceive or deny access to anything," he said.