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Feb 18, 20224 min read

Integrative Thinking Dialogue

We are here today to try to come to a solution to the problem of an apparent shortage of family physicians in rural communities in Ontario.


Character 1, a private sector- chiropractor and doctor of natural medicine:

I feel the key here is to be inclusive with all health services and cover natural medicine doctors under OHIP (Ontario Health Insurance Program), allowing us to fill the gap of service and be able to order tests and prescribe pharmaceuticals or herbs as needed. We are already providing healthcare and there is a visible gap in OHIP providing services to all residents. Many of our patients do not see family doctors, or do not have one. We feel we are already filling in the gap but only for people who can afford it. That is not universal health care. We feel we are a group who are being left out of the bigger picture. You are promoting a two tier system of care, not what we say we have, which is universal health care.



Character 2, Ontario Health Care Minister:

That is a very expensive proposition. Finances do not allow us to extend our range of health care services outside what is already provided. Is there a way to streamline services to be more efficient visa via technology? We know that we are graduating enough doctors to support the population. We have almost 15,000 practicing family and general practice physicians in Ontario in 2019 when our population was 15million, that works out to 1,000 clients for each doctor. Each doctor only needs to see 5 patients per day if they are only seen once per year gauging a 48 week year with a 4 day work week. One of the reasons for limited access to doctors in rural populations is recruitment and perceived isolation. With greater technological links could we not streamline transfer of information and expertise to provide the needed support to those rural communities through technology, especially to help new graduates with the support they need to not feel isolated or on their own island. When we can support each other, everyone wins.



Character 1, a private sector chiropractor and doctor of natural medicine:

Well do you go to the doctor only once a year, most patients need to see their doctors at least 4 times a year if they have any chronic health issues, even for well-baby visits and vaccinations. Most family physicians see 20 patients a day and spend many hours with paperwork, prescription repeats, tests results, and other things. We know how stressed doctors can get, we have seen that with the pandemic, trying to provide well being care and manage chronic care, diseases and geriatric care. Technology can only do so much; it is a tool what is needed is people who can respond to problems. With the funding of alternative health care professionals many who already reside in these rural areas, you support the intended idea of universal health care for all.



Character 3, a Health Coalition member:

There is a perceived shortage of physicians but maybe in fact we are just asking them to provide too much care. OECD reported that 79% of nurses felt they were being under-utilized, that they had unique advanced skills which were not being exercised. How about giving nurses, nurse practitioners, midwives, physiotherapists, pharmacists, chiropractors, natural medicine doctors, psychologists, social workers leeway to provide the missing care through OHIP? They have already been educated. Many live within the catchment areas of the underserviced. We know this is not universal health care if 20% of the population, those who live rurally, only can access a doctor in times of emergency or if they have to pay out of pocket for natural medicine services. Can everyone work more as a team. If the pharmacist has the expertise to repeat a prescription for a chronic condition without the patient seeing the doctor, would that not save money? If we could negotiate a portion of the doctor’s visit amount for prescription renewals to be paid to the pharmacist and then use the other portion to fund new providers like natural medicine doctors and chiropractors, there is no increase in cost. If the nurse or nurse practitioner could provide well baby visits, we could provide savings there. We need to look at a system which is integrative and inclusive not with top down thinking. We need to pool all available expertise to fill the gap. There is no one who should be without a health-care professional. With a sharing of responsibilities within their abilities and expertise this is possible without any financial strain. In fact this will open up time also for the family doctors to take on new patients because they are not providing the services which can be provided by others, just as qualified.


Along with that, is the need to share communications amongst providers. To streamline access to patient information through a cohesive use of technology, if there was a central server where all of your health records can be kept and accessed by each doctor or pharmacist or chiropractor simultaneously then there is fluidity and a good health service. If a rural nurse practitioner can see patients even virtually there is a cost savings from a doctor’s visit. If only patients who need an exam would visit the doctor, all others would be provided with virtual visits, this could be provided by all health professionals and potentially save money to be utilized in other ways. This is particularly helpful to patients with mobility issues, anxiety or phobias, autism or other mental health problems, viruses are less likely to be transmitted in the waiting rooms. If physicians were only providing a fraction of the care services which they are expected to do now, it would allow time for them to see more new patients. Seeing patient care as a professional health team would potentially provide a more integrative thorough plan of health and well-being for every patient.


Resources:


Ivy Lynn Bourgeault, Toronto Star, Ontario likely has enough doctors, May 22, 2018.


Frederic Michas, Statista, Number of family medicine and general practice physicians in Canada as of 2019, by province, Feb 20, 2020.



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