"Medicare needs remodelling.
Medicare does not need demolishing" Roy Romanov
in his 2002 Royal Commission on the Future of HealthCare
Back in April, Brighton, ON
a town where no doctors are accepting new patients
was chosen by Premier Dalton McGuinty and Health Minister
George Smitherman to announce the launch of the province's
new Family Health Teams (FHTs). And unlike the Ontario
Liberal government's earlier attempts at reforming healthcare
(eg their disastrous first physician
contract offer) the FHT plan received an overwhelmingly
warm response from the province's 22,000 doctors as
well as the public at large. What's more, the province
received 213 applications from communities for just
45 available FHT spots in the first wave of development.
The idea behind FHTs is that they'll
be interdisciplinary teams consisting of doctors, nurses,
dieticians, social workers, pharmacists and other professionals
seeking to provide comprehensive, accessible and coordinated
primary healthcare according to the needs of a particular
community. FHTs will play a key role in the government's
plan of action for healthcare that includes increasing
the number of doctors and nurses as well as reducing
wait times for key procedures.
"FHTs are a community-based flexible
model that address the specific needs of patients in
that community," says Dr Wendy Graham who chairs the
Ontario Medical Association's (OMA's) section on Primary
Care Reform. "This flexibility will allow communities
to focus on certain problem sets they may have in their
area, be they drug addiction, obesity, etc, and staff
the clinics accordingly."
How FHTs will work
Dr Wendy Graham breaks the FHTs down into four
- Organizational structure
- A capacity to manage chronic
diseases and help orphan patients
- An infrastructure to support
- A healthcare provider mix
Dr Jim MacLean explains FHTs will be open extended
hours during the week and weekend, and in some
larger centres patients will be able to receive
diagnostic and outpatient services like x-rays,
ultrasounds and minor surgery. Through the Telephone
Health Advisory Service (THAS), patients can talk
to a health professional 24/7, and if the patient
consents, a transcript of the conversation will
be forwarded to their doctor the next day.
Experts are claiming that FHTs will allow doctors to
see 50% more patients than traditional fee-for-service
models. This ultimately could be good for patients and
doctors alike, as physicians will be able to report
significantly higher earnings based on a larger patient
roster and further incentives for preventative medicine
and treating chronic diseases. Also, with help from
a solid support staff, the issue of burnout is at last
"The majority of the patients that
I see in my clinic are orphan patients with co-morbidities.
One single patient might be overweight, diabetic, and
have high cholesterol," says Dr Graham. "We can manage
these orphan patients with other providers FHTs
emphasize health and wellness promotion and disease
prevention through education.
With all this administrative and
infrastructure support, the logic is that doctors will
be free to spend more time with patients."
Innovative interdisciplinary health centres, such as
the Rosedale Medical Centre in Hamilton and the Group
Health Centre in Sault St Marie, were years ahead of
the government in following Roy Romanov's model. They'll
be rewarded for their innovation and allowed to continue
to lead the way. By becoming FHTs these centres will
be fortified with cash Queen's Park has pledged
$77 million this year and $300 million a year by 2007.
Nurses, mental health counsellors and many other support
staff will be provided, according to their needs.
The existing health teams will
further benefit by linking up with other communities,
allowing for collaboration and partnerships using advanced
Not everyone's so excited about the FHT model. Dr Douglas
Mark, president of the Coalition of Family Physicians
(COFP), has vocally protested the government's emphasis
on FHTs from the get-go. In fact the COFP is hoping
the government will accept its proposal for a different
solution that will expand on the fee-for-service concept,
rather than dismantle it. Above all, they want nothing
to do with rostering, which requires patients to sign
a contract with their family doctor.
"The government wants all primary
care doctors to sign contracts, and is enticing them
to do so with promises of more money for less work,"
says Dr Ilmar Kents, a Brantford GP and vocal opponent
of the scheme. "Why must we sign contracts with the
government when we have our patients to report to? These
new models are just that, new concepts. There will be
many more [government schemes] to come and they won't
be as good as what we have now. Newer does not always
In the pro-FHT corner, Dr Jim Maclean, who leads the
Primary Health Care Team for the health ministry, insists
the new scheme will indeed make things better. "Many
providers, including physicians, see this model as the
best way to provide comprehensive care to their patients,"
he says. "They are looking forward to working in an
interdisciplinary team and being able to leverage the
support and expertise of other professionals... I believe
our team concept will be an attractive model as medical
students ponder their career choices."
Dr Wendy Graham is also looking
forward to seeing FHTs up and running, but urges patience.
"It's exciting that we can help many patients with these
teams, but with pioneering also come challenges and