A LOOK INSIDE ONTARIO AND QUEBEC'S NEW DEALS FOR CLINICS

By Brent Woodford

Ontario pins hopes on Family Health Teams

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."

WIN-WIN SCENARIO
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 being addressed.

"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."

THE FHT VANGUARD
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 information technology.

THE DETRACTORS
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 equal better."

THE DEFENDERS
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 potential pitfalls."