A stipulation in the Ontario Medical Association's contract with the provincial government requiring 50 per cent of physicians in family health teams (FHTs) and family health organizations (FHOs) in Northern Ontario to have hospital privileges is impeding the recruitment of family physicians to the region's five major cities, warns Dr. Raymond Jacques of Sudbury.
Instead of trying to force family physicians to do rounds in hospital, hospitals should be hiring hospitalists, claims Jacques.
"Having 30 docs go to the hospital to see 30 patients is less efficient than having hospitalists. If the family health teams want to do hospital work, fine. They have more support. If the docs in family health organizations didn't have to do rounds, they could roster more patients."
Capitation
Physicians who are members of family health teams and family health organizations are paid on the basis of capitation – a set amount per rostered patient per year, depending on the individual's age and sex, but unlike family health teams, family health organizations don't have the support of nurse practitioners, social workers and dietitians paid for by the government. Neither do they get any funding from the Ministry of Health to set up a clinic where they can practice together. Their only obligation is to co-ordinate their schedules to provide care during extended office hours on evenings and weekends.
Some family health organizations are going along with the 50 per cent rule, but the St. Joseph Family Health Organization that Jacques belongs to voted against accepting doctors without hospital privileges.
"We decided we didn't want to accept docs who don't want to do hospital work because it would create a two-tier system. We didn't think it would be fair and we didn't want any hard feelings."
The 50:50 rule only applies to Northern Ontario, so "if you're a doctor in Ontario and if you don't want to do hospital work, you're not going to come to Northern Ontario. If you can't go to a FHO or a FHT in Sudbury, then you'll go to Barrie, or somewhere else down south."
According to Jacques, the rule found its way into the contract because of lobbying from hospital chiefs of staff, who "want GPs to come in so they don't have to hire hospitalists."
It's a totally different story in smaller communities like Kapuskasing, Kirkland Lake or Wawa. "No one goes there unless they're willing to do hospital work," said Jacques.
The problem is in bigger cities like Sudbury, where it's much more difficult logistically, more time consuming and more disruptive to a doctor's schedule to do hospital rounds.
Physician assistants
Jacques would like to see the Ministry of Health expand the family health organization model by providing FHOs with funds to hire physician assistants (PAs).
"If we were provided with PAs and if we were allowed to expand our roster, we could provide more service to more people. Within five years, we'd probably roster just about everybody."
Last summer, said Jacques, the Ministry had some money for physicians to apply for physician assistants who graduated from McMaster. "There were 22 graduates, but if I wanted to have a physician assistant, I had to pay half of their wages. If they went to a family health team, they'd get 100 per cent. If they went to a nursing home, they'd get 75 per cent or if they went to Emerg, they'd get 100 per cent."
The fact that doctors belonging to family health organizations in Sudbury aren't co-located complicates matters, but FHOs could still find a way to incorporate physician assistants into their practice, said Jacques.
Family physicians have embraced capitation and have found it advantageous to join family health organizations, but the disparity in funding for FHTs and FHOs still rankles.
"If you look at a doctor who works in a family health team, he has a nurse practitioner who may do 25 per cent of his work and he's still paid for that patient, where I have to do all the work on all of my patients and if I want to have a nurse, I have to pay for her myself. There's no way I can afford a nurse practitioner or a physician assistant. They're a hundred grand."
Eliminating the 50:50 rule, funding physician assistants to join FHOs and allowing physicians practicing in family health organizations to increase their rosters would go a long way toward meeting the primary health care needs of Northerners, claims Jacques.
