Marathon FHT accomplishments recognized

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The Marathon Family Health Team (MFHT) has received the 2009 Family Practice of the Year award from the Ontario College of Family Physicians.

The award recognizes the accomplishments of the team's rural practice and the stability and sustainable health services it has provided to the people of Marathon since 1996. Prior to the team's establishment, approximately 75 physicians served this remote Northern Ontario community over a period of 10 years. By 1996, one local physician remained, supplemented by locums.

The team practice was established when six physicians came together with similar goals and a desire to practice in an underserviced area.
 
"We had known each other and knew what we wanted to do," said Dr. Sarah Newbery. "The really unique piece was that Dr. Gordon Hollway, the physician here at the time, was able to let go of the way things had been done and say, ‘Let's create something new that will work for everybody, and allow this practice to be sustainable into the future.'"
The initial driver was a shared belief that a "deeply satisfying and effective professional practice could be balanced with a meaningful personal life." 

The physical office walls within the clinic came down to create an open, collaborative atmosphere, and a creative model involving a consensus-based decision-making process, shared funding and commitment to each other was developed. Since then, clinical and hospital health services have blossomed in this region of 6,000 people, which includes two First Nation reserves.

"The premise that underlies the consensus-based decision process is that if something is not going to work for any one of us, then it won't be a sustainable solution in the long run," Newbery said. "When we can't come to resolution, it often means we haven't found the right solution."

Consensus

Sometimes, it takes several meetings to reach a consensus, but often the extra time taken to study an issue results in a more creative, worthwhile solution, said Dr. Mary Wilson, who has been a member of the team for 10 years.

"It is important to be able to communicate with one another about some of the fears and concerns one may have regarding a particular issue, so it can be resolved in a manner that is more acceptable for everyone," said Dr. Joanne Berube, team director and another 10-year veteran.

"It does take time, energy, and sometimes, tears and frustration, but all of the physicians who have been part of our group over the last 13 years have recognized that there is value in staying committed to the process and to each other," said Newbery.

Currently, there are seven physicians, one of whom is on maternity leave. The clinic has had as many as nine, although they are funded for six full-time equivalents. Salaries are divided among the group based on hours worked in clinic and on committee. Newbery pointed out that for a shared funding model to work, there has to be a fairly high level of trust among the members and willingness to support one another.

This model has had a positive impact on the recruitment and retention of physicians in Marathon. Its inherent flexibility has allowed some to take time off or adjust their schedules to accommodate family or personal life. It has also permitted extra physicians to be hired to act as a buffer above the Ministry minimum, which in turn, creates greater capacity.

Recruitment

"Recruitment and retention is always an issue," Wilson said. "Because of the way we work, we've been successful in retaining people who enjoy working in this system. Paradoxically, one thing that has worked well for us is that we do encourage people to feel they can leave Marathon if it is time to move on."

She said one of the barriers to getting a physician in a smaller place is there is often a huge buy-in and the new recruits feel they will be stuck there with half the patients and not be able to leave. "One of our principles is that it has to be easy to come to and just as easy to leave if it is time to move."  

Over the years, new programs within the clinic, community and hospital have been initiated and previously closed programs were re-launched.

Aging hospital policies were updated and rewritten. The hospital's obstetrical program was reopened, chemotherapy services were initiated, and satellite clinics in the two First Nation communities were set up. A half-day clinic at the local high school began in response to a student's suicide several years ago. Students have come to rely on the clinic as a point of access to health care. 

The physicians wear many hats under the health-care umbrella and meet regularly in different capacities as representatives of the MFHT or the hospital. The same team and nurse practitioner responsible for primary care in the clinic also provide in-patient care, emergency room coverage and minor surgical and procedural services, including joint aspirations, lesion excisions, IUD insertions and endometrial biopsies at Wilson Memorial Hospital. One of the physicians completed anaesthesia training, allowing the hospital to offer colonoscopy and cataract surgery programs. The registered nurses (RNs) have been trained to provide pap and breast exam services, wart treatments, immunizations and basic travel counselling services.

A host of programs have been initiated in response to the community's needs (see box). Many of them operate within an inter-professional shared care model, tapping into expertise throughout the community.

The mental health program, for example, functions through the co-operation of local physicians, social workers and a telepsychiatrist.
Professional development is also valued and supported. A budget exists for staff to participate in educational opportunities relevant to their roles in the FHT or the services that are provided. The team has hosted a number of learners over the years, including medical and nursing students.

Since becoming a Family Health Team in 2005, the interprofessional staff has expanded, as has the range of services. In addition to the seven physicians, there is one social worker, two RNs, two RPNs, a nurse practitioner, a part-time dietitian and epidemiologist as well as several administrative support staff.

"I think we are providing better care," Berube said. "We've been able to do more with preventative health education."

Wilson said the extra staff has allowed the physicians to see more patients in a day and direct the right service to the right person in a timely fashion. Patient feedback has been positive. They appreciate the range of services and now feel like they have better access to providers.

The FHT has also taken the telehealth suite from the hospital and moved it to the clinic, which frees up staff at the hospital to perform other services.

An advanced access booking strategy is being piloted to reduce wait times for appointments. After three months, the wait time was reduced to one or two days from the traditional 26-day wait to obtain an appointment with a family physician, according to Berube.  

"The mantra is to do today's work today," she said.

The pilot will continue until year's end, at which time epidmiologist Margaret Cousins will compile statistical data and evaluate the methods and structure developed during the pilot to determine if the new approach is working.

The sustainable health-service model and collaborative team effort have contributed to this win-win environment for both physicians and the community in which they practice.


www.mfht.org