Twenty years ago, family health care was in crisis.
Too few medical students were entering family practice to sustain primary care in Canada. The result in Ontario was that the chairs of five university departments of family health met with the province to reimagine family practice in 2002. The goal was to coax more medical students into primary care by changing the way family physicians are funded and care for their patients. Up to that time most health care was delivered by solo fee-for-service physicians working out of their own office with little or no support staff except for a receptionist and a nurse. The work was lonely, exhausting and by comparison with their specialist colleagues, poorly paid.
The new model offered to sweeten the pill for prospective family physicians by offering better remuneration, a collaborative team model for practice including several other family physicians, nurse practitioners, nurses with special expertise in matters such as diabetes, cognitive care, psychological problems, specialist care as needed for patients and help in navigating a sometimes opaque health care system. From the first, the idea was to provide a broad range of services tailored to the community’s needs, round the clock coverage in some form, coordination of care, support for the terminally ill and in short provide for most of the needs of their patients.
Most of us are more or less happy with the FHT model. However, there are caveats. FHTs are expensive – very expensive. After all there’s a lot of support staff to support! Then there’s the matter of showing that all those add-on services actually achieve what they hope to achieve or believe they are achieving. Sometimes there’s more ‘belief’ here than ‘evidence-based’ medicine to support the added support. There’s also the matter of getting in touch with anyone. Many patients find it’s hard to contact their family physician or a nurse practitioner. And out of hours coverage has morphed into ‘walk-in’ clinics or ‘urgent-care’ clinics, sometimes scattered all over the community or by default the nearest ER.
These and changes to the way physicians and the FHT are funded, were the subject of the first installment on the FHT, which was well and fairly presented in the June Infohealth session by four McMaster medical students – Hannah Kearney, Michelle Murdock, George Hu and Yazid Bhathena and their mentor, Dr. Jorin Lukings. That material is still available for viewing on Cogeco’s On-Demand service and worthwhile reviewing before you come to the second instalment on the FHT presented by the same team on Oct. 9 at 2 p.m. in the Niagara-on-the-Lake Public Library. Plan on being there.