A possible solution to the family doctor shortage | About That

I want you to listen to something um what is unfortunately a very common problem my name is Carlene my husband and I we've gone without a family doctor for about two years my name is Ali ballen and I've been looking for a family doctor for about four years since 2019. I I got so desperate at one point I called every physician that practices in our city I am visually impaired I am not able to drive taking the bus to another city when I'm not feeling well is not not really appropriate nor great for me every office that I've called to inquire about has put me on a wait list I have not moved up on any of the offices now according to a recent Angus Reed survey close to 20 so one in five Canadians do not have a family doctor so like where do they go when they need medical attention right well the way I see it you know they have three main options one go to a walk-in clinic two go to a hospital or three go It Alone Now for almost my entire adult life so from you know Montreal to Vancouver to Toronto I've fallen into that first category so I I basically see whichever doctor will see me at whatever clinic is open because finding a family doctor is just hard right we just heard it but today we're going to do two things we're going to hear from a family doctor about why it's well worth the trouble to find one and and maybe for reasons that you haven't thought of but we're also going to take a closer look at a truly Comprehensive Health Care solution that has been in development in this country for nearly 20 years but that most Canadians don't have access to and that until recent I'm embarrassed to say I never even heard of but first we have invited Dr Danielle Martin family physician to join us here in studio to help walk us through kind of what we're missing when we don't have access to this pretty fundamental like Continuum right of of care primary care and first of all how are you doing I'm great nice to see you yeah thanks for being here so full disclosure okay let me set this up this way I'm a walk-in clinic guy okay so I'm sorry I know I know that hurts um but like it's actually kind of worked out okay for me right like I you know get my prescriptions filled just fine like I have asthma eczema whatever I can get epipens when I need them um you know like I've got a little bit of a like a rickety shoulder but you know and maybe some crackly knees but but like that's just because I'm getting old right so it's not that big of a deal tell me what am I missing yeah I mean first of all what you're expressing is that you value the convenience of the walk-in clinic and I agree that you're entitled to that convenience and that uh we need to try to build models of family medicine and primary care that uh respect your time and where you can access what you need easily but a walk-in clinic doctor is not going to have time or relationship with you over time but they haven't noticed right no they no they really don't and they're not sure if they have them they're not it's not their obligation they're treating every interaction that's a walk-in clinic as a one-off interaction they are not taking responsibility for your ongoing care so they're not going to step back and say did you know Andrew that actually asthma and eczema are linked and that actually that puts your kids at risk of certain kinds of other allergy related issues over time or that that actually maybe that rickety shoulder and that rash are linked and perhaps it's not eczema your family doctor knows you they don't specialize in a disease or an illness or an organ or a body part they specialize in their relationship with you and they will notice that your blood pressure is creeping up they will help you to prevent yourself from getting sick by doing the regular monitoring for chronic diseases have we checked your cholesterol have we are we keeping an eye on your blood pressure what was your family history again you know what did your mom have do we need to screen you early for certain forms of cancer and recognize the interplay over time and space of what is happening in your life what's happening in your body what's happening in the community around you that affects your health that's our job it sounds like what you're saying is that that family doctors are are not only exceptionally good at noticing things but but noticing patterns patterns is what it's about and and the specialty really is about relationships so if I've never met you before I might not say if you put on a bit of weight or whatever you know okay I think it's you know it's noticing change over time so patterns in the individual as well as patterns of symptoms and at the level of the population but I might also say you know I'm wondering if there's a link to what your what you're eating here maybe we should get you connected with a dietitian or every time you come in here with an exacerbation it's because you're under mental stress it's time for us to connect you with a therapist so it's not just referrals to Medical Specialists it's the full range yeah see that's how our care providers out there I normally think of doctors referring people to other doctors right to others we refer to social workers to psychologists to pharmacists to dietitians to that you know to uh uh physiotherapists an occupational therapist so you know helping to determine who is the right professional the right health care provider to support you is a big part of what we do in Family Medicine so why is it so damn hard to find out oh it's so hard I know and it's such a it's such a tough problem I mean some of it is because our population in Canada is growing but it's also aging which means the family docs are aging and theirselves themselves and retiring so we've seen then add the pandemic to that so we've seen a double of retirements during the pandemic here those doctors aren't being not it's impossible to replace them at a fast enough pace and that's not an exaggeration by the way at the outset of the pandemic during a six or seven month period we saw 385 doctors stop practicing this is according to a recent study in the annals of family medicine and that number is about double the number of doctors that we typically see retire during that same period of time every year between 2010 and 2019. that's 170 000 people who just lost their GP and part of that is also because the practice has shifted the new generation want to work in a much more supportive environment they want to work in teams and a team means multiple doctors working together but it also means multiple doctors working together with nurses and Pharmacists and social workers and all of those other health care providers so all of these doctors under one sometimes Under One Roof sometimes it's more of a you know we're in the same neighborhood and we share calls so I'm allowed to take a vacation but somebody's got to take care of you while I'm away my colleague steps in so it's it's about Cross coverage and it's about all of these other kinds of providers so that I have a an elder who's taking eight medications and now they've got kovid and I got to put them on Pax lovid which is a medication that has a million drug interactions rather than spending my whole afternoon trying to figure out what to do I pass that person to the pharmacist and the pharmacist knows how to figure out what to do you know what to hold what to discontinue how to adjust doses of things and get them on the Pax love it help me with the prescription and I can move on and see the next person so it's teams and we haven't been building the teams for our new grads to come into so people aren't choosing family medicine right and yet and I just want this to be clear for folks who are listening to you talk about this sort of team-based approach this isn't just like an idea no no this is a thing about a third of ontarians have access to a team right now either through a community health center or a family health Team and that's just in Ontario that those numbers are lower in some other provinces and territories and yet here I am in in not just in Ontario but in the biggest you know most populous city in the country with not able to find a single family doctor never never mind that the team-based approach that you were talking about so we're gonna have to I mean we don't bat an eyelash when we have to spend a billion dollars to build a bunch of new hospitals fancy buildings we are going to have to invest in Primary Care in this country we know that Health System systems that are built on fondness strong Foundation of primary care have better health outcomes for patients better equity and lower costs you don't end up in the hospital with a stroke if your family doctor has been seeing you and managing your blood pressure you don't end up with an a late stage cancer if you've been getting your regular screening so primary care more than pays for itself but we just keep investing in the Fix-It shop which is the hospital and under investing in the community so I'm not talking about paying family doctors more for their individual work I'm talking about building those teams and infrastructure that make it attractive for new graduates to choose family medicine and to provide this kind of care because you're right otherwise we end up in a situation where people use walk-in clinics and you know it can be convenient and fine when you're young and healthy but every investment of a visit that you make with a person who knows you will pay you dividends later when you need when you need health care which you know if we're lucky enough to live long enough we're all going to need Dr Martin thank you so much thank you we have a lot to talk about uh on the other side of the break more on this this team-based approach in just a moment okay so I'm here outside the Parkdale Queen West Community Health Center exactly the kind of place that Dr Martin was talking about just before the commercial break because we figured the best way for me to learn more about what goes on inside is to actually just go inside and I know my producer Drew has something that he's cooked up once I get it okay let's go all right so what are we doing here uh we're gonna take you on a patient Journey at this health Team smacked up you can hear me one two one two all good so this is this is a reimagining of who I am today that's right okay okay let's head on down yeah thank you drew come on in come on in hey Angela hello can you tell me about this place where we're at so this is a community health center um Parkdale Queen West Community Health Center um and we are one of um over 70 community health centers across Ontario in addition to the Physicians we have nurses Nurse Practitioners which has advanced practice nurses and we have physiotherapists we have social workers High need populations um so therefore you have complex health conditions that people have that is also complete complicated by social determinants poverty issues I have a feeling that there are some complex conditions yes should I open this okay so I'll just read this out loud you are a 50 year old man you live on social assistance because you sustained an injury at work 10 years ago and haven't been able to work since recently you started experience frequent urination and you're losing more weight than usual you live alone and don't eat as healthy as you know you should if I walked into this health center with this series of medical issues what happened so what would happen is the first person who you would come up on lightly and be directed to would be the our intake worker okay which would be someone who would take you know your you know the details and then they will use that to then connect you to the right care provider and who is the right care provider the first right care provider given what you have there as your condition would be a nurse practitioner and or a physician can we go so we can definitely take control hi there hi Andrew I'm Shona nice to meet you so I'm coming in here with a whole host of of issues that I'm struggling with and maybe the most acute one would be this frequent urination so I have to pee a lot more than I used to and losing weight does that does that trigger alarm Bells absolutely one of the things that we worry about when someone would come in with peeing a lot losing weight first thing you think of is diabetes and so what would you do in that case so um I would take a bit more of a history I'd work out if they had any other symptoms I would order some blood work but been diagnosed from a really simple blood test doesn't even have to be fasting we can even do that here I would connect you to our diabetes team so diabetes nurse educator and dietitian who would work with you around learning about diabetes any sort of Lifestyle measures that you could take and we have them she was actually here today so I can go and bring her in her name is Jane wonderful okay I'll wait here thanks very much okay so just as I wait for Jane the registered nurse and diabetes educator to arrive here I'm struck by something that Shona mentioned as she was leaving and she was saying that this case study that I've got here you know being a 50 year old man on social assistance frequent urination losing weight not eating as healthy as I perhaps should she said that this is actually a remarkably straightforward case for them that usually they handle much more complex cases sometimes involving things like substance abuse or mental health illnesses so this is something that they seem pretty well equipped to handle here hi Jane nice to meet you nice to meet you too you're a diabetes educator what is it that you and I would be having a conversation about at this point after I've done some blood work and I've sort of confirmed the worst a lot of it is talking about what their treatment is going to be so if they don't want to go on the route of starting any medications then we look at lifestyle for at least three months and if the lifestyle alone hasn't we keep it in the back of our minds that you know we may have to add some things to your treatment what might be a logical Next Step from there is a case manager okay yeah a case manager would be helpful for you in your particular case because you've been unemployed for a while you live alone you're on social assistance so those are all the social determinants of Health that can impact how you manage your diabetes can you introduce me to that person absolutely okay let's go so let's go hi it's Andy I'm Andrew nice to meet you thank you so much I appreciate it what goes through your mind as you as you see them somebody that needs a lot of support to get to a place where they're healthy and they're empowered around their health so I see things around food and security right so if you're not having adequate food how can you stay healthy how would you help me on my phone oh I would introduce you to one of the team on the first floor that would help you with food resources food banks sometimes we get donations of fresh food I mean medically I suspect at some point I would actually need to sit with a medical doctor yep yep so then you would also be referred to Dr Gillis who's one of our physicians here can you introduce me to Dr Gillis absolutely I'd love to okay let's go let's go hi nice to meet you I'm Alison Gillies okay so this has been a whirlwind so far so after I've had a conversation with someone like Tandy a case work manager what would our conversation be like so for in the case that's being discussed today so for example someone coming in with new diabetes um I'd be wanting to you know get a sense of what the symptoms are making sure that we're doing a physical exam checking the blood pressure seeing if there's any nerve damage from the sugars having been high there's screening that needs to be done eye screening for example because the high blood sugars can cause damage to the eyes so it would be coordinating those tests and then arranging follow-up based on the results of those findings so if everything is going really well and things are well controlled I might be seeing you again in three months if the results are coming back in a level that is more concerning I might be seeing you again in two weeks Dr Gillies thank you so much for this you're welcome I appreciate it Angela uh this this place is incredible thank you um I'm struck by just the diversity of expertise in this building it seems to me like you're you're really looking at the whole person the whole person the whole person and how closely are all of the the Professionals in this building working with each other like like are they are they Consulting each other often when they share patients yes so um so we are all part of The Circle of Care so it means that if you see a physician then that physician can easily chart something in the clinical record in the client record and the social worker can pick up on that to follow through with what is um being requested on the part of the clinical team what kind of financial pressures are there on you to to churn through patients as quickly as possible like like I'm looking at this place and I'm trying to think is this more like a shopping mall or an assembly line ah I would say that it is a lovely food court in that you have a range of offerings in a single setting and that you are directed to the stations which best meet your needs in terms of resourcing and the churning is because we're in a salaried model it means then if you need some more time then the provider can spend more time with you without becoming an impact on billing there's no one or two issues per visit no here no right there's there's no requirement to just push people through as quickly as possible if someone needs if someone has six eight issues then we have the ability to deal with um six or eight but it also means that the pressure isn't on one single provider to respond to the six or eight needs right that single provider may have for other people that they can draw on to support and again encircle the client because otherwise if such a person did not have access to a place such as this how would they manage um well I think in the absence of team-based care then an individual who is marginalized who is already facing challenges and or even you know you're a person who is relatively settled and stable can spend a lot of time what I call hopscotching within a system to find the care and particularly for folks who may be in a workplace where they don't get time off to go to a myriad of appointments then being in a space where you can be attached to multiple Services sometimes in a single visit just to come to one place it's easier it is easier so so Angela why isn't there one of these places on every street corner in every neighborhood in every Province across this country well you know you're saying what is my desire um you're saying what is my desire and I would say that these kinds of integrated care services can sometimes be seen as the by the system as an expensive model and I think when you look at the expense that you would spend in building this kind of team-based care versus the expense that you will spend in an acute setting responding to what happens in the absence of this kind of team-based care is you'll spend more you'll spend more in the acute care responding to the emergencies created by the absence of team-based care right and that's a high ticket item and I'm saying no more beds might be needed what we have may be imperfect but certainly more weighted investment should be placed at the Genesis of the site of need which is in community and team-based care and bringing care also closer to where people are Angela you've been exceedingly generous with your time your expertise and your team thank you thank you thank you deeply thank you thank you thank you hey welcome back to about that so so hey that was like genuinely cool to be there at the Parkdale Queen West Community Health Center uh big props to uh to Angela and Company for showing us around thank you for that and you know this is something that exists in other places too there there are apparently dozens of such community health centers in Ontario although about a quarter of ontarians have access to a community health center and you know I just think of myself I mean in my case I've you know been on this planet for nearly four decades and I have never encountered this sort of thing until starting to do this story and I've lived in four major cities right Ottawa Montreal Vancouver and Toronto although uh what I'm told is that for these particular types of Community Health centers they do tend to be more prevalent in rural areas that than you might find in urban areas this kind of teen based care but hey it's interesting right and and if if what Daniel Martin said was true that there is a problem in trying to refill all of those positions in general medicine in family medicine that were vacated during the pandemic interesting to think that maybe this is provides sort of an attractive workspace for folks to get into this type of medicine

Channel: CBC News

Views: 87,408

Keywords: health, doctor, doctor shortage, family doctor, health teams, canada, medicine, dr. danielle martin, doctors in canada, health care, about that, andrew chang, cbc, cbc news, cbc explore, exploreapp

Id: WPOxBGY7rmY

Length: 22min 26sec (1346 seconds)

Published: Thu Dec 15 2022