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CMAJ Today!

Ontario family doctors propose cure for ailing health care system

Date: Aug. 11, 1999
Time: 3:30 pm

The Ontario College of Family Physicians recommends the end of fee-for-service and solo practice for most Ontario family physicians.

In a bid to provide more comprehensive care for Ontarians while improving doctors' quality of life, the OCFP is proposing a revamped primary-care system that emphasized prevention as well as treatment and features a multi-disciplinary team in group practise offering 24-hour, 7-day a week services.

Initially critical of the proposal, the Ontario Medical Association (OMA) and the ministry of health are now talking to the OCFP about its ideas. Even the federal government has expressed interest. The OCFP has invited more than a dozen organizations, including nurses and the OMA, to discuss its paper, "Family Medicine in the 21st Century: A Prescription for Excellence in Health Care". The final version will be presented to the OCFP board in November.

"Some ideas are new and possibly revolutionary but they need to be assessed and to evolve," says OCFP President Dr. Walter Rosser. "It's ongoing work that will take at least 5 years to get in place."

The OCFP's proposal calls for a rostering system where patients register with a single family practice consisting of 7 to 30 physicians, plus nurse practitioners and other health professionals such as physiotherapists. All these professionals won't necessarily be in one building -- they will be linked electronically into a virtual group and will all serve the same population. Together, they will provide patients with a "basket of services" including obstetrical and palliative care, that no single FP could provide, says Rosser. Working in a practice network will also mean less on-call time for FPs and more opportunities to take time off.

Physicians would be expected to see a large numbers of people for very short periods (6 to 10 per hour). The practice networks would also provide 24-hour phone triage and other expanded services designed to reduce pressure on overcrowded hospital emergency rooms. In addition, the OCFP proposes province-wide electronic records, such as the UK is now implementing.

Instead of paying doctors a fee for each service they perform, the college also advocates a new "blended" payment, incorporating a base salary, overhead costs, incentives for providing needed services and a payment based on the amount of work they do. Presently, 92% of Ontario's 12 000 FPs receive fees for service. The college, which represents half the physicians, argues that this model doesn't provide any incentive for comprehensive or community care such as hospital work, home visits and obstetrical services, which take considerable time but are compensated at a relatively lower level.

Rosser says blended payments have been "received quite well" by members. A survey indicated that although 90% preferred fee-for-service, 80% would accept blended funding. This system provides doctors with the stability and security they crave while "reasonably rewarding" them," says Rosser.

-- Barbara Sibbald, Ottawa

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