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Dr. Michael Green

Inside "The Green Room"

As we enter a new year, there is renewed attention on the critical importance of access to comprehensive team-based primary care for all. The critical health human resource shortages that cross disciplines and involve family physicians, nurses, and other allied health professionals have been brought to the forefront during this most recent Omicron-driven wave of COVID-19. In every profession, there is more demand for health-care workers than there are people to respond.

I recently spoke to CBC news about our situation here in Kingston, where there are tens of thousands of people without regular access to primary care. Sadly, this is a common situation across Ontario and the rest of Canada. In addition to ensuring there are adequate numbers of health-care professionals trained, there are concrete solutions that could be implemented now to help with this.

The College of Family Physicians of Canada recently published a policy statement titled “Strengthening Health Care Access Done Right” that comments on two specific areas where governments could act.

The first is in opening up access to alternatives to fee for service (FFS) payments for comprehensive family physicians. While this is only one piece of the puzzle, it is critical. Across the country, FFS payments undervalue the work of family physicians who take the time to address the complex needs of patients with multiple problems, and they encourage brief encounters focused on single issues. This is frustrating for patients and doctors alike. (See CBC White Coat, Black Art piece on nurse-practitioner-led clinics in BC.) It also increases inequities in access to care by discouraging physicians from taking on care for complex or vulnerable patients who need more time than this system supports.

The second key recommendation is that access to team-based care, not just family physicians, is a necessary part of the solution. The current status, where some family physicians and their patients have access to teams and others do not, is highly inequitable. This is particularly so as the access is not based on patient need.

We need to move from the current situation where there are essentially three tiers of patients with respect to their access to primary care: those with no access, those with access to a physician only, and those with access to teams to one where everyone has access to comprehensive primary care supported by an interdisciplinary team. These are the environments our graduates are looking for, and they need to be made available to support graduates’ entry into practice.

I know that provincially and nationally, this goal is shared among many of our professional organizations, and that Ontario Health Teams across our region are also committed to this. It will be challenging and will require investments in primary care from governments at all levels, but it is critical to the health of the populations we serve.

I want to thank all our health-care workers for all they have been doing to maintain access to comprehensive primary care services throughout this pandemic while also planning for the future and exploring creative ways to help increase access to care. Your ongoing efforts are noticed and appreciated, and make me hopeful that we will achieve this important goal.

It is your work that reminds me every day that “We are Family Medicine For Learners, For Patients, For Communities.”

Dr. Michael Green

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