Windsor Star article published on November 8, 2015. Article in full pasted below.
Brian Cross, Windsor Star
Family health teams are keeping their patients healthier, according to research that’s emerging a decade after Ontario started approving these big operations loaded with physicians, nurse practitioners, dietitians, social workers and various other health practitioners.
But while new studies are concluding that Ontarians would be healthier if they were all served by these teams, the government has effectively stalled any expansion by not allowing new doctors aboard, according to advocates. They suggest the marginally greater cost of taking care of patients in a family health team is forcing the fiscally squeezed health ministry to favour short-term savings over long-term benefits.
One study showed the annual cost per patient for those served by a team is $4,117 compared to the Ontario average of $3,990 for traditional primary care.
“In a word, it’s money,” says Essex County Medical Association president Dr. Tim O’Callahan, who is lead physician at the Amherstburg Family Health Team, where five doctors and other health professionals — including a social worker, nurse, nurse practitioner, dietitian and diabetes educator — care for about 10,000 patients.
“It comes down to: do you want to invest in better outcomes or not? And they’ve decided, right now, not,” he said.
The Health Ministry denies it’s put the brakes on expanding family health teams, even though it hasn’t approved a new one since 2011-12. It is in the midst of studying how to deliver on a promise to connect everyone in Ontario with a primary care provider — a family doctor or nurse practitioner, spokesman Gabe De Roche said in an email. “And it’s important that we let these conversations finish before moving forward.”
He said the ministry is proud of what the health teams have accomplished.
Recent studies measuring the impact of family health teams show: more patients can get an appointment the same day; 90 per cent say staff are courteous compared to 63-75 per cent for all doctors’ offices; more patients get screened for colorectal, cervical and breast cancer; and diabetes care is better.
The ministry’s De Roche said that patients with depression get better attention, sending them back to work earlier and adding 52,000 extra person years into the labour force each year.
“All told, this could save the Canadian health-care system almost $3 billion in direct and indirect costs,” he said.
Today, 3.2 million people in Ontario get their health care from more than 200 family health teams, including 900,000 patients who previously did not have a family doctor. In some communities in Essex County, like Leamington, Harrow, Amherstburg and Kingsville, the majority of the population uses the teams instead of traditional fee-for-service family doctors, whose only staff is a receptionist.
“The incentive in the old (fee-for-service) system was to see a high volume of patients,” said Dr. O’Callahan. “The new system, and I stand behind it, I think incentivizes quality.”
Team doctors are paid based on the number of patients they have, not on how many times they are seen. O’Callahan said if a physician can sit down with patients and spend more time, they’re going to walk out feeling well cared for and won’t show up a week later with some other problem.
The team approach also means a doctor can work with other staff to provide a blanket of care. If a patient has depression, there’s a social worker down the hall who can start counselling, eliminating the need for the doctor or patient to look elsewhere.
The team approach may appear more costly, but the sole practitioner still has to send a patient elsewhere for help. The cost of that service isn’t factored in when comparing the two models, said administrator Jim Samson, whose large family health team has 15 doctors in Leamington and Kingsville. It has about 30,000 patients and a waiting list with more than 1,000 names, because it can’t add doctors in Leamington.
“Regretfully, the ministry has been very particular about the number of doctors that can join (a family health team),” said Samson. “We’re caught between a rock and a hard place.”
While they dominate in the county, Windsor’s single family health team has about 6,000 patients, three per cent of the population. The team is limited to four physicians and could probably enrol another 600 patients, said administrator Mark Ferrari.
He said Windsor residents have been less interested in signing on with a family health team, perhaps because they’ve become used to going to the area’s 25 walk-in clinics, using them like doctor’s offices.
“It’s only when the walk-in clinic can no longer serve their needs that they start to look for an alternative and discover us,” he said.
Windsor does have several other health centres that use a similar team approach, many serving low-income areas or specific populations, such as teens or people with mental illness.
Windsor Family Health Team physician Darin Peterson has worked in every family medicine model — walk-in clinics, hospital emergency rooms, and sole-practitioner and group practices. The team is “supreme,” both for him and for patients, he said.
“If someone needs extensive counselling we’ve got a social worker, if someone needs great dietary planning we have a dietitian, so it’s just complete comprehensive care,” said Peterson, who gets benefits and a salary that ranges between about $158,000 and $200,000, depending on patient load.
Angie Heydon, the CEO of the Association of Family Health Teams of Ontario, said she thinks the Health Ministry is being “really, really, really cautious” about where it’s spending any extra health-care dollars, and that’s why expansion of the teams has stalled.
Only recently have studies started coming out proving the teams reduce total costs of health care, including hospital admissions, home care and long-term care admissions.
“It takes time, it’s not like you put in a family health team today and you (instantly) have fewer people having legs amputated because of diabetes,” Heydon said.
“We’re starting to see that relationship, that when quality of primary care gets better we see the relationship with a lower total cost of care.”