Seeking a remedy for doctor wait times
The health system may be broken if patients wait more than a month to see their family doctor.
Although many people say they receive great care when they do get in to see their family physician, those who wait weeks for an appointment have become frustrated.
“He's never really explained it to me,” said Kristi Lalonde, who's had the same family doctor in Midland for the past 25 years.
With two children under the age of 16, Lalonde said she has waited months for an appointment with her doctor.
“I love the care I get from him. He's fantastic with my (eight-year-old) son and we're in and out within an hour. And I guess it's one of those things that's been going on so long, I've never questioned it, but yeah, it can be months to get in to see him,” she said.
There's no doubt there's a shortage of family physicians in Ontario and many parts of rural Simcoe County, and there's also no shortage of walk-in clinics that parents with sick children or sore throats can visit.
Colleen Power, of Barrie, has two children that she takes to a walk-in clinic when they get sick.
“We're not sickly people, so it's not an issue right now,” Power said. “When we do get something and it's severe enough, I'll go to a clinic. It can take two weeks or longer to see my family doctor.”
There are approximately 26,000 physicians in Ontario with 12,300 working as general practitioners and the other half as specialists.
According to a 2007 Commonwealth Fund survey, Canada ranked lowest in same-day visits to their family medical practices. Only 22% of survey respondents saw their physician on the same day, versus 30% in the U.S.
Canada also had the highest rate of respondents who said it took more than one week to see their doctor.
Yet doctors had a significantly different response. In the 2007 National Physician Survey (NPS), 65% of family physicians said patients with urgent needs were able to see them within 24 hours and 41% said they saw non-urgent patients within one week and 66% were able to see non-urgent patients within the month.
Dr. Ken Klassen, a professor at Brock University at the Goodman School of Business, believes a new patient/doctor model called Open Access would solve Power's problem of long wait times.
According to Murray and Tantau's 2000 research paper Family Practice Management on 'Same-day appointments; exploding the access paradigm', it's easily explained as 'doing today's work today'.
The College of Family Physicians Canada agrees.
In its Canadian Best Advice – Panel Size 2012 report, the new family medicine model is about '"eliminating the distinction between urgent and routine," but it doesn't mean every appointment is open.
The Best Advice study quotes the Murray and Tantau model, which leaves 65% of the day's bookings open and the remaining 35% for patients who want to book the next day, instead of the doctor scheduling the patient for another day.
In essence, Klassen explains, see the patient today.
“It's used in the U.S., and we should be starting to use it in Canada. Don't pre-schedule patients, they should call and get an appointment the same day,” Klassen said.
Other factors play into the model, such as a one-year-old baby needs five times the care of a healthy 50-year-old man. Yet doctors can determine whether they'd rather see fewer high-risk patients and more healthy patients, or vice versa.
Klassen also says doctors know if they need 12 minutes to see a patient, but book patients at five-minute intervals, they're adding more stress to their own and their patients' lives.
“I've done tons of math to prove this, but the math doesn't matter if the doctor doesn't care,” he said. “Others may not need my math to just learn how to schedule less.”
Once the demand for doctors is sated, booking will no longer be solely at the doctor's discretion; the market will flatten out the demand and patients won't be as likely to stay with doctors who continually offer poor scheduling services.
Collingwood, Orillia and Midland host between two and six resident-doctors each year. Michelle Hunter of the Rural Ontario Medical Program said those areas are maintaining an 85% retention rate.
“In Barrie, 18 (residents) train in the family medicine program each year. They move into town and stay for a year or two and we've got excellent retention in that at about 85%, too,” Hunter said
For doctors who jumped on the Open Access bandwagon, their patients have responded well.
Apryl Munro, another local mom, said when her son had a double-ear infection, she was turned away from a busy walk-in clinic and the local hospital didn't diagnose the condition properly.
“I called my doctor the next morning, and was seen immediately and got the care we needed. (He) only does same-day appointments to make sure his patients get to see him,” Munro said. “I understand he's one of the only docs in Barrie that does this.”
AT A GLANCE
- There are approximately 3,500 medical students studying to become doctors
- There are 4,760 residents or doctors-in-training
- Ontario has 16,600 male doctors and 9,800 female doctors
- The average age of a physician is 50.7 years
- There are 25,309 non-rural physicians, but only 1,073 rural doctors.
Source: Ontario Medical Association
Do you have to wait a long time to see your family doctor?
Yes, all the time
Wish I had one