We cannot keep doing what we have always done and expect different results.
Executive Summary
Hastened by the Covid-19 pandemic, Canadians are generally now in agreement that our healthcare system is in crisis and in need of major reforms. Many healthcare leaders, politicians, journalists, and patients are proposing solutions. This paper is intended as an added voice to the discussion through a long-term lens.
Family medicine has lost its appeal
Current trends indicate that the ideal of every citizen having their own family doctor is no longer tenable or sustainable in Canada. The reasons are outlined, including practise preferences for younger physicians, an aging population with increased needs, medical technology, and diminished population resiliency.
Although nurse practitioners have been rising to fill the gap, their move from bedside nursing to primary care is contributing to a shortage of critical care nurses in areas such as ERs and ICUs. And so far, they have not proven to increase primary care throughput to avoid overrun ERs, private virtual care alternatives, or walk-in clinics.
Recommendations
There are proven principles that global healthcare leaders and economists all agree on:
- multidisciplinary collaborative care to full scope,
- payment and funding models that reward value, innovation, and well-being,
- interoperable IT solutions with robust connectivity,
- a biopsychosocial approach, and
- healthy lifestyle promotion and disease prevention.
Train and credential based on real and future needs. This includes leveraging non-physician primary health care workers more effectively. A new educational and credentialing stream is required (a four-year post-secondary Bachelor of Science in Primary Care is proposed).
Group treatment. Many chronic diseases can be very effectively treated in groups with a lay sponsor or facilitator (like the AA model). Good data to support this is already available.
Population health and resiliency initiatives. We need to revisit parenting strategies, educational practises, and cultural norms to bolster the resiliency of our young people and the future healthcare team (indeed the entire workforce).
Dialogue that includes both federal and provincial stakeholders, and all professional disciplines. No idea or proposal should be immediately discarded as non-tenable without serious consideration.
Primary care is the bedrock of our healthcare systems
Frontline community-based healthcare is the bedrock of a nation’s healthcare system. Primary health care (PHC) should address the health needs of all patients at the community level, integrating healthcare, prevention, promotion, and education.
This is now considered by global experts to be the way forward in both rich and lower income countries.
Read more in the following paper entitled, “Why Strengthening Primary Health Care is Essential to Achieving Universal Health Coverage.”
CMAJ. 2018 Apr 16;190(15):E463-E466. doi: 10.1503/cmaj.170784
Medical homes are the way forward
The College of Family Physicians of Canada has endorsed the “Medical Home” concept of primary care delivery in the community.
In this vision, every family practice across Canada offers the medical care that Canadians want — readily accessible, centred on the patients’ needs, provided throughout every stage of life, and seamlessly integrated with other services in the health care system and the community.
https://patientsmedicalhome.ca
For this vision to be successful, all of us as stakeholders (healthcare providers, political leaders, and patients), need buy-in to implement a successful strategic rollout of this model. We need to lay aside any “us versus them” mentality and truly work together toward a unified mission of “well-being for all.”
Proposed clinic workflow template
A group of retired family physicians have authored a proposed workflow template which we believe if implemented with full buy-in by leaders and clinicians, will go a long way to eradicate the registry of un-affiliated patients on PEI. And reduce reliance on the ER or Maple for urgent care.
As a working document, the authors welcome dialogue to achieve win-win-win-win (political leaders, HPEI leaders, clinicians, and patients) solutions.