This article originally appeared in the September/October 2020 issue of the Ontario Medical Review magazine.
Virtual care, wait lists, physician workloads among key topics in OMA President’s video address to delegates
by Lisa Murray
OMA Member Relations, Advocacy & Communications
The OMA participated in the Association of Municipalities of Ontario’s (AMO) annual conference from August 15-17, providing health care insight and information to municipal leaders on behalf of Ontario’s doctors. The conference was held virtually for the first time, and it’s no surprise that a major theme was COVID-19.
On the first morning of the conference, OMA President Dr. Samantha Hill addressed AMO’s Regional and Single Tier Caucus on The New Normal of Health Care in the Era of COVID-19. Her remarks provided the physician’s perspective on the short-term and longer-term prognosis for our health care system as Ontario emerged from the first wave of the pandemic.
Dr. Hill stressed that while Ontario has been “reopening,” doctors were never closed: “Throughout the pandemic, we continued to care for patients, although in dramatically reduced numbers. This was mainly done through virtual care, but also by physicians working on the frontline in hospitals, and community physicians seeing some patients in person who just couldn’t wait for treatment.”
Dr. Hill described that virtual care was a literal lifesaver for patient care. She noted the OMA successfully lobbied the government for temporary fee codes so all patients would have equal access, especially those who are economically disadvantaged and/or living in rural or northern parts of the province where Internet service is either unreliable or non-existent.
“Given the success of virtual codes through this first phase of COVID-19, OMA and government have agreed to an extension of the virtual care codes until March 14, 2021. Ultimately, the OMA’s goal is to negotiate permanent access to virtual care, for all patients, and all appropriate medical services.”
She confirmed that pre-COVID, Ontario’s more than 32,000 practicing physicians would see 340,000 patients a day. However, from March to the end of June, even including care provided virtually, patients received 11.5 million fewer services from their physicians as compared with the same period last year. Two-thirds of these postponed services were related to family doctors, specialists and diagnostic clinics in community medical facilities, and one-third was within hospitals.
Dr. Hill warned that there is no quick fix to catching up on the enormous backlog caused by COVID-19, let alone catching up on long pre-COVID wait lists. She explained that like other spheres of public life, capacity will continue to be limited and doctors will continue to see fewer patients each day because of health and safety protocols.
“Doctors already work an average of over 50 hours a week, not including on-call hours. Some routinely work 80 to 100 hours,” she said. “It isn’t reasonable or sustainable to expect them to work more hours indefinitely.”
The result, she notes, is that patients will have less access to preventive medicine, and patients with existing health conditions will have to wait longer to see their doctor.
“When this happens, smaller health issues can become bigger heath issues. Some patients who otherwise could have been treated earlier will end up in hospital, or worse. This is what keeps me and other doctors up at night.”
Dr. Hill spoke at length about the challenges that many fee-for-service physicians face in keeping their community clinics viable as some have seen up to a 70% reduction in their billings.
“We never wanted to become small business owners and weren’t trained to be small business owners. We were trained to be doctors and care for patients, but found ourselves operating a business because that’s just the way our health care system is set up.”
She described that when waiting rooms are full, the fee-for-service model is not as much of an issue. However, when the number of patients seen doesn’t even bring in enough to cover expenses, like all small business owners, physicians must use their personal resources to keep their clinics afloat. Physicians in early practice do not have these resources. For physicians near retirement, there will be no opportunity to recoup the costs. Both are likely to be forced to close their clinics in the absence of meaningful infrastructure support by government.
“The loss of even a piece of our crucial health care infrastructure will have a major impact on our ability to address the backlog, leading to increased wait times and hallway medicine. There are already one million Ontarians who don’t have a family doctor.”
Referencing a June report by the Conference Board of Canada for the Canadian Medical Association, Dr. Hill emphasized that our health care system and economy are linked, and that we can’t have a strong economic recovery without a strong health care system, and vice versa. She noted that the report found that physician clinics contribute just under $14 billion a year to Ontario’s economy, generating 125,000 direct and indirect jobs and contributing $5 billion in taxes.
Dr. Hill concluded her remarks by thanking municipal leaders for their valiant efforts to shepherd their communities through COVID-19, including in some cases literally keeping the lights on.
Throughout the three days of the conference, the OMA also hosted a virtual booth in AMO’s virtual exhibit hall. Some 250 municipal leaders visited the booth, asking questions of staff and accessing resources including the virusfacts.ca website and the contact tracing Community InfoBulletin and companion Pocket Journal in 21 languages.
The OMA’s presence at the conference was very much appreciated by the delegates, with many spontaneously thanking the OMA for supporting AMO and municipalities, and thanking all of Ontario’s physicians for the incredible work they did, and continue to do, in the face of the pandemic.