This article originally appeared in the Fall 2023 issue of the Ontario Medical Review magazine.
New OMA report builds on advocacy campaign and consultations that began in 2021
The Ontario Medical Association is launching its Prescription for Ontario: Doctors’ Solutions for Immediate Action report this month, marking the next major step in its unprecedented advocacy campaign that began as the COVID-19 pandemic wreaked havoc on the health-care system.
The report is being released as Ontario grapples with a post-pandemic health system in which 2.2 million people are without a family doctor, according to a study conducted by INSPIRE-PHC, a Canada-based primary health-care research program. Physicians are also increasingly frustrated with a fragmented system and too many patients are occupying acute-care hospital beds because there is no space for them in more appropriate care beds elsewhere.
The campaign, which has seen the OMA consult thousands of its members as well as external health-care stakeholders, will culminate in the release of 11 pragmatic solutions in three immediate priority areas — fixing the primary care crisis to ensure everyone has access to a family doctor, addressing the growing burden of unnecessary administrative work and increasing community capacity and tackling hospital overcrowding.
The Solutions Report will be released in conjunction with the OMA’s annual Queen’s Park Day, on Oct. 16. OMA leaders, members and staff will meet with politicians that day and call on them to invest in the solutions to the three priorities identified by physicians as the most urgent issues currently facing the health-care system.
“Taking Ontario doctors’ advice today will get the system out of crisis mode tomorrow,” OMA President Dr. Andrew Park said. “Then we can shift our focus back to implementing the other transformative recommendations outlined in our original Prescription for Ontario. The OMA is aware of the many other important issues to members, such as negotiations and scope of practice. Our focus has been, and always will be, to advocate for the well-being of members.”
The OMA’s consultations and surveys all pointed to the urgency of addressing the primary care crisis, beginning with the shortage of family doctors. Ontario now ranks eighth in family physicians per capita among the provinces and territories.
“Family doctors are the bedrock of the health-care system,” said Dr. Park, who has worked for years as an emergency physician in London. “When we don’t have enough family doctors, that leads to problems across the system.”
Two immediate solutions in the new report address the shortage of family physicians:
The primary care crisis has taken an enormous toll on patients and doctors alike, with almost three-quarters of physicians reporting some level of burnout in 2021. Moreover, the OMA’s 2022-23 member survey found that 40 per cent of physicians are considering retiring in the next five years.
Excessive administrative burden and other challenges have created a system where family doctors report that they spend, on average, 19.1 hours a week on administrative tasks, based on a 2023 Ontario College of Family Physicians survey.
Following the launch of Prescription for Ontario: Doctors’ Solutions for Immediate Action, the OMA will work with members to promote it to the public, stakeholders, community leaders, MPPs and political parties.
The objective is to ensure that the provincial government supports its solutions to the three urgent priority areas and includes them in the 2024 provincial budget, expected in March 2024.
Member advocacy will be critical in the coming months and will include:
To communicate with the public, there will be media briefings and outreach to provincial and regional media, as well as public engagement through social media and OMA.org.
OMA President Dr. Andrew Park will speak at regional and provincial events to reach stakeholders. He will also meet regularly with local MPPs and ministers of health, long-term care, finance and others.
“Family doctors are the bedrock of the health-care system. When we don’t have enough family doctors, that leads to problems across the system” — OMA President Dr. Andrew Park
The OMA is working with the government and other stakeholders to address the administrative challenges so that doctors can spend more time with their patients. The Ministry of Health-OMA Bilateral Burnout Task Force is already working on reducing or streamlining forms.
To address the administrative burden that contributes to burnout, the Solutions Report recommends:
Meanwhile, too many Ontarians are languishing in hospital beds when they could be discharged and better cared for elsewhere, at home or in long-term care. This bottleneck is part of a national problem, estimated to cost Canada’s health-care systems $5 million to $9 million per day, totalling billions of dollars a year in staffing and resources. The issue has existed for many years, but the pandemic made a bad situation even worse.
The OMA has come up with five solutions that will increase community capacity and move alternative levels of care patients into more appropriate care settings. They are:
The OMA consulted widely this year to develop these 11 solutions. But the scaffolding for the new report was built several years ago when the association undertook the largest consultation in its then 140-year history in 2021.
During that period, more than 1,600 physicians and physician-leaders provided expert advice about challenges in the health-care system, while more than 110 health-care stakeholders, social service agencies and community leaders gave their perspectives. And almost 8,000 Ontarians representing 600 communities shared their health-care priorities through an online survey.
The result was the landmark report, Prescription for Ontario: Doctors’ 5-Point Plan for Better Health Care, released in October 2021. It outlined five key pillars — reduce wait times and the backlog of services; expand mental health and addiction services in the community; improve home care and other community care; strengthen public health and pandemic preparedness; and give every patient a team of health-care providers and link them digitally — and included 87 recommendations to rebuild the health-care system. A secondary report, Prescription for northern Ontario, was released at the same time, offering an ambitious plan to address serious health-care gaps in northern Ontario.
“Prescription for Ontario set out priorities and pathways to address health-care challenges all across Ontario,” OMA CEO John Bozzo said. “With its release in 2021, Ontario’s doctors began building momentum to ensure that their voices would be heard by the public and decision-makers.”
Following the release of 2021’s Prescription for Ontario, OMA leaders and members embarked on key advocacy activities to secure widespread public and political support for the report’s recommendations. The OMA held membership training sessions and town halls to familiarize physicians with the report; the CEO and president gave speeches at provincial and regional events; OMA staff arranged meetings with MPPs and cabinet ministers; multiple stakeholder events were held; and the organization engaged with the public through social media, websites and news stories.
This was especially important in the leadup to the June 2022 provincial election, as the OMA encouraged all parties to adopt the Prescription recommendations in their platforms.
The OMA was also active in prioritizing physician burnout, with a groundbreaking white paper on the issue released in 2021. OMA physician surveys pointed to a growing problem, with 72.9 per cent of members reporting in 2021 that they experienced some level of burnout, up from 66 per cent a year earlier. Just over one-third described their symptoms as persistent or said they felt completely burned out in 2021.
When the OMA released Prescription for Ontario in October 2021, it promised regular updates to refresh the original recommendations and priorities. The first update, Progress Report 2023, was released in May 2023.
“Prescription for Ontario set out priorities and pathways to address health-care challenges all across Ontario. With its release in 2021, Ontario’s doctors began building momentum to ensure that their voices would be heard by the public and decision-makers” — OMA CEO John Bozzo
It tracked what action the government had taken to implement the Prescription’s 87 recommendations — concluding that action had been taken on 51 so far — and it outlined three urgent priorities for the remainder of 2023: access to a family doctor, physician burnout and lack of access to home and community-based case.
These priorities were based on thorough consultation. More than 1,600 members completed an online survey from December 2022 to January 2023 and more than 100 physicians participated in a broad series of facilitated workshops. The top issues they identified were access to a family doctor, wait times, access to mental health services and physician burnout.
In April 2023, the OMA commissioned an IPSOS survey to better understand the health-care priorities of Ontarians, 57 per cent of whom said access to a family doctor was one of their top five health-care priorities.
The association also held workshops and round tables with about 40 stakeholders, listening to their perspectives on a wide range of issues and priorities.
“This broad consultation with physicians, patients and other health professionals was key to finding tangible and immediate solutions to fixing the serious problems we have identified,” Bozzo said.
One of the stakeholders involved in the consultations was the Ontario College of Family Physicians. Its president, Dr. Mekalai Kumanan, said her organization appreciated being able to work closely with the OMA and its Section on General and Family Practice to advocate for family physicians. If successful, “this will have a positive impact on the health of Ontarians, the health-care system as a whole and those who work within it.”
“We believe that alignments across organizations on solutions that matter to family physicians will allow for faster progress,” she said.
The OMA also consulted non-physician organizations, including Home Care Ontario, which represents 60,000 workers providing a wide array of home-care services to about a million Ontarians each year. Its representatives attended three OMA round-table sessions, CEO Sue VanderBent said.
She described the round tables as open conversations about what the home-care system needs — principally, increased funding to allow agencies to raise salaries and attract more workers, many of whom have left the sector for better-paying jobs in long-term care and hospitals.
“I have the greatest respect for the OMA’s leadership and thought leadership and system leadership,” VanderBent said.
“I know that anything that comes from the OMA is highly respected by government, as doctors are. We all respect our doctors. And the OMA’s previous work has been very supportive of home and community care, because that’s where the future lies.”
Keri Sweetman is an Edmonton-based writer.