This article originally appeared in the Winter 2022 issue of the Ontario Medical Review magazine.
How are you demonstrating leadership in health-system transformation?
Affecting positive change in any circumstance starts with one step. That action may be an idea, writing a letter or running for a seat on a governing body. The Ontario Medical Review asked representatives from OMA sections what steps they’re taking to make a difference in leading health-system transformation. From individual advocacy and clinical work to innovation and research, Ontario physicians share how their actions are impacting the health-care system and improving patient care.
“Our hope is that interventional radiology can continue to be developed in Ontario. Interventional radiology can help treat everything from peripheral vascular disease, stroke, vertebral fractures, cancer, uterine fibroids, to many other pathologies. The problem in Ontario, and more broadly in Canada, is that it’s chronically underfunded. Our wait times often blow past international guidelines’ recommendations. One example where a lot of work is being done is at Cancer Care Ontario. There are a number of interventional radiology-focused committees helping to develop funding models to support delivery of interventional radiology services in the realm of cancer. For example, there are committees dedicated to various forms of ablation of cancers of the liver, kidney and lung (microwave, radiofrequency and cryoablation), transarterial chemoembolization (TACE), and vertebral augmentation (for fractures, in this case due to cancer). There is also now a committee dedicated to advancing radioembolization (yttrium-90) for certain liver cancers (a procedure that we performed quite commonly 12 years ago in California). Interventional radiology has a vast array of treatments that it can offer but needs resource support.”
“The Ontario health-care system is facing unprecedented challenges. Recovery from the COVID-19 pandemic has brought our chronic health-care issues to the fore. Acute-care medicine is strained to the limit owing to the aging population and rising comorbidity. To reduce the burden on our hospitals, the OMA Section on General Internal Medicine is committed to focusing on preventive health and in-home care. Additionally, we are looking at creative ways of providing acute care, including physician extenders, nurse practitioners and artificial intelligence, all of which can allow a single physician to see patients more efficiently.”
“Over the past decade, there has been a 400 per cent increase in opioid deaths in the province. With the help of OMA leadership, we have been able to preserve access to care and current funding. We are pleased the government and Ministry of Health recognize the special needs of our patients, but current funding remains inadequate (and considerably less than it was in 2012 when opioid deaths started to climb). Ontario’s addiction crisis needs physician leadership and physician-delivered addiction care. The OMA is helping us advocate for the government to fund new comprehensive treatment models which will include medical treatment, case management, housing support and counselling that can, and will, reduce crime, overdoses, HIV and hepatitis C, and improve outcomes and lessen the burden of addiction on patients and their families.”
“As a palliative care physician, I often care for patients living with life-threatening illnesses that result in significant functional decline. I often meet my patients in hospital and follow along on their journey when they become homebound. We are experts in ‘palliative’ care, but we have yet to broadly define and identify ‘frailty’ care. In our local Ontario Health Team, we have recognized frail older adults as a priority population and are embarking on identifying and meeting the needs of this unique population. Throughout our consultations, we have witnessed that homebound older adults have significant difficulty accessing primary care, which we know is critical in chronic disease maintenance and management of acute issues. We hope to establish a home-based primary care program that will ultimately address health-care issues earlier on and decrease the unnecessary use of acute-care resources.”
“I hope to demonstrate my leadership in health-system transformation by working with the OMA and the Ministry of Health to improve access of care to my patients in the community. I also want to tackle wait times for digestive disease consultation and endoscopic procedures. I will assist the OMA to better address our section overhead via my contribution with the Fee Adjusted Income Relativity (FAIR) model and lack of technical fees for digestive endoscopic procedures. Lastly, I wish to try to balance gender representation and to narrow the gender or intrasectional pay gap.”
“Obtaining an accurate diagnosis through genetic testing has become increasingly essential to limiting investigations and guiding prophylactic management. However, the small number of genetics providers has resulted in significant wait times for timely access. To help address this, our section has been changing the paradigm around how genetic testing is organized. By extending the concept of ‘mainstreaming,’ genetic testing can be initiated by the referring specialist in certain patient populations under the guidance of a geneticist, avoiding lengthy wait times for initial consultation. The results, interpretation and family considerations are then discussed by the genetics care provider in an expedited fashion. This has the potential to significantly reduce barriers of access to genetic testing and care.”
“Throughout my career, I have believed in the importance of soft mentorship and teaching by example. My best teachers were those that showed me how to embrace the richness of our profession while integrating clinical skills with life lessons. In the same context, I was very fortunate to cross paths with Drs. Setareh Ziai and Caitlin Schwartz some years ago when they founded the grassroots organization now known as Canadian Women in Medicine. As one of the original board directors and past president, I feel honoured in the opportunity to interact with a younger generation of women physicians in a supportive and uplifting manner.”
“As chair of the OMA Section on General and Family Practice, I have spearheaded the work that will lead to better collaboration between specialists and family physicians as we work toward solutions for our referral barriers and inappropriate delegation of tasks to family physicians. I also represented family physicians at the OMA’s Queen’s Park Day held in November and reminded our MPPs that all patients deserve a family doctor and access to team-based care. Finally, through my discussions with senior management at our parent organization, the Section on General and Family Practice and the OMA have an improved relationship as we work toward a joint payment reform policy for family physicians.”
“Systems thinking is one of the cornerstones of public health and preventive medicine. Primarily focusing upstream, public health and preventive medicine specialists collaborate with community partners, leverage technology, voice public health concerns and otherwise share in the leadership of health-system transformation to improve population health. This work goes beyond individual patients to enable optimal health for communities. Public health and preventive medicine specialists have advanced innovative approaches to mass vaccinations and disease surveillance informing health-system planning to re-orienting services to promote health and reduce health inequities. Moreover, specialists have engaged with Ontario Health Teams, bringing population and public health perspective to their deliberations.”
“The pandemic years have shone unaccustomed light onto Ontario’s infectious disease physicians, but it has been a specialty on the move for far longer. The profession has grown over the last two decades, expanding out from large academic centres to community practices and smaller centres. In addition to being better able to serve the most vulnerable people in Ontario, community infectious disease physicians have taken leadership roles in quality, patient and staff safety, and stewardship, while academic infectious disease physicians have remained central in expanding our knowledge of existing and emerging infectious threats.”
“I lead the OMA Section of Medical Students, also known as the Ontario Medical Students Association, which represents the views and concerns of over 3,000 medical students in Ontario. We demonstrate leadership in health-system transformation through direct political action, meeting with MPPs to advocate for improved policies regarding long-term care and public health funding, among others at the OMSA’s annual Day of Action. We provide grants and hold an annual conference for cutting edge medical education research, and bring together students, faculty and instructors to identify equity, diversity, inclusion and decolonization curricular gaps and showcase grassroots efforts for curriculum reform.”
“A core area of my advocacy journey has involved ensuring that publicly funded, physician-delivered psychotherapy remains intact without arbitrary restrictions. I have partnered with several groups to engage in political meetings, to set up online resources; and to contribute via print, video and radio media to promote appropriate access to psychotherapy. I have incorporated a similar strategy to advocate for ongoing access to virtual care as appropriate. I have also worked with District 5 on @togetherinopenspace, an Instagram mental health hub for which I have given talks on grief and eco-anxiety. Furthermore, I have organized/hosted online events such as one for Bell Let’s Talk Day 2022, to create safe spaces for people to talk about mental illness in the context of equity, diversity and inclusion.”