Family docs OPEN for business! by Dr. Carolyn Malec

I’ve been in my office every day since the beginning of COVID in March, 2020.

I work in a collegial group of 4 family docs – part of a dying breed of family docs still doing in-patient care at Milton District Hospital (MDH). In March and April, the phones were pretty quiet – but we all came to work every day. As the months have marched on, we are seeing more and more patients in-person.

Because we all work at the hospital, and also at the COVID assessment Clinic at MDH, we are pretty comfortable with seeing sick patients. At the end of the summer with the school year rearing its head, we all agreed we needed a plan to see the “sick” patients in the office. But we wanted to ensure that our “healthier patients” would still feel safe as they were starting to finally come in to see us when needed.

Every day between 3-5 pm, we have our “ARI” time (Acute Respiratory Infection). Each of us takes one day per week, and sees ALL patients that need to be seen with colds/fevers/coughs. We wear full PPE, and schedule one patient per 15 minutes to allow appropriate time to clean the rooms. The other docs must all do virtual phone assessments during these hours to limit patient flow. Most patients have already had a COVID swab by the time they call the office, but rarely do we know the results yet.

We felt that a place was needed for kids with ear infections, strep throat, etc. They didn’t belong in the ER.

So far we are not overwhelmed. Granted we are only seeing our own patients between the 4 docs in our clinic.

Patients are extremely thankful.

We could easily start to do the COVID NP swab during this visit, but it hasn’t honestly been a need at this point.

Our patients seem to be able to access our local COVID assessment clinic within 24 hours for the swab – they just need to someone to help them out with their non-COVID illnesses.

We ultimately decided to use up our PPE, see the sick patients, and see where we land when this is over.

Dr. Carolyn Malec is a family physician in Milton, ON.

If you have any tips to share with your Mississauga Halton Primary Care Network community, please send your ideas to us through our contact form and we will connect with you for more information.

This resource is shared with permission. The views, thoughts, and opinions expressed in the text belong solely to the author(s). The Mississauga Halton Primary Care Network board and staff are not responsible for your use of the information contained here.

Fee-for-service needs an overhaul by Dr. Ali Damji

Fee-for-service is long overdue for an overhaul to bring it to the 21st century realities of medicine. Our current fee-for-service prioritizes volume of care, which can improve access, but may come at the expense of providing comprehensive care that is patient centred. These days, with our aging population, the incredible advances that have been made in medicine, and the advent of electronic record systems that puts years of data at our finger tips, a visit is almost never a “single issue, single code” visit. Yet this is what our fee-for-service system assumes. And this is highly problematic and frustrating both for patients who want to see a doctor that looks at the entire problem, and physicians whose payment models don’t incentivize them to practice medicine the way they want to or are trained to.

Conversely, salaried/blended models offer the ability to spend the time that is needed with each patient without as much of a pressure to see volume (but this is still an important consideration because you need to ensure your patients are still able to access you). If I need 30 minutes with an elderly patient who has three problems to discuss, I can address their concerns and not worry about the bottom line.

The second advantage is that the fee-for-service system does not capture a large portion of the care that is provided by patients. Without a code, physicians are often not paid at all for this work which can drive burnout and frustration and reduce willingness to provide this care e.g. telephone calls/virtual care prior to COVID-19 which could replace in person visits and be more convenient for patients, documentation, forms.

As someone who works with both models (blended capitation in my primary care practice, and fee-for-service for addiction medicine), I see the strengths and drawbacks of both. I personally feel that there may still be a role for fee-for-service in certain focused “single issue” areas of medicine that are very technical and focused, but that the vast majority of us should embrace novel models of compensation that incentivize still seeing volume by providing blended incentives, but will not penalize a physician financially for providing holistic comprehensive care that looks at the entire patient, without suffering financially. When we look at the patients who are often left behind like vulnerable populations, complex chronic disease, or the elderly, our payment model may hold part of the blame.

Dr. Ali Damiji is a family doctor in Mississauga, ON.

This piece originally appeared on the Medical Post’s website and newsletter. Reprinted with permission.

If you have any thoughts or tips to share with your Mississauga Halton Primary Care Network community, please send your ideas to us through our contact form and we will connect with you for more information.

COVID-19 Testing in Family Practice by Dr. Adam Chen

According to Dr. Chen, testing for COVID-19 in a community primary care clinic can be simple, safe, and mindful of limited PPE.

In this article he shares what works for him in his busy Oakville family practice, including how to coach patients to self-swab.

COVID-19 Testing in Family Practice PDF

Dr. Adam Chen is a solo GP in Oakville, Ontario.

If you have any tips to share with your Mississauga Halton Primary Care Network community, please send your ideas to us through our contact form and we will connect with you for more information.

This resource is shared with permission. The views, thoughts, and opinions expressed in the text belong solely to the author(s). The Mississauga Halton Primary Care Network board and staff are not responsible for your use of the information contained here.