I wish to add my voice to the letters, the comments of the minister of Health, the Newfoundland and Labrador Medical Association (NLMA) and the recent report by Dr. David Peachy all on the subject of family doctors
There is no doubt now that we are facing a crisis. Twenty per cent of people in the province have no family doctor.
That is simply unacceptable. These individuals can only use the emergency department in hospitals which are not designed for this type of care. Thus a patient with a lump in the neck which could be cancer or someone who has excessive thirst and frequent urination (early signs of diabetes) may have delayed diagnosis
Family doctors are the frontline of our health care system. They have to keep up to date with a large variety of conditions such as hypertension, diabetes and arthritis. I can only admire their dedication and efforts.
In my career as a thoracic surgeon I only needed to read a monthly journal and attend a annual conference
The public impression of family doctors also contributes to the problem. We have all heard the comment that someone is no brain surgeon. I have never hear the comment that they are no family doctor. This perception gives medical students the false impression that a specialist is on a higher level than a family doctor. Thus fewer graduates opt for family medicine.
Memorial University has done a commendable job in keeping the percentage of graduates opting for family medicine to about 40 per cent, but for how long?
The trend across the country is alarming. In 2018 at Dalhousie University the figure was only 25 per cent compared to 50 per cent in 2014.
The Health Minister John Haggie has recognized in his recent comments that the compensation model for family doctors i.e. fee for service may not be the ideal for family doctors
Under this system family doctors have no choice but to have a volume-based practice
Due to a high overhead they simply cannot afford to spend a lot of time with each individual patient. I am now proposing two compensation options.
First — a blended system like that established in New Brunswick in 2017. Under this plan 60 per cent of compensation is based on capitation. Doctors receive a weighed amount fee for each patient on their list. It is meant to incentivise quality of care. Forty per cent of income is based on fee for service. In addition the program provides doctors with free coverage of an electronic medical record system. This allows patients to book appointments on line, and access medical records The program encourages doctors to practise in groups so that after hours care can be provided. This new program has been a huge success Both family doctors and patients see it as a major step forward
Second — allow more family doctors to have the option of a salaried system which already exists for some doctors here. Benefits would include paid vacation, a pension and no overhead expenses. Provided the salary is reasonable I think many family doctors would find option attractive
I applaud Haggie for his long-term plan to establish collaborative care which would include nurse practitioners, registered nurses and midwives
However, the situation regarding family doctors requires an urgent solution.
Earle Wright,
St. John’s
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