City’s response to homeless encampments still causing harm to unhoused, report says

From the CBC article

The City of Toronto’s current response to homeless encampments is not only inadequate but is also causing further harm to the unhoused people who are most affected, a new report says.

The report by the MAP Centre for Urban Health Solutions, looks at the supports available to people living in encampments last year, how some of those services were helpful and also ways they could be improved. 

“The biggest thing people needed and wanted was permanent housing and that was the thing they did not get,” said Zoe Dodd, a community scholar with the centre.

The report, released Friday, follows the controversial eviction of homeless encampments from three Toronto parks in the summer of 2021. Many unhoused people chose to live in those encampments rather than risk contracting COVID-19 in the city’s shelters. According to the 83-page report, 127 surveys were conducted, along with 23 interviews with current or former encampment residents across Toronto. Researchers also interviewed 16 outreach workers and volunteers from a variety of organizations and groups.

“I think the stark thing is that people felt pretty abandoned in terms of the help they needed, but then there were neighbours and people who stepped up,” Dodd said.

The report says the study demonstrates the community-based outreach supports provided to encampment residents during the COVID-19 pandemic were highly beneficial for their survival and well-being, and that residents had a great appreciation for the social relationships that developed with outreach volunteers and workers.

Why Ontario is reducing doctors’ payments for one-off virtual appointments. And what it could mean for your health care

From the Toronto Star article

The provincial government and the Ontario Medical Association have agreed to decrease payments to doctors for one-off virtual appointments — a move meant to stem the tide of virtual-only clinics and encourage doctors to provide comprehensive ongoing care to patients.

As of Oct. 1, the one-off virtual visits are being paid at a reduced rate of $15 to $20 when the “physician renders a service to a patient where there is not an existing patient-physician relationship,” according to the Physician Services Agreement.

“An ongoing relationship with a family physician is the foundation of a good health-care system as it provides both comprehensive care and continuity of care,” the OMA said in an email.

“This is significantly better quality of care than episodic walk-in services,” said the association, a reference to both virtual and in-person walk-in clinics.

The new fee structure is a departure from the pandemic, when temporary fee codes “paid physicians on par with face-to-face fee codes,” according to the OMA.

There is a range of fees charged by physicians. “The most common visit fee-code billed by family physicians is $36,” the OMA said.

Physicians who see their patients on an ongoing basis will continue to get paid the same amount for a virtual visit as an in-person one, as will specialists who see patients who get a referral.

But critics say the province’s new approach to the virtual fees is a disincentive for physicians who are adding capacity to the system by offering in-person care as well as virtual appointments to patients who aren’t their own.

“In the first few months of the pandemic, virtual care really skyrocketed,” said Dr. Tara Kiran, a family physician and scientist at St. Michael’s Hospital, Unity Health Toronto. “One of our studies found that virtual care increased 56-fold during those first early months of the pandemic.”

Kiran is also the Fidani Chair of Improvement and Innovation at the University of Toronto.

In Ontario, virtual care, mostly by phone, continues to account for more than 40 per cent of primary care visits.

The Ontario government set a target for a 60-40 ratio between in-person and virtual care for family doctors in the new Physician Services Agreement, although Kiran said that no one really knows what the right mix is.

But she did say that evidence points to better outcomes for patients who have an ongoing relationship with a family doctor.

“I don’t actually think you could get the same care when you see someone at a virtual walk-in clinic compared to your own family doctor,” said Kiran. “There are some very big differences. One is that they don’t have your personal and health history, either from personal knowledge or from your file. And that can result in different decisions than your family doctor might make, having known you.

“And there’s a lot of literature that supports how relationship-based care, care that is continuous with the same doctor over time, leads to better outcomes,” said Kiran, including better care for chronic conditions and preventative care, as well as lower emergency department use and even lower mortality.

Kiran is head of a project called OurCare, an online research survey that asks for input from Ontarians about their experiences with family doctors as well as their views on how to improve the health-care system.

Changes to virtual care billing in Ontario raise concerns over health care access

From The Globe and Mail Article

Some Ontario physicians are concerned pending changes to virtual care will make it difficult for a wide swath of patients to access a health provider, adding tocontinuing challenges facing the province’s health system.

The province is restricting payment for telephone-based doctor visits later this year and requiring physicians to be able to see patients in person if necessary, which would make it impossible for virtual-only clinics to operate.

There have been growing concerns throughout the pandemic that some doctors are leaning too heavily on virtual care and refusing to see patients in person or using virtual clinics to see patients on a one-off basis, which is linked to poorer health outcomes. The changes are, in part, designed to encourage face-to-face interaction and reduce the frequency of one-off calls with patients.

As of Dec. 1, Ontario’s health insurance plan will no longer fund initial telephone visits between new patients and their physician. Only video calls will be eligible for payment under the new permanent virtual care funding model.

Follow-up phone calls between patients and doctors will only be eligible for 85 per cent of the fee doctors can bill for video calls or in-person visits.

Virtual care is here to stay. But what are patients’ expectations?

Blog post for Healthy Debate by Dr. Tara Kiran

he pandemic has changed much of the way we live – including the way we deliver family doctor care.

When COVID-19 case counts were high, we avoided asking people to come see us in-person where possible. Instead, we pivoted to virtual care – namely care delivered by phone or video. Reducing in-person care had many COVID-19 benefits. Patients and staff were less likely to be inadvertently exposed to someone who was positive, we could better maintain physical distancing in cramped waiting rooms, and we could preserve personal protective equipment that was expensive and hard to get early in the pandemic.

Of course, there were non-COVID benefits, too. Many patients liked the convenience and appreciated not having to take time off work, arrange for childcare, commute or pay for parking or transportation.

Our research has shown that, in the first few months of the pandemic, the use of virtual care sky-rocketed, increasing 56-fold. The total number of family doctor visits fell when the pandemic was declared. But by fall of 2020, visit volumes were back up to pre-pandemic levels – only now a large portion was virtual. The amount of care delivered virtually has fluctuated throughout the pandemic with more care delivered virtually when COVID-19 case counts were high. As of this past March, about 46 per cent of all family doctor visits were virtual.

It’s time we asked Canadians what kind of family doctor care they want

Op-ed in The Hill Times by Dr. Tara Kiran

Family doctors are the front door of our health system. They’re where you go when you are sick. And they keep you from getting sick in the first place — providing immunizations, screening tests and care for chronic conditions like diabetes or asthma.

Family doctors connect you to other parts of the health system so you can get extra help when you need it. They know you as a person and can help guide you through tough decisions.

But for too many people in Canada, that front door is now closed. Even before the pandemic, 4.6 million people in Canada didn’t have a family doctor. The pandemic has just made things worse.

Research we published earlier this month found twice as many family doctors stopped working during the first six months of the pandemic compared to what would have been expected based on trends from the past decade.

Honouring our incredible staff: Congratulations to the 2022 MAP Award Winners!

On Oct. 11, MAP Centre for Urban Health Solutions announced the 2022 winners of the second annual MAP Awards: Kristy Yiu, Anna Yeung, and Ayan Yusuf. These awards recognize three outstanding MAP staff, students or volunteers who have excelled in their roles and demonstrate a passion and commitment to applying MAP’s values in their work.

Kristy Yiu (she/her), Research Coordinator on Dr. Sharmistha Mishra’s team, is the winner of the MAP Values in Practice (MVP) Award, an award to recognize an individual who exemplifies and advocates for MAP values in their work and interactions. Her colleagues shared that “Kristy has been a great team member, a fabulous mentor, a huge asset to our team, and is so deserving of this award and recognition.” They also note that she “creates an environment based on listening (over just a focus on productivity) and a path to mutual understanding. In her team leadership, she has helped shape a culture of powerful and open discussions on empowerment, equity, and social justice – including in our global health partnerships.”

Dr. Anna Yeung (she/her), Research Manager on Dr. Ann Burchell’s team, is the winner of the Peer Mentor Award, an award to honour an individual who works hard to help colleagues learn, feel valued, and do well at work. Anna’s colleagues shared that “Anna holds individual check-ins with staff and students to understand their challenges and celebrate accomplishments, offering to help workshop solutions together. She seeks out opportunities for trainees and fellow staff to gain experience aligned with their professional development goals that will benefit their careers.” A member of her team noted that “having seen how much she gives of herself to others… I believe that her kindness and generosity deserves recognition—she ‘sees’ others around her and, in turn, I would like her to be ‘seen’ for all she does for our team.”

Ayan Yusuf (she/her), Research Coordinator on Dr. Stephen Hwang’s team, is the winner of the Community Partnership Award, awarded to an individual who consistently models exemplary community partnership practices and integration of the perspectives of community and people with lived expertise into their research. Members of her team shared that she “brings extensive theoretical knowledge and a strong perspective about the importance of community engagement to MAP, but it is Ayan’s ability to translate that theory into practice that has been particularly impressive,” and that “she is constantly interrogating her own approach and gently but firmly pushing all of us at MAP to invest and improve in community engagement.”

Congratulations to the winners, and to all of the 2022 MAP Award nominees!

Join the conversation and help shape the future of family medicine

Blog post for Healthy Debate by Dr. Tara Kiran

The family doctor shortage in Canada has been in the news a lot lately, highlighting the struggle for many to find one.

An aging population, declining numbers of medical students entering family medicine, and an uptick in family doctors stopping work are all indications of a problem that is only going to get worse. Unless we do something about it.

There are many potential solutions. We need to increase the number of family medicine role models in medical school. We need to offer new grads the option of going into practice that doesn’t involve running their own small business. We need to improve family medicine pay relative to other medical specialties. We need to make it easier for family doctors to take a vacation while having their patients cared for.

But there’s one solution that comes up over and over again. We need to expand interprofessional teams.

Right now, most family doctors in Canada are small-business owners who run their own practices. They may work with a group of other doctors, sharing expenses for office space and reception staff but most run their own practice. However, few work with other health professionals like social workers, dietitians, pharmacists or nurse practitioners in their practice.

Yet the evidence is clear that family doctors working in teams with other health professionals is better for patients and better for clinicians.

Our own research has shown that patients who have a doctor working with an interprofessional team were more likely to get recommended diabetes care. They were also less likely to visit the emergency department.

‘A better system is possible’: Asking Canadians what kind of family doctor care they want

Op-ed in the Toronto Star by Dr. Tara Kiran

Family doctors are the front door of our health system. They’re where you go when you are sick. And they keep you from getting sick in the first place, providing immunizations, screening tests and care for chronic conditions like diabetes or asthma.

Family doctors connect you to other parts of the health system, so you can get extra help when you need it. They know you as a person and can help guide you through tough decisions.

But for too many people in Canada, that front door is now closed. Even before the pandemic, 4.6 million people in Canada didn’t have a family doctor. The pandemic has just made things worse.

Research we published last week found that twice as many family doctors stopped working during the first six months of the pandemic, compared to what would have been expected based on trends from the past decade. Other research we’ve done has found that one in five family doctors are thinking about closing their practice in the next five years.

At the same time, our population is aging, and fewer medical students are choosing family medicine as a career. Even those who do are more likely to specialize in something afterward rather than open a family practice.

Female doctors in Ontario earn 34% less on average, even in fields they dominate, Globe analysis finds

From The Globe and Mail

Female doctors in Ontario made less on average than their male counterparts in 35 medical specialties tracked by the Ministry of Health, a Globe and Mail analysis of physician billings has shown.

This was true even in specialties such as obstetrics and gynecology, where the majority of practising doctors were women.

The most male-dominated disciplines were also the ones that paid the best. Based on the average compensation within each specialty, male doctors dramatically outnumbered female physicians in all 10 of the most highly remunerated areas of practice.

Meanwhile, female-dominated specialties were both rare and among the least lucrative. Overall, women outnumbered men in only six of the 35 disciplines and half of those female-dominated specialties fell among the 10 lowest paid. The constant was that women made less money.

Michelle Cohen, a family doctor in Ontario who researches the gender pay gap in medicine, said the gender gaps in medicine have been well-established by numerous studies, but there are still those who push back.

“One of the first things you’re going to hear as a criticism is: this is fee-for-service. You do a service, you bill a code and you get the money. It seems fair … but there is built-in bias,” Dr. Cohen said.

For example, Dr. Cohen’s research has found that certain procedures – particularly those performed on female bodies – pay less. In a 2020 paper that Dr. Cohen co-authored with Tara Kiran, they noted that a surgeon in Ontario is paid $50.90 for an incision under general anesthetic on a vulvar abscess, but $99 for a scrotal abscess. And a biopsy on a penis paid $39.60, but one on the vulva paid $26.85.

One enduring myth, said Dr. Kiran, is that the wage gap can be explained by the fact that men tend to work longer hours. It’s true that male physicians do work longer hours, but not enough to account for the gap. A British Columbia study that looked at primary-care physicians in 2017 found that women made 36 per cent less than men, but worked just three hours less per week.