Cross-country project gives patients a say in solving primary-care crisis

From Healthy Debate

As a family doctor, Tara Kiran has seen first-hand the reverberating effects of the primary-care physician shortage on Canada’s health-care system. And it is in her role as a scientist with MAP Centre for Urban Health Solutions that she plans to uncover what patients have to say about these gaps.

Kiran and a team of collaborators are launching OurCare, a three-phase research project that aims to provide much-needed answers to Canada’s primary care woes. “We’ve been having conversations within the profession and with governments about (improving primary care) for a while,” says Kiran. “But we generally don’t bring the public into those discussions in the way that we should. This project is about extending the conversation to include the public’s view about what that future should look like.”

The idea for the project was conceived in June 2021 as a collaboration between Kiran and Peter MacLeod, who runs MASS LBP, an organization that works to involve people in policymaking. Plans were finalized with buy-in from provincial and national health-care partners, stakeholders and the public through the Canadian Medical Association’s group, Patient Voice.

“Primary care is the foundation of the health-care system, yet we’re in a country where almost 5 million people report not having a family doctor or nurse practitioner,” Kiran says.

The ongoing COVID-19 pandemic has exacerbated existing issues in primary care. Burnout, retirement and change of professions have all contributed to dwindling numbers of family physicians.

Replacements are slow in coming: the number of medical students choosing to go into family medicine is declining. Specifically, fewer medical students are going into “comprehensive office-based care,” in which physicians look after patients of all ages throughout their lifetimes.

“This kind of family medicine has become increasingly challenging for a number of reasons,” Kiran says, explaining that comprehensive office-based care models have doctors dealing with the business aspect of medicine on their own. Instead, many family physicians are opting for hospital-based work or specializing in family medicine within emergency medicine or palliative care.

For Kiran, another driver of the shortage of comprehensive office-based family doctors is the payment model. “I’m very lucky to work in a practice where I get paid not by fee-for-service (FFS) or pay-per-visit, but by a payment called capitation.”

FFS is the predominant model in Canada, in which doctors are paid per patient visit. With capitation, the province pays doctors a fee for each person who enrols in their family practices. “(Capitation) gives me more flexibility to spend more time with patients.”

Kiran adds that she feels more supported in her work because she is in a team-based setting, another model preferred by younger family doctors. “There are ways of making practice more attractive, but our systems haven’t moved to that.”

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