CKL Family Physician Interviews (2022)
CITY OF KAWARTHA LAKES PHYSICIAN INTERVIEWS - FINAL REPORT – JANUARY 30, 2023
EXECUTIVE SUMMARY
PURPOSE:
Retention of our local family physicians has always been a goal for the Kawartha Lakes Health Care Initiative’s (KLHCI) Retention Committee. This goal faced increased pressures with the COVID pandemic. With the approval of the KLHCI Board, our local family physicians were virtually interviewed in September 2022 regarding views of their own practice pressures.
The attached report is the culmination of those interviews to be presented to major stakeholders such as the Ontario Minister of Health and Long-Term Care, President of the Ontario Medical Association, MP – Jamie Schmale, MPP – Laurie Scott, Mayor – City of Kawartha Lakes, CEO – Ross Memorial Hospital.
HIGHLIGHTS:
While the family physicians interviewed were largely satisfied with their practices, each physician expressed frustration with the amount of unbillable time spent on administrative tasks such as:
· form completion, reviewing lab work and specialist referrals (approximately 20 hours per week);
· feeling devalued by patients and government;
· practice management and human resources issues along with increasing overhead;
· struggling to find care for their patients.
CONCLUSIONS:
Primary Care providers, family physicians in particular, are key to the whole healthcare system. As one physician stated “A family physician does whatever it takes to help their patients”. If they decide to either retire early or leave the profession altogether, health care for the citizens of the City of Kawartha Lake (CKL) will be further impacted. Currently, approximately 6,000 citizens have NO family physician and between 25,000 – 30,000 have family physicians outside CKL.
The Retention Committee recommends the following:
· personally present and review the attached report with our local MP and MPP and provide copies to those listed above, at a minimum;
· investigate consultants who are experts in HR and practice management who can present to our family physicians.
BACKGROUND
The Kawartha Lakes Health Care Initiative (KLHCI) is a non-profit, charitable organization with the mandate to recruit and retain family doctors for the City of Kawartha Lakes. In 2003, the City of Kawartha Lakes (CKL) recognized the need for family doctors in our community, at which time a volunteer committee was established to address this need. That committee evolved into KLHCI. Since its inception, KLHCI has been successful in recruiting 41 family physicians. However, recruitment has not been our only task – we have also focused on the retention of those physicians.
Family physicians are at the very core of our health care system, both locally and Canada-wide. Having a healthy, stable group of physicians is integral to ensuring that the CKL citizens receive the best care possible. However, it has become increasingly apparent, for many reasons, that recruitment/retention of our family physicians has become a much larger challenge. We are very aware that this is not just a local issue but we can only speak to the situation in CKL.
Since the pandemic began in March of 2020, health care has come under increasing strain. That has been well documented but what has only recently been highlighted to the general public is the shrinking pool of family physicians. The Baby Boomer generation is retiring, leaving practices of two to three times the size that current family physicians prefer to accommodate. As local experts in the field of recruitment, KLHCI has determined that for every retiring physician, it takes roughly 2.5 FTEs (full-time equivalents) to take on those patients. Those physicians want work/life balance, diversity in their practices (participating in emergency shifts, hospitalist, anaesthetist, etc.) and less administrative duties that take them away from their medical functions.
During the summer of 2022, our Retention Committee proposed to the KLHCI Board as a whole that we interview our local family physicians with a view of getting their individual feedback about the current situation of their own practices. KLHCI approved that proposal and, during the month of September 2022, a series of virtual meetings were held. The following paragraphs are the culmination of those interviews. Note: we have assured those who participated that no identifiers would be taken, e.g., name, sex, age, type of practice, etc. As a result of that assurance, we believe we received open and honest feedback. A standard set of questions were asked in order that all responses could be tabulated without identifiers.
RESULTS
Each interview began with this qualifier: KLHCI is keenly aware of the pressures on all physicians but our focus is on CKL’s family physicians. Although the issues that have been impacting family physicians have been around for many years, it is our impression that the current pandemic has exposed and widened those cracks. It is our hope that, given your feedback, we may be able to add our influence/voice to bring about change.
For statistical purposes, KLHCI asked each family physician the number of years they have been practising along with the number of patients they support. The average number of years in practice was 15. The average practice size was 1,369.
Family physicians are trained to provide care in a number of areas of medicine. The CKL family physicians interviewed advised that along with their clinic work they are, or have, provided care in the following areas: long-term care; after hours’ clinics; obstetrics; in-patients/hospitalist; surgical assist; emergency; palliative care; house calls.
When asked the amount of time spent in their clinics compared to the other areas of medicine noted above, the average time in clinic was 82.5% with17.5% of time spent in the other areas.
In order for KLHCI to keep the current recruitment and retention programs up-to-date, the family physicians provided a variety of reasons why they chose to practice in CKL along with why they have stayed. The main reasons for choosing to practice here are: friends, family near by; good central point in Ontario; spouse’s career/employment; area not city centre or suburbia however close to airport; hospital was functioning well between RMH administration and family physicians, minimal hospital politics; right size of community; medical training in the community.
The indicators of why the family physicians remain in CKL are: family and friends near by; established practice; schooling and extra curriculums for family; rural living; satisfied with community personally and professionally; spouse’s employment; friends and connections here; connections with patients; practice and colleagues; nice place to practise.
Currently, the average level of current satisfaction in their practice among the family physicians interviewed is seventy-seven percent (77%). When asked to expand on what provides this satisfaction, overwhelmingly they replied it is the medicine and the patients along with their colleagues.
Conversely, when asked what portion of their day was stressful due to systemic problems, the average was thirty-seven percent (37%). The reasons provided for this ranged from patient expectations to non-medical aspects such as forms, checking lab work, and specialist referrals, all of which are not compensated; feeling devalued by patients and government; practice management and human resources issues along with increasing overhead; struggling to find care for patients.
A large portion of KLHCI’s discussions with the family physicians revolved around how paperwork influences their daily practice. While all of the family physicians accepted paperwork as part of the practice requirements, they all stated that there is an increased demand from specialists, patients, insurance companies, employers, etc., for forms and documentation. Completing these forms and documents are not included in any compensation models and can average 1.5-2 hours/day. With the recent introduction of electronic medical records, they also noted multiple incoming reports with minor changes or additions to previous reports. These all required extra reading time to ensure nothing was missed. There was also frustration expressed that specialists, after having seen the patient, ask the family physicians to arrange for MRIs, etc., rather than the request being made by the specialist. Again, the inference that family physicians have more time than the specialists or that their time is not as valuable.
At the end of each interview, the family physicians were asked for any final thoughts to share. They all recognized that the work KLHCI is doing is important for the community and acknowledged the recruitment struggles in the past few years. It was noted that “primary care is the key to the whole healthcare system” and should be taken seriously by all physicians and government. A healthy primary care system is cheaper overall and better for patient care. It was also noted that the cost of running a practice is making it more difficult to practice primary care properly, especially as expectations for higher salaries by staff are the norm. The system is also not fairly compensating family physicians for their time.
A final quote from one of the family physicians was “a family physician does whatever it takes to help their patients”.
RECOMMENDATIONS/ACTIONS
1. KLHCI will look into arranging for HR and practice management consultants to present to the family physicians.
2. KLHCI will present and review this report with the MP and MPP for Kawartha Lakes. The Minister of Health, Ontario Health, Ontario Medical Association, Society of Rural Physicians, CKL physicians (family and specialists), Municipal leaders, the K-L Ontario Health Team, and the Ross Memorial Hospital will receive a copy of the report.
SUMMARY
The lack of family physicians in CKL is currently a critical situation. The difficulties with recruitment are well noted. While there is room for optimism, if the status quo is maintained, we are in real jeopardy of there being even fewer family physicians for our citizens. This will create further strains on an already fragile healthcare system.