Only READ and SIGN if you are a licensed Family Doctor in Ontario

Introduction: 

Despite Ontario having more licensed Family Doctors per capita than ever before, a pressing issue remains: over 2 million Ontarians are without a Family Doctor. The government's recent announcement to allocate some of the new $3 billion in federal transfer payments towards hiring 600 Family Doctors over the next three years is a step in addressing this shortfall. However, this initiative faces a significant challenge.  More than half of the current Family Doctors are considering either closing their practice or reducing their capacity within the next five years due to unsustainable working conditions and compensation rates that are far below the cost of delivering comprehensive care.  

It's critical to act swiftly to preserve the core of our healthcare system—the dedicated Family Doctors who are now under-utilized and the Vulnerable Clinics at risk of closing in the next 5 years. This Family Doctor's Pledge is our collective commitment to reinforcing the foundation of Ontario's healthcare system by offering an alternative solution that strengthens and supports our existing Family Doctors not practicing Comprehensive Family Medicine and those practicing in Vulnerable Clinics - ensuring that they continue to serve the communities that depend on them.

The Problem:

Family Doctors in Ontario are confronting a multitude of systemic issues that hinder their ability to provide comprehensive care, including:

• Being compensated at rates far below the cost of delivering comprehensive care, with a stark 66% disparity (2024 OMA Multiplier 2.7x) between OHIP compensation and operational costs, leading to an operational crisis. In contrast, the Ontario Medical Association guidelines advise Physicians charge patients 170% more for uninsured services. 
• Zero start-up capital to establish a new clinic
• The OHIP billing system failing to reflect the cost and quality of care provided, often underpaying and undervaluing physicians’ work.
• Inconsistent payment structures leading to a 30% variance in compensation between Family Doctors for delivering identical services.
• Increasing complexity of patient care on a backdrop of long specialist and elective surgery wait times.
• Epidemic of Adults and Children with mental illness who must endure long wait times to access one-time-only psychiatric assessments with no continuity of care, or access to community support services.
• Heavy administrative burden of unpaid paperwork
• The corporatization of Family Medicine (i.e. non-physician corporations building clinics and dictating physician compensation and working conditions), which prioritizes profits over patient care, undermining the traditional patient-doctor relationship

The Impact:

These challenges has already lead to an exodus of Family Doctors.  There's more to come with over 50% considering leaving their practice and/or reducing their practice size within the next five years. This exodus will leave additional millions of Ontarians without essential Family Doctors, exacerbate wait times, and overwhelm the remaining healthcare infrastructure.

Immediate Demands:

• Immediate 100% increase in all OHIP billing codes and Patient Enrolment Model capitation payments for Family Physicians to reflect the true cost of delivering Comprehensive Family Medicine.
• Comprehensive funding for leasehold improvements, leasing, IT services, EMRs, and Telecommunications, and essential medical office equipment that meets Accessibility for Ontarians with Disabilities Act.
• Comprehensive funding for salary and benefits for 1 Medical Office Assistants (MOAs) per 500 patients to manage patient data and improve customer service experience.
• Reject the model of being hired by government agencies or arms-length agencies to operate in expensive Health Teams managed by non-physicians and bureaucrats. Instead, enable Family Doctors to run their clinics independently or as Family Physician Co-operatives with direct budget control linked to patient care.

Long-Term Commitments:

• If the government meets these demands, each signatory commits to either a) returning to the practice of Comprehensive Family Medicine and accepting on a minimum of 500 patients, or b) preventing the closure of a Vulnerable Clinic, or c) preventing a Family Doctor from having to close their individual practice, and maintaining continuity of care for a minimum of 5 years.
• Encourage an environment where doctors can practice Comprehensive Family Medicine to their full potential without the threat of premature clinic closures or reduced patient care quality.

Call to Action:

• We call on the Ontario government to pivot from their plan of hiring new staff towards empowering the current, ready, and capable Family Doctors by providing the necessary support and funding.
• The above is not just a list of demands; it’s a Pledge from Licensed Ontario Family Doctors to the communities they serve, promising continued care if the conditions for sustainable practice are met. 

Closing:

The Family Doctors of Ontario are not asking for more than they deserve. They are asking for the ability to serve, to heal, and to sustain the noble path they set out on when they chose this profession. Now is the time for the Ontario government to step up and deliver the support that will keep Family Doctors in stable clinics and patients out of the perpetual waiting game for essential healthcare.

Signatories:

This petition is endorsed and will be activated by the commitment of family doctors across Ontario, each ready to serve under conditions that respect their professional dedication and the health needs of Ontarians.

Not sure if you should sign.  Review the vulnerable clinics indicators below

For signatories, after signing the Change.org petition, please email Ontariofamilydoctor@gmail.com.  Your name, CPSO #, city of practice, Vulnerable Clinic or Returning to Comprehensive Care, and the number of patients you will accept if any.   Anonymous signatories may email directly.

Please support the cause by including some of the information above in the Reason For Signing Section: (e.g. Dr. Alkesh Patel, Burlington, Vulnerable Clinic, +500 Patients)

I appreciate the sensitivity and confidentiality necessary when choosing to leave an existing clinic or workplace.  If you wish to remain as an anonymous signatory until a serious offer is on the table, please email Ontariofamilydoctor@gmail.com.  Please indicate your name, city, Vulnerable Clinic or Returning to Comprehensive Care, and number of patients you will accept (if any). 

Framework for Identifying Vulnerable Clinics in Ontario

Definition of a Vulnerable Clinic:

A vulnerable clinic is an individual or group family medicine practice at risk of closure within the next five years. The viability of these clinics hinges on several factors, notably the well-being of the family doctors and the financial stability they offer to a clinical practice through their OHIP Billings. Group clinics with vacancies for new Family Doctors are particularly vulnerable to closure in the next 5 years due to the shortage of Family Doctors.  Compound below inflation revenue increases, and an OHIP billing system designed not to pay out, there comes a point when a clinic or Family Doctor must close their practice.  One may not realize it, but your clinic may be vulnerable to closure in the next 5 years.  Join The Family Doctor’s Pledge if you select one or more of the indicators below.

Key Indicators of Vulnerability:

Human Resource Shortage:

• Doctor Attrition: The loss of family doctors, leading to increased patient loads and orphan patients.
• Recruitment Challenges: Difficulty in replacing retiring doctors or attracting new graduates to comprehensive family medicine.
• Burnout Rates: High burnout rates among family doctors affecting the ability to provide services.

Financial Pressures:

• Rising Operational Costs: Expenses exceeding revenue, inability to offset cost increases with medical service fees.
• Ownership and Overhead: The challenges of clinics that do not own their property, particularly with unpredictable rent increases by landlords, or renovictions.
• Clinic Size and Funding: Small group practices, especially those with less than six physicians, facing amplified financial strain due to funding changes and cost inflation.
• Revenue Streams: Reliance on increasing patient rosters to compensate for financial cutbacks, and declining net income due to inflation.

Infrastructure and Operational Risks:

• Facility Issues: The need to relocate due to inadequate or failing clinic infrastructure.
• Landlord Relations: Complications arising from difficult or unresponsive landlords.

Interpersonal Dynamics:

• Inter-Office Conflict: Disagreements among physicians that could necessitate the relocation or dissolution of practice.

Corporate Involvement:

• External Ownership: Clinics operated by publicly traded companies, non-physician private equity, or international investors, which may introduce additional complexities to clinic operations.

Impact of Vulnerability:

• Increased Patient Wait Times: As clinics struggle to maintain operations, patients face longer wait times for appointments.
• Continuity of Care: Vulnerability can disrupt the consistent and reliable delivery of care to patients.
• Community Health: The closure of clinics affects the health of the community, especially in areas with few medical resources.

Drawing Credit: Dr. Tara Troy, age 7 (Gastroenterology, Northbrook, IL)