Clinic model must change, doctors say

If Fort Frances is going to try and attract new physicians, and keep the doctors it already has, the operating model for the Fort Frances Clinic has to change.
That point was stressed to well over 250 people who packed into the Memorial Sports Centre auditorium last Wednesday night to learn more about how the doctor shortage came to be, the current situation, and what a proposal for the Group Health Association taking over management of the Fort Frances Clinic would entail.
Dr. Jason Shack, who started practising in Fort Frances two years ago, said the clinic must be sold, put under new management, and the operating model changed if the community wants to attract new doctors—and keep its current ones.
“We don’t want to run a business,” he told the crowd, adding recent graduates are not willing to come into a community and pay money to start a new practice, or buy into an existing one.
He noted any new doctors who think of coming here will consider what the community is like to live in, where they will work, who they will work with, and whether the community welcomes them as not only a new professional but a citizen.
Dr. Shack felt Fort Frances and the area has a lot to offer—it just has to buy out the doctors’ 36,000 shares in the clinic and put it under new management, such as that proposed by the Sault Ste. Marie-based Group Health Association.
Dr. Shack stressed the GHA wouldn’t completely change the way the clinic is run so much as “augment what we have here already.”
“The Group Health Centre knows what they’re doing. We need someone who knows how to manage a medical business,” he remarked. “We want to keep it going, and work better.”
Dr. Shack noted the community must act quickly, and as a team, because there is a doctor shortage nearly everywhere else and so other communities are competing for them.
“If we’re going to compete with communities, we need a unified voice,” he stressed, adding a plan to bring new physicians here is imperative in the immediate future.
Dr. Robert Algie gave an overview of the current situation regarding primary care and stressed that it has to improve. “The old ways don’t work any more,” he warned. “Doctors are overworked and overwhelmed.”
Dr. Algie said that right here in Fort Frances, patients have to book three months in advance to see a family doctor, which hampers primary care, where a patent and physician should have a trusting relationship that has been proven to aid in patients remaining healthier over their lives.
Without sufficient doctors, this can’t happen.
Dr. Algie noted new medical school grads have strayed away from the model like that used at the clinic due to lack sufficient training, lack of balanced lifestyles, and a lack of role models.
Only 24 percent of recent graduates want to do comprehensive care, he added.
“We need a system that can deal with the new wave of doctors,” Dr. Algie remarked, adding this would include further training and instilling a greater sense of social responsibility in them.
He stressed the doctors here must be set up in a clinic they do not own, and change the operating model to a Family Health Team format—like the one utilized by the GHA.
“The province is looking for a success story. I think Fort Frances can give them a success story,” said Dr. Algie.
Mayor Onichuk agreed Fort Frances is not alone in its doctor shortage, noting nearly every community has a doctor recruitment and retention committee.
He added cash incentives won’t help out, and doctors don’t want to move into a community only to have to buy into a practice and worry about running a business.
Mayor Onichuk noted the solution has two parts: getting doctors out of the business as landlords and assembling a Family Health Team.
Regarding the former, the mayor said the town has been contacted to provide financing for the clinic. It also recently received word from local business owner Kim Metke that he may be interested in buying the clinic and renting it out.
As for the latter, he noted with a Family Health Team, doctors will have more time to attend to patients who truly need their help while other health care workers, such as nurse practitioners, can perform duties like giving ’flu shots that are not necessarily the most efficient use of a physician’s time.
Local MP Ken Boshcoff, speaking as a former mayor of the City of Thunder Bay, gave a history of that community’s physician recruitment strategies.
The solution so far has included building a state-of-the-art hospital, partnering in the Northern Ontario School of Medicine, and spending $250,000 a year to recruit new doctors—and it seems to be working, he noted.
Boshcoff stressed the importance of getting more doctors here, not only to attract yet more professionals here but to take care of the retirees who want to stay in the community.
While he cautioned competition for doctors is fierce, Northwestern Ontario has much to offer them. As such, he is optimistic that with teamwork, the community can succeed in getting more physicians here.
Bill Liggins and John Rafferty, representing local MPP Howard Hampton, delivered the provincial perspective on the issue.
Rafferty stressed the doctor shortage has increased ten-fold in the past decade. He felt the area should take advantage of its geographical proximity to Manitoba and focus on drawing new doctors from there.
Coun. Todd Hamilton, who moderated the meeting, also read out written statements from David Murray (former CEO of the Group Health Association and current CEO for the North Eastern Ontario Local Health Integration Network), Dr. Nancy Naylor, a former president of the Fort Frances Clinic, and John Harrison, general manager of the Abitibi-Consolidated mill here.
All agreed a partnership with the Group Health Association would be beneficial to the Fort Frances area as a “turnkey solution,” in the words of Murray.
Dr. Naylor added the Group Health Centre, run by GHA in Sault Ste. Marie, has proven “itself over the past 40 years to be a centre of excellence for medical care, with specialists, doctors, and ancillary health personnel working side by side in an environment that fosters teamwork.”
“My parents have attended this clinic for a number of year and have received excellent care,” she noted. “I envision this for Fort Frances. It is something achievable and a tremendous boost for the community.”
Dr. Naylor urged town council to assist with the transference in ownership of the clinic as soon as possible “before there is another Geraldton situation in the northwest.”
Meanwhile, Harrison wrote the new clinic model supported by the GHA would “break down barriers” to recruiting new doctors here.
GHA representative Greg Punch offered up its vision for primary health care in Fort Frances, which includes the use of “leading-edge technology” with its electronic medical records.
He clarified GHA would not own the clinic per se, but would manage it.
It would be owned by a non-profit corporation, with a board of directors likely consisting of local physicians, GHA management, and community members (in the health care field or otherwise).
If a financing deal was struck, GHA then would have to get final approval from its board of directors in Sault Ste. Marie. It then would apply to the Ministry of Health and Long-Term Care to become a Family Health Team (FHT) and get ministry approval.
Then, a business plan would have to be developed and approved, and the FHT would be put into operation.
Punch stressed the GHA has been in existence for 30 years, and has an excellent reputation—nationally and internationally—for providing primary health care.
Aside from the speakers on the agenda, the crowd on hand for the information session were vocal.
Former town councillor Sharon Tibbs said while there’s no doubt the town needs to recruit and retain doctors, she was wary of the way the proposal had been handled thus far.
She feared any use of “smoke and mirrors.”
“I have a real problem with the municipality becoming involved in financing if it doesn’t go to a public process and tender for the ability to run that clinic in that manner,” she remarked.
Tibbs also warned this current proposal may not be the ultimate solution to the shortage. “You must be aware that if you build it, they will not necessarily come. This is not baseball, this is health care,” she warned.
“I would agree that if we built it, they may not come,” replied Dr. Shack. “But if we don’t build it, they definitely won’t come.”
Former mayor Glenn Witherspoon, who said he heard on street the town has been asked to provide $1 million in financing, noted the town probably could afford to pay that amount as he estimated the town must have about $5 million in its reserves.
(While no amount was ever specified at Wednesday night’s meeting, a $1-million figure was bandied about by several people, including members of the panel).
Local resident Mark Kowalchuk said the doctor shortage must be addressed, and if the financing doesn’t come by any other way, he suggested 1,000 people in the town come forward and pledge $1,000 to buy the clinic.
Cathie Sinninghe said there’s no doubt there’s a doctor shortage here, but wondered if buying all the local physicians’ 36,000 shares in the clinic would result in them leaving.
Dr. Algie answered that those shares aren’t a factor. If he was frustrated enough with being an overworked doctor here, he would quit and leave—shares or no shares.
Local labour leader Bob Dakin said he felt doctors and the town should look to someone local, and not a group out of Sault Ste. Marie, to manage the clinic.
“I’m flabbergasted we would go to someone on the outside,” he remarked.
“To think they’re going to move in and move jobs out is incorrect,” countered Dr. Algie.
Punch added GHA will train people who already work here to do clerical/management work, and GHA staff would fill a consulting role, as well as provide back-up personnel (e.g., if the current transcriptionist went on sick leave, GHA could provide one to fill in).
Besides comments made at the meeting, sheets were distributed so the public could leave the town with their suggestions on physician recruitment and GHA.
This information now will be considered by council and the local physician recruitment and retention committee.