Doctor gives update on clinic status

The process of having a not-for-profit, community-owned clinic here, and getting the Group Health Association (GHA) on board as consultants, is moving ahead slowly but surely.
In an interview Friday, Dr. Robert Algie, president of the Fort Frances Clinic, said the latest news is the GHA will be taking a slightly different role than first thought.
“Things are moving ahead,” he noted. “We’re still looking at Group Health being on board, [but] they’re looking to be more of a consultant now and allow the not-for-profit to be a community-based company completely.
“And they’ll be an advisory member of that board, rather than a full board member,” Dr. Algie added. “They won’t have any specific ownership function.
“In terms of the concept of whether there will be Group Health employees here, operating out of the clinic, that has sort of changed as the model has evolved,” he continued.
“They’re taking more of a hands-off approach. Some of that has come from their own board of directors and some of the politics in their own community, in terms of recruitment and where their priority is—is it in Sault Ste. Marie or is it here?”
Dr. Algie said they soon hope to start to structure the new not-for-profit company and be able to take over ownership of the holdings company.
While details still have to be worked out, this not-for-profit company likely will have a board of governance consisting of physicians as well as representatives from the Town of Fort Frances, La Verendrye Hospital, and local residents.
Dr. Algie reiterated the plans for the future of the clinic involved two issues: the ownership of the building and changing the operating model to a Family Health Team (FHT) format.
“We’ve gotten into a position where, as physicians leave, that burden is falling on a smaller and smaller group,” said Dr. Algie, referring to the current structure of the Fort Frances Clinic Holdings Ltd. and how it’s been operated over the years.
“The community’s basically had a community-owned health centre they’ve had no obligation for for 50 years,” he noted. “The Fort Frances Clinic has always provided a place to family care.”
He added Atikokan, Dryden, and Sioux Lookout currently all have community-owned clinics.
“I think a community-owned facility is the way to go. The town’s taken the leadership there and we’re moving towards that,” he said.
“People have some concerns about the building, but I think a lot of it’s just cosmetics,” Dr. Algie added. “And four or five years down the line, if people feel there’s a need, we’ll look into fixing that.”
As far as the FHT model goes, the local clinic is hoping to get approval from the Ministry of Health and Long-Term Care early next year to start “detail planning” as to how the new model will work here—and what it will mean for patients and physicians.
“I think that’s where some of the concerns people might have might be answered,” said Dr. Algie. “If we’re accepted, the government will provide extra funds for a more detailed business plan.
“And that involves setting up our governance structure, having physicians affiliated, and deciding what sort of other health providers you want to bring into the mix.”
With the FHT model comes the potential for more health-care services for patients—ranging from asthma specialists to nurse practitioners who could carry out some tasks currently done by doctors.
It also entails concepts new at the local clinic, like rostering (where a patient signs a contract with a physician to obtain services from the Family Health Team) and capitation (where the government will allocate a fixed amount of money periodically, based on a per capita rate, for each rostered patient).
While there have been concerns mentioned by some people locally about rostering and capitation, and whether it will affect the quality of patient care, Dr. Algie said he felt this won’t be the case here.
For instance, in some parts of southern Ontario, communities are looking at adding physiotherapy services under their FHTs. If someone is part of a particular FHT, they will get access to a physiotherapist that’s funded by the government.
But if they’re not part of that FHT, then it’s not available to them.
As it stands now, in most communities in Ontario, the availability for hospital physiotherapy is limited to in-patients.
“But in our area, we’re lucky. We already have pretty good access to those programs,” said Dr. Algie. “To have this level of access here is great, and it’s a tool physicians have to deal with their patients.
“I don’t see [rostering] as a major issue for our community.”
Rather, Dr. Algie believes rostering comes down to accountability.
“When you roster, there’s a much more explicit relationship with the patient,” he explained. “You’re agreeing to take a patient onto your list, and that’s the first time a lot of physicians have ever had to do that.
“Some don’t mind it, and feel the obligation was there anyway. But when it’s put on paper, some might feel more nervous.
“In this community, most physicians are pretty big on commitment,” he remarked.
Meanwhile, Dr. Algie said the province likely will make capitation a component of the FHT model here.
While some critics have claimed capitation encourages doctors to under-service or show biased selection of patients, Dr. Algie said he doesn’t feel it will adversely affect patient’s quality of care at all.
“The same issues exist in fee-for-service,” he argued. “Fee-for-service is when physicians get paid to deal with a patient on an individual basis on a single day.
“If someone is time-consuming, either they don’t speak English, or they have multiple medical problems, or they have a developmental handicap, there are subtle ways physicians don’t see those people—even on a fee-for-service basis.
“So I think the same potential to under-serve a population exists under fee-for-service as well as capitation,” he said. “That’s why the government has community health centres [where physicians are hired on a salary or hourly basis].
“In terms of capitation and the Family Health Team model, a lot of it is responding to government programming,” Dr. Algie continued. “It’s catching the wave, trying to improve the funding for local health services, trying to attract funds so we can hire additional people to provide health services.
“Getting a Family Health Team isn’t necessarily going to get us more physicians, but it may get us the opportunity to get us some nurse practitioners, who can do a fair bit on their own with back-up from the physicians,” he noted.
“So hopefully, the primary care health system would be enhanced by the addition of nurse practitioners.”
From the physicians’ perspectives, Dr. Algie said having nurse practitioners working at the clinic would mean they could free up doctors’ time, doing routine duties like administering influenza shots, checking over blood test results (following strict medical protocols), co-ordinating diabetic care, and so on.
Dr. Algie noted capitation under the FHT model also should be able to provide newly-graduated doctors with a better idea of what kind of money they’ll be making.
“When you’re based on fee-for-service, the way we are currently, we can’t promise them anything. We can’t say this is how much you’re going to make,” he remarked. “It all matters on how fast they work, how many people they see.
“We’re trying to respond to the government’s model to improve health care locally. It’s not necessarily a preferred way of working,” Dr. Algie said.
In terms of trying to attract new physicians and younger physicians to Fort Frances, Dr. Algie said FHT provides an opportunity to provide a more attractive package to new grads.
“It’s very tough competition out there,” he warned. “Dryden has incentives we shouldn’t try to match. I think we have to try and sell the community on a different basis; money’s not the only object.
“We’ve seen in the past, when those short-term incentives run out, often physicians disappear.
“I think the Family Health Team will allow us to provide guaranteed funding so that when these new grads come out and say, ‘What am I going to make this first year?’ we can give them a new number,” said Dr. Algie.
“As far as I’m concerned, the only real difference is with the Family Health Team is it gives a greater structure to things, and it allows for the community to hire other health professionals to help out with provisional care,” he added.
Dr. Algie reiterated many details still have to be worked out regarding how such an FHT will work.
For instance, local health care services such as the Community Care Access Centre, Northwestern Health Unit, Gizhewaadiziwin Health Access Centre, and the various mental health services will have to be consulted to ensure services aren’t duplicated.
“Do we want one nurse practitioner or two? Do we have a need for a midwife? Do we really need a social worker in the clinic to help people get through some of the paperwork?
“Do we need to enhance the diabetic education program to become more like the diabetes management program the health access centre has, so that perhaps we don’t duplicate them but add on to a program that already exists?
“That’s the sort of detail planning people are looking for, and that will happen when we get approved by the government,” said Dr. Algie.
In response to the negative feedback from some local residents regarding the future of the Fort Frances Clinic, Dr. Algie said he’s hopeful everyone can start thinking forward to a better future,
“I think one of the things that [Dr.] Jason Shack said during his talk [at the public meeting on Oct. 12] was the biggest deterrent to recruitment is to have a community in turmoil with respect to their health care.
“I think as long as the community’s on the same page, it’s a much more stable situation. It shows things are happening, we’re moving ahead,” he stressed.
“When [physicians looking at coming here] see a lot of debate, and they’re not sure about where things are going, they stay away and keep watching from a distance.
“If we can learn from Jason, the sooner we can all get on the same page with respect to where we’re going, the better it will be for recruitment,” Dr. Algie concluded.