Family physicians providing primary care are the backbone of our health care system. People without access to primary care are forced to utilize walk-in clinic or hospital emergency rooms. Neither of these options are designed to provide ongoing comprehensive care to Ontario residents. Hospital Emergency Departments are overrun with non-urgent issues and wait times have grown well beyond capacity.
Small rural hospitals normally staffed by the local family physicians. This typically means these physicians have somewhat lower rosters of patients resulting in more unattached patients in their communities. Such is the case in the town of Carleton Place, Mississippi Mills, and the bordering township of Beckwith.
The health care system has, to date, focussed much of its efforts on long term solutions such as increasing opportunities for medical school education or supporting foreign trained doctors. While these are important initiatives, neither adequately address the province’s immediate crisis.
Family physicians are leaving their practices in record numbers due to burnout, unmanageable workloads, administrative burdens etc. All of these challenges can be addressed with very simple solutions. Providing our family physicians with the appropriate level of qualified support will enable our doctors to perform the work they were trained to do.
Physician Burden
The average family doctor is forced to run his or her practice as a small business. Administrative duties such as staff management, financial management, bookkeeping, clinic maintenance, managing IT systems such as their EMR, phone systems and internet all fall under the doctor’s responsibility.
Additionally, each family doctor will be required to work an average of extra two to three hours per day managing patient needs like, phone calls to patients, ordering diagnostic test, referrals to specialists, completing insurance, legal, employment and government required forms. It should be noted, that much of this work is not compensated for.
A family doctor usually employs an administrative staff member. This person would be responsible for answering phones, booking patient appointments, greeting patients, sending consultation requests to specialist physicians, managing incoming documents, billing non-insured and government funded through OHIP services, and office and medical supply inventory control.
The family doctors in Carleton Place as well as many other small communities do not have appropriate clinical support. For the average doctor, this means on average 45 to 60 minutes of work each day providing clinical services that could easily be provided by qualified nursing staff.
Below are some examples of efficiencies that can be realized when a family doctor is properly supported.
Nursing Support
Many family doctors are not able to afford hiring and paying nursing staff to support their practices. The cost of this comes directly from the revenue they receive billing OHIP. Nursing salaries can be cost prohibitive.
RPN Triage
The nurse triage program in Almonte is served by a Registered Practical Nurse. This staff member answers calls from patients who may have an acute issue that requires attention.
- Average calls triaged per month – 35.
- Number of calls that resulted in an appointment – 19.
- The nurse was able to record the presenting complaint in the EMR for the doctor to read, making the patient visit much more efficient.
- Number of calls where no appointment was necessary – 16.
- The nurse providing medical advice on symptom management without the need to see their family doctor.
This resulted in an average of 46% of triaged calls not requiring the physicians time or 3 appointments per day.
RPN Clinic Nursing Support
The family doctors in Almonte are supported by clinic nursing for many routine services such as: childhood and adult immunizations, allergy serum injections, wound dressing, stiches, or staple removal post-surgery, etc.
- Our clinic nurses see on average 4 patients per day supporting a family doctor. This results in a time savings of 45 minutes for each physician.
Registered Nurses
Registered nurses can be utilized to care for simple medical conditions. Utilizing Medical Directives, (a written directive from a physician to a nurse that provides instruction on how to deal with specific medical conditions), RNs are able to treat patients without physician intervention. Some examples of these conditions are, uncomplicated urinary tract infections, wart treatments, blood pressure checks, ear infections, etc.
Nurse Practitioner, (NP) Support
Nurse Practitioners are able to see patients for the majority of routine medical issues. The average NP salary is $120,000 per annum which far exceeds the average primary care doctor’s ability to afford. The NP provides primary care as well as acute, episodic care.
- The NP can see an average of 25 patients per day.
- On average 15 would be seen for primary care.
- Ten patients would be seen for same day/next day acute care.
- The goal of the NP Program is to provide patients alternatives to seeking care at the local Hospital Emergency Department. At the inception of this program, there was a marked reduction of patients visiting the ED for lower acuity visits.
The Solution
It’s clear to see why family doctors are choosing to leave their medical practices. They simply can’t keep up with the demands of providing comprehensive care to their patients. Doctors need to be provided with both administrative and clinical support as well as lessen the financial stressors that comes with providing care.
If you consider the numbers illustrated above, you can see that patients would be much better served if family doctors were appropriately supported.
- A simple nurse triage service with direct access to a patient’s family doctor can free up 45% of unnecessary patient visits.
- Clinic nursing support frees up at least three to four patient appointments per day.
- Utilizing Medical Directives for Registered Nurses allows doctors to focus on providing better care to more patients.
- Nurse Practitioners can utilize their skills to deliver both primary care as well as episodic care that can result in an additional 10 to 20 patients seen each day.
- Additional administrative support can alleviate the physician’s burden currently required to manage his or her practice.
These solutions require a financial investment