Organization
[May 09, 2024 3:37 PM]
Ontario Medical Association (OMA)
 
Response in PDF format:
OMA Response_20240509.pdf
Member of the public
[May 06, 2024 5:57 PM]
Much has changed since 2017.

Large number of Ontario patients without a family doctor also while a shortage of nurses continues.

Gender identity, more transient lifestyle, recreational drug use, AI and internet for medical information, COVID, MAID, obesity related health complications, backlogs for imaging eg MRI wait list, referrals to specialists, private services delivering public paid health care not well understood, more.

Consideration of the perspective of the doctor especially during and following the pandemic years - now in year 5.  His or her beliefs associated with MAID, abortion, other patient options and choices which I appreciate must not impact professionally.

As a mature member of the public living in Guelph, I am sharing comments for consideration. 

I agree that family members should be considered with restrictions.  A new baby after pregnancy care and delivery, yes.  An aunt or other more distant family member likely not.

An introductory meeting yes if feasible.

If a family doctor might accept new patients who for a period of time without a family doctor now presents as very complex undiagnosed, untreated chronic disease(s), that patient will require much time - must be considered.

I do not agree with a provincial central list except for a local list when there are new patients waiting for a family doctor in their immediate town or region.

With respect to referral to specialist, depending on the medical details, a specialist may have no need for more than need extensive history beyond focused medical history.  I assume there might be preference or criteria with respect to how quickly an appointment might be scheduled - referral from outside the region would depend on more information - exclusive, limited number of available specialists, complex medical status, rare indications.

Regional: in southwestern Ontario, one small town hospital shared news on CTV Kitchener that the OB, delivery unit will be closed until at least September because several nurses were on their maternity leaves.  That is short term and happy news.  However elsewhere in the region another obstetrical unit will close permanently since an average of 60 deliveries a year does not allow continuing for budget and likely other reasons.  Those women will have options including St. Thomas, London or ER in their town for their labour and delivery.  The options especially for ER delivery might compromise the very early infant care. 

I appreciate the role of the family doctor and her/his professional office staff wherever they might practice in the province.  I consider they are valuable and worth more than current compensation provided especially for the general practice family doctor and office staff.

Private delivery of publicly funded health care delivery has been poorly communicated.  I understand it however many do not.
Physician (including retired)
[April 17, 2024 7:48 PM]
This policy is wonderful- sliced bread and apple pie wonderful – but… 

Despite this policy being out there for years in much the same form, no one, except the most noble of us, follow it.  Specialists pick and choose who they see (I have had specialists refuse to see patients because I am not practicing in their geographic area even though my patient lives in their geographic area – I get back from them “My waitlist is too long” and my colleague who works in the geographic area gets their patient accepted.  This not right).  I have had people I see in the ER on waiting lists with complex medication lists and WSIB claims and things like that who are on family doctor’s waiting lists for years and are not invited to the practice.  I then see a 40 year old healthy male who applied to be on that same doctor’s wait list in the last few months and was going to be seen in the next week or two).   These doctors use the forms that patients fill in to cherry pick.  This has been going on for years.  How do you as a college put a policy like this out there, but there is no way to police it?  This is a pointless policy unless it is policed.   I see no evidence that the CPSO does that.  Patients don’t even know who to complain to and much of what they would complain about would be hearsay. 

My thought is that all waitlists should be publicly managed.  A physician should never be allowed to ask a patient to fill in a form with their medication list and history etc – that is PHIPA information and patients should not have to give that up or lie to get invited.  First come, first serve is how it should be.  The only cherry picking should be take on more complex patients who REALLY need a family doctor – high needs individuals.  I think taking on family members should be allowed – we do call ourselves family physicians after all.  

There should be a central wait list for family doctors and specialists.  Only reason to refuse is, as you put in the policy, that “…I don’t have the expertise to do what is being asked.”

Bottom line is that this policy if it were policed would be a great policy, but as it stands, it is just words
Physician (including retired)
[April 17, 2024 5:00 PM]
I have another concern re 'First come, first served'. In our rural community we tried over the years to prioritize our local residents when accepting new patients. When we didn't, we found patients coming from other communities, some near, some far. The care provided to these patients was more labour intensive as we were coordinating care in areas we had less familiarity with. My understanding is that First come, first served does not allow us to use patient's residence location as a criteria in acceptance/rejection of request of new patients.
Physician (including retired)
[April 12, 2024 8:30 PM]
The “first come first served” policy may need to be reconsidered, especially in communities with many unattached vulnerable patients. For example, it may be appropriate for a family physician to expand their practice by taking only patients who are >80 yo, if there are many such patients in the community, or if a nearby physician has retired with no replacement. Some physicians do home visits and should be able to prioritize patients who are housebound and would otherwise have difficulty accessing care. A first come first served policy is more likely to benefit young, healthy, motivated patients.

The section on specialist care allows accommodation for patients requiring priority access to care. The same should apply to family medicine, as access to primary care has become a limited resource.
Physician (including retired)
[April 12, 2024 5:11 PM]
Ask consideration, for the sake of clarity, with the statement pertaining to physicians must comply with the human rights code, if it would be clearer if a phrase to specify actual examples (ie. "eg. Must not be discriminated based upon identity, background, religion...").
Also, would it be helpful to consider adding if the receiving physician must clarify if they are a fully licensed physician (considering the new policies for physician assistants) and/or their credentials (eg. Obstetrical specialist vs. Family Physician with Obstetrical training).
Other health care professional (including retired)
[April 12, 2024 11:04 AM]
New patients need to be asked if they are being treated by other Ontario regulated professionals.
For example: A patient being treated by a Regulated Ontario Homeopath could lead to high potential for the uninformed misdiagnosis by a physician. As the CPSO is mandated to protect the public, this question has to be part of the intake of new patients.
Physician (including retired)
[March 12, 2024 9:27 PM]
Regarding the following statement: "Physicians must use their professional judgment to determine whether prioritizing or triaging patients based on need is appropriate, taking into account the patient’s health care needs, and any social factors, including education, housing, food security, employment, and income that may influence the patient’s health outcomes."

As written, I interpret this to mean that medical need may not be the appropriate criteria on which to triage/prioritize patients. If that's not the intent, it should be worded differently. If it is the intent then the follow concerns arise:
1) medical need is indeed the appropriate criteria that should dictate how specialists triage referrals
2) most referrals do not include information on social factors, education, housing....so specialists would not be able to evaluate that information
3) even if referrals did include such information, it would be impossible for a specialist MD triaging incoming referrals to consider all of those factors and how each might or might not impact the medical need of a given patient or how to compare to other referrals to sort out which patients to prioritize.
Physician (including retired)
[March 06, 2024 7:30 AM]
Can this policy clarify if specialist physician wait time to see a patient is long, it is ok for physician to send out letter to primary care providers that they are not accepting new patients
Physician (including retired)
[March 05, 2024 10:34 PM]
Considering that all specialists, hospital-based services such as CT scans & other imaging modalities have absolutely no “must” clauses in the provision of services, I find the policy on the acceptance of new patients discriminatory and frankly ridiculous.
The college has been perceived at least through my 45 years of practice to be a cabal of failed clinicians exploiting the opportunity to beat up the front line health care workers.
This needs to be rewritten completely, unless you wish to drive more physicians out of primary care.