08/01/2024
Cross posted...
In the Toronto Star this AM...
"I’m an emergency physician. I’ve seen what a functioning health care system needs and it’s not more downloading to pharmacies
By Mark Unger, Contributor
Imagine moving to a new town, walking into city hall, receiving a list of family physicians, and then being assigned the family physician of your choice.
That’s what happens in Denmark, where I worked the past year, and where every resident has the guaranteed right to a doctor. In contrast, in Ontario we are confronted by the grim reality that more than two million residents lack a family physician, with the Ontario government offering a pharmacist as the solution.
As an emergency physician, the differences between the two systems are obvious. In Denmark, family physicians manage 90 per cent of patient encounters and emergency departments treat a small number of patients referred by their family doctors. In contrast, in Toronto the emergency department is overwhelmed by patients with preventable diseases, many who lack any other access to health care. The emergency department is the backstop where symptoms from the rot in the health-care system become most apparent.
The reasons behind the failure to ensure an adequate number of family physicians in Ontario are complex. But complexity is not a reason to avoid addressing the problem, even if avoidance is the preferred government strategy. This strategy continued last week with the announcement that the Ontario government would explore expanding the role of pharmacists to allow them to treat more illnesses, administer more vaccines, and perform more testing. They described the plan as “bold and innovative.” It is not. Rather, it is flawed for three significant reasons.
First, rather than strengthening primary care, it further fragments the delivery of care. These drawbacks could be mitigated if the province had a shared health-care platform that could, for example, track vaccines. Unfortunately, health information technology infrastructure has similarly been fragmented.
Second, the judgment of the pharmacists is clouded by financial conflicts of interest. Just this past month, the Ontario College of Pharmacists concluded that “corporate influence on pharmacy professional autonomy (was) compromising the delivery of ethical, quality patient care.”
Third and most significantly, this scheme drains resources and distracts from the real issues impacting health care. While the government touts that pharmacists performed a million assessments for “common ailments” this past year, the challenge in health care is not delivering episodic care for minor ailments, but rather lifelong management for complex illnesses.
Primary care providers, both family physicians and increasing nurse practitioners, are the backbone of the health-care system — not urgent care clinics, not virtual health-care platforms, not emergency departments, and not pharmacies.
Rather than focus on episodic care in a way that further fragments the health-care system, a “bold and innovative” government would address the major source of health-care rot — the lack of primary-care providers. It would reorder incentives and invest in strategies to ensure that every Ontario resident has a primary care provider to manage their episodic and complex medical needs, as is the case in Denmark, not a pharmacist to manage their sore throats and warts.
Dr. Mark Unger is an emergency physician in Toronto and an assistant professor at the University of Toronto, Department of Family and Community Medicine."
