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CMAJ Evolution in models of primary care
B
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access to professionals not usually ritish Columbia has jetcovered by the public system, such tisoned its ambitious as psychologists. Only 25% of 2013 election promise Ontario’s family physicians practo match everyone in the provtise within the Family Health Team ince with a family doctor. It’s model, although more are involved yet another sign that governin similar organizations, such as ments are beginning to recogCommunity Health Centres and nise an evolution in the proviAboriginal Health Access Centres, sion of primary medical care that also provide access to other — an evolution that’s suphealth care professionals. Quebec ported by the College of Famand Alberta also offer team-based ily Physicians of Canada. family medicine. The GP for Me program had Mazowita supports this evoluaimed to match every BC resition, but cautions that it is vital for dent with a family physician Given the ongoing shortfall in family physicians, team (FP) by the end of 2015. That practices with doctors, nurses and others seem like a the teams to continue to offer the didn’t happen, despite the fact more practical option — and one preferred by younger level of care that individual doctors have always provided, including that BC has 125 FPs per physicians. strong relationships with their 100 000 population — higher patients. “It’s essential that they prothe way that the profession is changing. than the national average of 114. vide comprehensive and continuous The traditional model of family pracInstead of individual FPs, BC will care. Those factors are the ones that tice, with a single doctor providing match people with a primary care team are most correlated with efficient and comprehensive care in a variety of setthat includes doctors as well as nurse effective health care, and with safety.” tings including the office, nursing home practitioners, mental health counselSufficient numbers of FPs are critiand hospital, is no longer a good fit for lors, physiotherapists and others. cal to providing that care, he says. the young doctors graduating from The government does not see the Firm numbers are hard to come by, medical schools today. change as a defeat. but Mazowita estimates between 10% “There are some changing genera“We make no apologies for our and 20% of people across Canada lack tional norms on work–life balance and aspirational goal,” said Kristy Anderaccess to a family doctor. satisfaction,” he said. “We have graduson, media relations manager for the Family medicine had been considating cohorts now who want to work in Ministry of Health, in an email. ered a less attractive or fashionable teams, and they are more dissatisfied Thanks to the program, 50 000 addispecialty in the past, but the college is with fee-for-service systems of pay.” tional people now have access to a working hard to turn that around. Moving toward more team-based, family doctor or primary care clinic, “There has been a resurgence of intercollaborative systems of primary care she said. Dr. Christie Newton, presiest in family medicine residency prois a step in the right direction. “It’s dent of the BC College of Family Phygrams,” said Mazowita. “The training encouraging,” said Mazowita. It’s sicians, said the college supported GP programs are turning out more family more aligned with the direction many for Me, but the timeline may have doctors than they ever have.” think the health system needs to go to been too ambitious. BC, for example, doubled the numaccommodate the increasing burden of The change in focus is intended to ber of medical school places since chronic disease and complexity that create a more integrated health care 2003, and nearly tripled the number of family doctors are facing, he adds. system, said Anderson. “The ministry, residency positions, resulting in more Ontario began implementing teamdoctors and health authorities are now than 500 additional family physicians based primary care in 2005. Family working on a broader primary care graduating. The BC college would like Health Teams, which include doctors, strategy. This strategy includes focusto see half of all graduates choose famnurse practitioners, social workers, ing on the full range of health care ily medicine as their specialty — curdietitians and others, have proven professionals, working as part of a rently, 44% do so, with the number popular with both patients and physiteam to better meet patients’ needs.” gradually increasing, said Newton. — cians. But the province has only 184 That change is the right choice, Brian Owens, St. Stephen, NB such teams, with no plans to add according to Dr. Garey Mazowita, past more. The teams are proving expenpresident of the College of Family Physive to run because some provide sicians of Canada, and is a reflection of CMAJ 2016. DOI:10.1503/cmaj.109-5283
© 2016 Joule Inc. or its licensors
CMAJ, July 12, 2016, 188(10)
E205
CMAJ Evolution in models of primary care
B
nullplus/ iStock
access to professionals not usually ritish Columbia has jetcovered by the public system, such tisoned its ambitious as psychologists. Only 25% of 2013 election promise Ontario’s family physicians practo match everyone in the provtise within the Family Health Team ince with a family doctor. It’s model, although more are involved yet another sign that governin similar organizations, such as ments are beginning to recogCommunity Health Centres and nise an evolution in the proviAboriginal Health Access Centres, sion of primary medical care that also provide access to other — an evolution that’s suphealth care professionals. Quebec ported by the College of Famand Alberta also offer team-based ily Physicians of Canada. family medicine. The GP for Me program had Mazowita supports this evoluaimed to match every BC resition, but cautions that it is vital for dent with a family physician Given the ongoing shortfall in family physicians, team (FP) by the end of 2015. That practices with doctors, nurses and others seem like a the teams to continue to offer the didn’t happen, despite the fact more practical option — and one preferred by younger level of care that individual doctors have always provided, including that BC has 125 FPs per physicians. strong relationships with their 100 000 population — higher patients. “It’s essential that they prothe way that the profession is changing. than the national average of 114. vide comprehensive and continuous The traditional model of family pracInstead of individual FPs, BC will care. Those factors are the ones that tice, with a single doctor providing match people with a primary care team are most correlated with efficient and comprehensive care in a variety of setthat includes doctors as well as nurse effective health care, and with safety.” tings including the office, nursing home practitioners, mental health counselSufficient numbers of FPs are critiand hospital, is no longer a good fit for lors, physiotherapists and others. cal to providing that care, he says. the young doctors graduating from The government does not see the Firm numbers are hard to come by, medical schools today. change as a defeat. but Mazowita estimates between 10% “There are some changing genera“We make no apologies for our and 20% of people across Canada lack tional norms on work–life balance and aspirational goal,” said Kristy Anderaccess to a family doctor. satisfaction,” he said. “We have graduson, media relations manager for the Family medicine had been considating cohorts now who want to work in Ministry of Health, in an email. ered a less attractive or fashionable teams, and they are more dissatisfied Thanks to the program, 50 000 addispecialty in the past, but the college is with fee-for-service systems of pay.” tional people now have access to a working hard to turn that around. Moving toward more team-based, family doctor or primary care clinic, “There has been a resurgence of intercollaborative systems of primary care she said. Dr. Christie Newton, presiest in family medicine residency prois a step in the right direction. “It’s dent of the BC College of Family Phygrams,” said Mazowita. “The training encouraging,” said Mazowita. It’s sicians, said the college supported GP programs are turning out more family more aligned with the direction many for Me, but the timeline may have doctors than they ever have.” think the health system needs to go to been too ambitious. BC, for example, doubled the numaccommodate the increasing burden of The change in focus is intended to ber of medical school places since chronic disease and complexity that create a more integrated health care 2003, and nearly tripled the number of family doctors are facing, he adds. system, said Anderson. “The ministry, residency positions, resulting in more Ontario began implementing teamdoctors and health authorities are now than 500 additional family physicians based primary care in 2005. Family working on a broader primary care graduating. The BC college would like Health Teams, which include doctors, strategy. This strategy includes focusto see half of all graduates choose famnurse practitioners, social workers, ing on the full range of health care ily medicine as their specialty — curdietitians and others, have proven professionals, working as part of a rently, 44% do so, with the number popular with both patients and physiteam to better meet patients’ needs.” gradually increasing, said Newton. — cians. But the province has only 184 That change is the right choice, Brian Owens, St. Stephen, NB such teams, with no plans to add according to Dr. Garey Mazowita, past more. The teams are proving expenpresident of the College of Family Physive to run because some provide sicians of Canada, and is a reflection of CMAJ 2016. DOI:10.1503/cmaj.109-5283
© 2016 Joule Inc. or its licensors
CMAJ, July 12, 2016, 188(10)
E205
![[Preventive health care and health promotion: Which models for supporting the evolution of clinical practice in primary health care?].](/assets/img/hold.png)
