SooToday received the following letter to the editor from local pediatrician Dr. Jonathan DellaVedova, who offers an insider's perspective on the Group Health Centre's announcement that another 10,000 patients will be dropped from its roster.
Like many people born and raised in Sault Ste. Marie, the first time I passed through the doors of the Group Health Centre I was in a bassinet carried by my mom.
These days I rush in every morning on my own two feet juggling a ringing phone, a beeping pager, a stack of forms, and usually a coffee. I don’t want to keep my patients waiting. I feel enormous pressure every day to do the best I possibly can for my patients with limited time, limited resources, limited everything. But I love my job as a pediatrician. I am happy to be here, in particular.
Not because of my office, which is pretty tiny. My various overflowing in-baskets threaten to consume the space entirely. Not because of my particleboard desk, which has seen better days, passed down from one doctor to another until I inherited it. Not because, embarrassingly, we can barely squeeze a wheelchair down the hallway of our department. I look around and I’m reminded every day we need a new building. But if and when that happens, I will actually miss these brown bricks all around me that practically shout mid-century Sault Ste. Marie. They are the same familiar bricks I see everywhere in this town, at my elementary school, the mall next door, the art gallery, my grandparents’ house.
My grandfather was what we call a “first bricker,” trading a portion of his salary at Algoma Steel to not only lay these brown bricks, but for an assurance of lifelong comprehensive medical care for his family. Though it may be hard to imagine now, at the time this was an extraordinarily disruptive action that helped pave the way for our Canada-wide model of universal public health insurance.
At the Group Health Centre, which is still the largest multi-specialty ambulatory care centre in the province, my grandparents were expertly cared for by family doctors and specialists for their entire lives. In her final years, my grandmother’s appointments were a welcome excuse to swing by the pediatric department to visit her grandson, now sporting a real stethoscope instead of a toy one. I think those visits meant a lot to her, not just as a proud grandparent, but as a stalwart believer in the power of public healthcare and the collective effort of working-class people. Those visits definitely meant a lot to me as a grandson who was equally proud of his grandparents for what they had accomplished. It completely breaks my heart that many members of my grandparents’ generation can no longer access primary care during their time of greatest need, not only here at GHC but all across the province. That generation understood the difference between “group health” and fend-for-yourself medicine. What they worked for is now crumbling.
Like just about every medical graduate, I had a dizzying number of job offers when I finished residency. You should know that doctors today still receive job offers from other communities who are trying to recruit. This means every day is a decision to keep going or pack it in for something else. So why stay here?
The simplest answer is that extraordinary things happen here at GHC every day, often unnoticed or taken for granted. When I see a child for asthma and I hear some unexpected crackles in her chest, I walk her down to diagnostic imaging and ask if they can squeeze in an urgent X-ray. In minutes, I can review the image myself and electronically prescribe an antibiotic to her pharmacy. When I spot a rash I can’t quite identify, the dermatologist is right next door to bail me out. When I receive an in-house referral, our shared electronic medical record allows me to pull up the entire chart including growth curves, notes, and diagnostics within seconds. Every week, several family doctors knock on my office door. Can you listen to this kid’s murmur for me and tell me what you think? Should I increase the dose of this seizure medication or start a new one? Often this averts the months-long wait for a full consult, which conserves the patient’s time and mine, maybe even saves lives. I’ve been working here for 10 years now, and I have to keep reminding myself that this is not normal; this is incredibly special.
The established support structure at GHC also means I do not have to hire, interview, or pay my nurse or clerical staff, nor do I have to worry about the rent or keeping the lights on. Of course, this is drawn from our earnings, but I am not responsible for running the business, which saves me an immeasurable amount of administrative time that I can repurpose for patient care. When my nurse - who is brilliant by the way - takes a parental leave, another nurse takes her place. If she calls in sick, I do not have to cancel and re-book 20 visits. By working in a large group of doctors, I have health benefits and a pension that I would struggle to pay for on my own.
I am also bizarrely excited by the effective use of taxpayer dollars. You should know that by gathering a large number of providers under one roof, what emerges is an unrivaled economy of scale. We pool not just our staff, but our building maintenance, utilities, custodial, equipment, and medical record licenses. I recently learned that compared to Family Health Teams, which are our nearest comparator, the GHC receives funding for far fewer supporting healthcare providers than it should. Patient for patient, the GHC is a leader in value for money.
For answers to the sudden de-roster of 10,000 patients you have to look outside these brick walls. The GHC has actually insulated our community from the attrition of retiring family doctors for as long as possible. However, if we expect the dwindling number of family doctors to keep enlarging their practices they will also burn out and leave.
You also have to look beyond our community. When I talk to my colleagues in Kingston, Hamilton, Collingwood and Windsor, no one is taking patients and family doctors there are heading for the exits too. Toronto is short over 400 family doctors, Ottawa over 200. Those numbers are fairly proportionate to our missing 20. So where did they all go?
First, despite the welcome increase to medical school enrolment in Ontario, we are still so far short of the workforce required to serve our growing population. The new medical school seats today will produce practicing physicians about a decade from now, by which time there will be millions more Ontarians and they will be even older.
Second, a record low proportion of graduates are choosing family medicine. Ask any family doctor and they will describe a crushing burden of record-keeping and other mundane administrative tasks that pull them away from actual patient care and spill over into evenings and weekends. They are coping with increasingly complex and aging patients with fewer resources and, frankly, they are undervalued, under-supported, and underpaid for their expertise. Episodic shift-based care at hospitals and walk-ins is more tolerable by comparison.
Third, Ontario is becoming an increasingly hostile place to practice medicine in general. When the cost of running a practice increases by 8% year-over-year and the offer at the bargaining table is 0%, you might as well hang a sign at the border that says “doctors are not welcome here”. Yesterday I just about fell out of my chair when I read an op-ed in the Toronto Star written by leading doctors asking family medicine graduates not to set up shop in Ontario. This is unprecedented.
So far, those who remain in primary care practice have withstood these mounting headwinds. At the Group Health Centre, I work shoulder to shoulder with the most inspiring, resilient, and hardworking professionals, all of whom are caring for every patient they possibly can, and none of whom signed up for a career in healthcare to disappoint or de-roster patients. For each other, and for our patients, we keep going.
Personally, I practice at GHC because this place is legendary. I practice here in honour of my grandparents. I practice here because the GHC model is the perfect intersection of smart economic policy and high-quality care. In fact, when funded properly, ours is the model of collaborative, innovative, and interprofessional care that should be replicated to rebuild healthcare all across Ontario. Brick by brick, starting right here in Sault Ste. Marie.
Dr. Jonathan DellaVedova
Pediatrician