A high-ranking Sault medical official has described the scope of one obstacle that is keeping some medical school students from choosing to practice family medicine.
That obstacle is the amount of paperwork primary healthcare providers face in the course of their duties.
“We have to go back and look at where all the paperwork comes from and there are a variety of different sources and so definitely a variety of different solutions,” Dr. Jodie Stewart, Algoma District Medical Group CEO and chair, told SooToday in an interview Wednesday.
“There are some things like insurance companies requiring notes for things like massage therapy that we would love to not have to do.”
Family doctors and nurse practitioners sign a variety of papers such as sick notes for a patient to hand to an employer, as well as disability notes.
“We’re quite happy to do that but the interval of them maybe needs to be looked at. Some of the forms require you to repeat them every so often when it's clear that a disability is permanent. We can look at changing some of those requirements that require us to complete forms over and over again,” Stewart said.
“Currently, roughly half our time is spent doing administrative tasks when we very much rather prefer to be seeing patients,” Stewart said when the Group Health Centre announced on Jan. 25 that approximately 10,000 of its patients will lose access to their primary care provider and the same-day clinic services at GHC as of May 31, 2024.
An additional 6,000 GHC patients are at risk of losing primary care in the near future if trends continue.
Many long-serving GHC family doctors have retired with no new blood to replace them, paperwork being a factor in some medical students shying away from family medicine.
Referring patients to specialists can be a time consuming paper chase, Stewart said.
“That’s a really big one for us.”
“If we refer to a provider who isn’t in Sault Ste. Marie, if I need a specialist of some kind, there’s not a great way for us to know who’s accepting patients. We are often sending off blindly to specialists in southern Ontario and waiting for their response as to whether they'll see our patients or not. They’ll often refuse it. They’ll say their wait list is long or they don’t deal with that type of problem and then we’re having to pick another person and generate letters and packages all over again. We often will do that multiple times before we find a specialist who will take our patients so that is a very big time burden.”
Entities within the healthcare system often don’t communicate easily with each other, Stewart said.
“A lot of agencies have created electronic systems and the problem is that the systems don’t interconnect. I wanted to send a patient somewhere through a portal. So I had to download the portal, create a login, then login and once I found the referral pathway I had to manually enter all the patient’s demographics myself because they only allow the physician to login to their portals. It’s a huge amount of time for us to navigate the healthcare system for our patients and get them where they need to go.”
Family doctors typically set aside one day a week or stay behind after traditional business hours to catch up on paperwork, Stewart said.
“All of our physicians are logging in after work hours. Lots of them have young families. They’re getting the kids to bed and then going back onto the computer to do a couple of hours of administrative work every night. Most people are doing work on the weekends to stay on top of things. All of us are doing work on our own time.”
That, of course, leads to tiredness and low morale.
“It’s a major driver of burnout,” Stewart said, stating that doctors need help in order to give themselves time to recharge.
Who can help?
A doctor’s nurse and administrative assistant have their own duties to perform and don’t have the authority to sign certain forms such as prescription renewals and searches for specialists.
“This is where team-based care models are really essential across the province,” Stewart said.
“There are other members of the team, people like physiotherapists, social workers and dieticians which we would like to see further developed as members of allied health support in getting the patients to the right person at the right time.”
Stewart said the services provided by home care nurses employed under the province’s Home and Community Care Support Services are much appreciated.
“I think home health care is a vital part of our system. We have a complex aging population. There are a lot of frail patients within our community who are best served in their own homes for a lot of the things that can be done there.”
Stewart reiterated the importance of more coordinated teamwork.
“There are a lot of ways that the patient would be better served before they see me. There are a lot of things that a physiotherapist can manage much better than I can, so having a team based system where the right individual is seeing the patient first, I think, is part of our vision and plan.”
Sault MPP Ross Romano, in attendance at GHC’s Jan. 25 announcement, said a task force of local health professionals to address the Sault’s family doctor shortage problem will be formed and wants that task force to have its first meeting on March 1.
Stewart said she and other GHC officials are looking forward to being a part of that task force and attending its meetings.
Reducing the amount of paperwork that family doctors and nurse practitioners perform during a typical work week is seen as part of the solution to recruiting and retaining primary health care providers, said Dr. Andrew Park, Ontario Medical Association president told SooToday Jan. 26.
“The family doctor is sitting there doing 19 hours of paperwork a week which is not really what you want your family doctor doing," Park said. "You want them taking care of patients. We need to streamline our system so that doctors are able to be doctors. I don’t think that’s an unreasonable ask."