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At a time when there is renewed pressure to have the graying primary care work force work longer and provide more service, I thought a eulogy to the quiet passing of an institution is in order.
It is less than one generation ago that the West Mississauga landscape was dotted with vast stretches of prime farmland between the numerous small hamlets that now form a city. The vision of a small group of determined individuals created the Credit Valley Hospital, and it was staffed by a contingent of Family Doctors supported by a group of dedicated Specialists.
In those days, the emergency department was run by local doctors with practices. The same doctor who admitted you, looked after you and often provided care after you left the hospital.
Family Doctors performed almost half of all deliveries, assisted at major surgery and performed minor out-patient procedures. The emergency department was always overrun with patients.
In response to this pressure in 1990, a group of family doctors created an alternative called the Credit Valley After Hours Clinic. It ran seven days a week, and could divert up to a 1000 urgent patient visits every week from other sources.
There were no government budgets or payments to help establish the clinic. The family doctors dipped into their own savings and built a place for patients to go. They took time away from their own practices and hospital duties to ensure quality urgent care was available.
As time went on, their hospital roles were "redefined", their hair grew grayer, stress of long hours took its toll. By 2007 their ranks were decimated with retirements, new horizons and almost 40% eased away from urgent clinic work.
By 2010, the situation was critical. Less than 10 of the 56 who once worked there remained. The large medical building across from the hospital where it was located, saw a similar loss of several dozen family practices.
Pleas went out to the local hospital, local health integration network, even to the Health Ministry to warn of how one small clinic closing may further impact the emergency gridlock. Luke warm interest but no solutions.
Alas, the last sick child was seen in December of 2011, just in time to see the hospital smothered into a mega-merger. The few rag-tag surviving docs gathered not to discuss medical issues, but to deal with the mortgages and bills, as car after car drove by staring at the "Closed" sign in disbelief.
Now I stare in disbelief at a summary of the recently released Drummond report that suggests they would like to re-invent the wheel, and "Wouldn't it be nice if primary care doctors worked more overtime to see more urgent cases on top of their day load?" Where have they been?
● Drummond Report: New roadmap for Ontario includes higher hydro bills, larger school classes from Toronto Star.
● Primary care in Ontario, Canada: New proposals after 15 years of reform by Gregory P. Marchildon and Brian Hutchison, Health Policy, Volume 120, Issue 7, July 2016, Pages 732-738.
● Family Medicine in Canada: Vision for the Future from the College of Family Physicians of Canada (CFPC), Nov. 2004.
● Progress of Ontario's Family Health Team Model: A Patient-Centered Medical Home by Walter W. Rosser, MD, Jack M. Colwill, MD, Jan Kasperski, RN, MHSc, and Lynn Wilson, MD, Annals of Family Medicine, 2011 Mar; 9(2): 165–171. "Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices."