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A couple of years ago, I attended a meeting run by a few people from OHIP (Ontario Health Insurance Plan). Burnout and physicians leaving practice was a problem. The increasing hours of behind the scenes work was a major culprit. It outlined one of the new methods of practicing medicine that would allow outreach to orphaned patients. It is called a Family Health Organization (FHO). There are a lot of these terms bantered about worth finding a little something out about. I am the first one to suggest that these terms confuse almost everybody. This is partly because I am just coming out of a FHG (Family Health Group), something that just took the better part of 5 years for me to understand.
As of the new year, Dr. Remtulla and I are transforming ourselves into FHO Docs. We join forces with a large group of other doctors around town. The capes, tights and masks are on back order. I am attracted into this new model because it dangles the ability to spend more time dealing with sicker patients, and perhaps extend services to some of the hundreds on waiting lists looking for doctors. It allows for time to seek out and book the best tests and look for availability within the system. It boasts of other benefits such as electronic medical records. I imagine that very soon, an abnormal result or testing done elsewhere may be beamed to my belt gadget even quicker than news of Tiger's latest mulligan. The ability to respond to telephone inquiries and incorporate the help of new personnel may streamline prescription renewals and referrals. The least attractive feature is the extensive contracts and paperwork that need consideration since we are in it for at least three years.
Patients are also given responsibility in an FHO. One of the biggest problems that we will be tackling in the New Year is to figure out just who exactly is registered in our practices. Many doctors face this dilemma, and just how you define the term "patient" is elusive. In this case, it will be defined by those wishing to continue receiving most of their medical care from their primary care physician and staff, aided in off hours and holidays by other FHO physicians in the group. Most regular patients will notice almost nothing different. We will be able to compile a list of regular patients by using the registration forms that were signed over the last 7 years, and data summaries that will report visits to specialists, other doctors and clinics. Truly orphaned patients, those receiving virtually no care, will be more easily identified and targeted for care, as will those who double-doctor. FHO physicians are paid by a complex formula resembling a salary. They are expected to promote and encourage health prevention, update and refine their knowledge base, and in our case, teach medical students and residents. This will be complemented by health care assistants, allowing scheduling flexibility for evenings, weekends and even walk-in hours.
We and our staff approach this new model with some glad tidings and trepidations. After all, we have spent twenty years in a system offering new and exciting things, only to be repeatedly disappointed. We try this because it carries no risk for the majority of our patients. The docs are taking a chance to make a difference. I encourage everyone to call in the next month and double check that you are truly part of this new way of health. Have a safe New Year!
Related resources:
● FHO. What is FHO? ... It is an initiative of the Ontario Medical Association and the Ontario Ministry of Health and Long Term Care. Your doctor's Family Health Organization (FHO) is a group of family physicians who are working together to give you and your family better access to quality primary services. The care your physician delivers includes making referrals to specialists and being involved with, or informed about, your care in hospital ... For you, registering in a Family Health Organization means that you will have access to primary care treatment or telephone health advice 24 hours a day, 7 days a week."
● Guide to Physician Compensation. Updated September 2009, Version 3.0, from Ontario Ministry of Health and Long Term Care.
● Letter of the week by Dr. David Rosen, Mississauga. "Dr. Peter Kujtan talks about the advantages of the Family Health Organization (FHO). Primary care is undergoing revisions. Do these changes address the determinants of the health of populations - education, poverty, socio-economic status? I'm not convinced."