TORONTO - Ontario's push to have family doctors work in collaborative teams with other health professionals is paying off financially for the physicians and is resulting in better patient care, according to the New England Journal of Medicine.
An article in the latest edition of the esteemed publication offers a glowing review of Ontario's move to create so-called family health teams, multi-disciplinary groups that provide more patient-centred care than the usual fee-for-service model.
The average net income for Ontario family doctors who joined the teams increased about 40 per cent, from $180,000 in 2004 to $250,000 last year, "but it has not risen substantially in the fee-for-service sector," said the authors.
The province has more than 700 doctors working in about 150 family health teams, which are paid financial incentives for providing comprehensive care seven days a week to about one million patients. The family health teams are also paid bonuses for various services such as visiting homes and nursing homes, and are paid to take on new patients, receiving more for higher risk patients including infants and people over age 75.
Doctors sign a contract with the Ministry of Health and agree to a remuneration package in exchange for providing agreed services, but about 40 per cent of their incomes comes for other fees and bonuses.
"Since income is not based primarily on physician visits, practices can explore broader roles for team members and may use telephone, e-mail and group visits to enhance efficiency," said the authors.
"The total number of visits per patient has not declined, but more visits appear to be occurring with team members other than the primary physician."
The Ontario Medical Association said there are about 7,500 doctors working in other collaborative care models besides the family health teams, providing service to about 8.5 million residents.
The Ministry of Health said its 2004 and 2008 agreements with the OMA included a variety of incentives and premiums for specific services and expanded hours of care.
"Joining a family health team does not, in itself, result in an increase in funding levels to the physicians involved," said ministry spokesman Greg Dennis.
"But there is a potential that they could get paid more based on the ability of the physician to increase their roster size in an inter-disciplinary, team-based setting."
The change to a team approach with other doctors, nurses, nurse practitioners and other health providers has also helped attract more new physicians to family medicine, according to the OMA and the article in the New England Journal of Medicine.
The number of new doctors in Ontario that decided to specialize in family medicine jumped from 25 per cent in 2004 to 39 per cent last year, while it increased from 24 per cent to only 29 per cent in other provinces during that same time.
Large studies on the success of the family health team approach are still being conducted, but early results are promising, and show the team practices are more efficient, provide more preventive services and better care management for chronically ill patients.
The New England Journal of Medicine said for many primary care physicians in the United States, Ontario's model of family health teams "represents the type of practice they always hoped to have."
The authors of the article, a nurse and three doctors, said the fee-for-service model rewards high volume practices rather than broad, patient-centerd care, which leads to improvements in health for patients and reduced costs of care for everyone.
"Although many physicians were initially skeptical about its potential for success, as-yet-unpublished studies document high levels of patient and physician satisfaction," said the report.
"The use of interdisciplinary teams expands the range of services provided and reduces overload for individual physicians."
