A New Strategy on the Doctor Shortage: Super Clinics
Abstract: An op-ed published in the Whig Standard on May 27, 2024
Read the original article in the Whig-Standard
There is clearly a crisis in family medicine. Last year there were about 32,000 people without a family doctor. In two short years that number is projected to grow to 53,000. Twenty-one thousand people who had a family doctor last year will not have one by 2026. Despite the City's best recruitment efforts, we are still going backwards.
Some have suggested that we just keep throwing more money at the problem. Unfortunately, as the mayor has correctly said, this is unsustainable because the City can't afford to make doctor recruitment a regular budget line item. We need a new strategy; a more sustainable and effective strategy. Council needs to be adaptable when new information or new opportunities present themselves.
The time is now to set up the groundwork for a new strategy because the crisis is being recognized by more and more players. Last year the federal government committed more new dollars to primary care. Also last year the province committed to the right care in the right place, faster care, and hiring more healthcare workers, pledging to add hundreds of new family physicians and nurse practitioners, as well as thousands of nurses and personal support workers to fill staffing shortages. Also last year Queen's University, thanks to Dr. Jane Philpott, set up a special campus and "a special selection process … to identify applicants who are authentically committed to becoming family doctors. That's never been done before in Canada". In other words, more doctors are coming. Kingston must not miss out on what these opportunities can bring to residents. We need to work in synergy with what others are doing to alleviate the family medicine crisis. We must proactively prepare to receive the new medical graduates and any new funds that upper governments make available while also trying new ways of facilitating healthcare. We can do this together when Queen's University and all three levels of government work together pulling in the same direction.
The City has a part to play. And play our card we must. If we convert the whole building at 309 Queen Mary Rd. into a family medicine center, leverage economies of scale with many family medicine health teams, with both doctor led and nurse practitioner led clinics, with ancillary and allied health professionals, we could roster tens of thousands of residents without access to family medicine. If this new super clinic model works well, we could duplicate it to keep up with Kingston's population growth over the next 25 years. But first we must try.
So, what must Kingston do? First, we identified a factor in the healthcare professional shortage. We have consulted with family doctors and know that debt and business uncertainty, high overhead and administration cost, and the difficulty of achieving a good work-life balance are detrimental factors that make family medicine less desirable to enter.
The City of Kingston, as the landlord and administrator of 309 Queen Mary Road, can alleviate these negative factors by offering safe, long-term, at-cost lease options to family medicine practitioners that want to practice here. These clinics would still bill the province (as healthcare is a provincially funded service) but the City could reduce their business costs, lower their opportunity costs, and their business uncertainty. For example, today family doctors must do themselves or hire someone to do the administration and overhead work. If the City would help organize and pool medical administration within the City's existing administrative departments then economies of scale and scope could be achieved. We would pass on these financial and time savings. These healthcare practitioners would then be free to focus on healthcare with more patients.
In the short term, family doctors remain scarce. While we wait for the new healthcare students to be educated and trained, new healthcare delivery models can be tested. For example, existing family medicine doctors who may want to expand their services but who find their costs too burdensome should be invited to expand at 309 Queen Mary Road. The incentive we provide would be far lower or no administrative costs. A nurse practitioner led clinic could offer tens of thousands of residents care for the most common ailments. Work at these clinics would take some of the strain off urgent care. Lower wait times at the emergency room and at walk-in clinics is a big benefit. As is getting more care for more people. Family medicine is the entry point to specialized care. This means more people who might have life threatening conditions may be diagnosed sooner (before reaching the ICU) thus giving them a better chance to survive. Access to good healthcare is literally a social determinant of health. Better health outcomes for the larger population also means less need for downstream solutions like transitional housing.
The point of this business plan and the City's role is twofold. First, to make family medicine attractive again and second to provide more people with access to healthcare. The City can do this by doing what we do best: managing buildings and administration. Two things that steal a lot of time, money, and energy from medical professionals and therefore also take away from providing healthcare – if the City were to do these tasks it would free up time, mental and physical energy for healthcare professionals to follow their vocation with less financial stress, with less business uncertainty, with a better work-life balance, with less burnout, and most importantly with more patient care.
This is the most sustainable and most effective opportunity available to get un-rostered patients access to family medicine. 309 Queen Mary is zoned for medical use, it is in the geographic center of Kingston and is on an express bus route. Very few other buildings match its accessibility and its central location. The need for equitable access to healthcare is very high and rising.
If this plan appeals to you, please let me and your council representative know. It won't happen without broad public and political support. Please tell your City Councillor how you feel so we can do what is best and what the community wants. I hope you will say: let's try to get healthcare access for as many people as we can. Let's try solving the family medicine crisis with several new family medicine clinics with several new models for healthcare at 309 Queen Mary Road.