Thread by @waters_eugenie

Hey! I'm a #FamilyPhysician and I personally know at least 10 other mid-career Family MD's in Ottawa who have left comprehensive (cradle-grave) family medicine recently... I have thoughts on this.
#MedTwitter #Health @OntarioCollege #LifeWithoutADoctor
ottawacitizen.com/news/sutcliffe…

First off - it takes years to train a Family MD. There are SO many reasons why we aren't training enough of them. But before you talk recruitment you need retention. My colleagues haven't left Ottawa - they still doctor, they just don't do comprehensive family medicine anymore!

They work in all sorts of specialized areas of medicine / focused-practice like long-term care, in hospitals, in ERs, in palliative care, sexual health, psychotherapy, urgent care, sports med, walk-in clinics - you name it! but not in comprehensive Family Medicine. Why?!!!

Increased funding to Family Medicine & Healthcare are necessary (looking at you @fordnation), but is NOT sufficient to retain or recruit Family MDs. You need to understand some of the big 'Pain Points'. And the city can actually address some of them....

USELESS PAPERWORK - Family Physicians are drowning in paperwork - major source of burnout!!! - so as a city, you can stop making your residents who need essential services jump through hoops (using up valuable medical appointments) and making us fill out forms and write letters.

Exhibit A: have you seen how long a paratranspo application is... the medical part alone is 5 pages!!! nobody pays us for this time! As if i'm going to charge my patient living in #ODSPoverty so they can get essential transportation and actually get to medical care?

Exhibit B: housing problems... multiple times a week I'm writing letters to advocate for better / more appropriate housing for my patients. This time could be better spent! And housing issues hugely impact mental and physical health problems.

Exhibit C: sick notes... @OCtranspo and many other @ottawacity workers need to use up valuable medical appointment slots to get sick notes because their employer doesn't trust them to stay home when they're sick a cold.

FUND SOCIAL SERVICES! When they're not available or underfunded, Family MD's and ER's end up playing the role of back-up social worker and much more, leaving less time and energy to address medical needs.
So many appts could be avoided if people's basic social needs were met!

Family Physicians love EBM (aka Evidence-Based Medicine) - so please make evidence-based policy decisions that make our patients healthier! This includes deeply affordable housing, #HousingFirst, public transport, social services, recreation, libraries, walkable communities, etc

And don't get me started on need to seriously address climate change. It's a health emergency - we need ambitious climate action: A) most climate solutions lead to improved health outcomes now (yay!) and B) every fraction of a degree of warming prevented saves lives! @CAPE_ACME

(ps - this includes a top-notch cycling network and bike share system!)

NOW - about promising a recruitment strategy of some sort. In a small town or small-medium city, a few extra doctors is HUGE and retention programs likely help (FYI Kingston offers 100K over 5 years for full-time Family MDs who commit). Is this what @marksutcliffe has in mind?

If so, I'm not sure he's done the math. Very low estimate is that at least 100,000 Ottawa ppl are without a Family MD, so how much will it cost to recruit ~100 full-time Family MDs - yeah, maybe $10million?!!! uh huh.

That's a lot of money, and it will compete with rural and remote Ontario communities who are far more under-served than Ottawa, where recruiting 2-3 physicians is the difference between keeping the local hospital or any medical services in town.

Ottawa could better spend this type of money to shore up the social determinants of health (full disclosure - I support @cmckenney because I see them doing this throughout their platform). And make a few important city admin changes to reduce Family MD 'Pain Points'.

Oh and - for bonus points - @ottawacity could help get data - where are the comprehensive Family MD's working and where is need the greatest? Ottawa is HUGE. There might be ways the city could support Family MDs starting clinics where they are needed most, closer to home for ppl

Anywho... I think this is a great conversation - but not last-minute campaign pledge material. A strategy for recruitment is vague, the problems are complex. I have a lot more faith that @cmckenney's plan will make my job less stressful and my patient's healthier.
#ImWithThem