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Agatha Farmer Editorial
Muskoka Post recently conducted two polls; One asking if residents have a family doctor in Muskoka and one asking if Huntsville should have a year round walk-in clinic. Thirty one percent of respondents out of 368 votes said they are not rostered with a local family physician.
Many public comments regarding not having a doctor in Muskoka had a re-occuring theme summed up like this answer from Sara McRae "Been waiting too many years for one. Lol I moved up in 2008 and still don't have one up here. So I travel to Toronto to see the one I've had my whole life ... and go to walk-ins if something is urgent." A surprising number of Muskoka's expats have retained family physicians as far as three hours away.
Let's segue to walk-in clinics because this is where our tax dollars and our convoluted health care system make an appearance. When we posted the doctor survey in Muskoka we also included a poll regarding the need for a year round walk-in clinic in Huntsville. Currently the town has a 2 month seasonal clinic when the population increases during the summer months of July and August. Using myself as an example and as a mother who lives in Huntsville all year around and does not have a family physician due to doctor shortages in the region I often drive to a Bracebridge walk-in clinic. You might not think that is much of a drive and you would be correct when you aren't transporting a feverish or pukie kid. As a mother I'm also responsible for ascertaining how serious my child's condition is and generally not grave enough for an ER visit. I was surprised upon moving to Huntsville in 2015 when I was told that with a common ear infection I should take my kid and sit in the hospital ER for hours to be seen. Something about this scenario doesn't sit right with me, neither for the hospital nor for me as an end user. Interestingly, when the Muskoka Post Huntsville walk-in clinic poll was released I immediately received an email from a local Huntsville councillor. He expressed disappointment in bringing up the discussion of a year round walk-in clinic and informed me that if we want to continue funding our hospital we should steer clear of surfacing debates regarding more health care for Muskoka residents. Councillor Tim Withey said that "simply put year round walk-in clinics threaten the existence of our hospital."
So it seems we are at an impasse as our Huntsville walk-in clinic poll indicated that out of 338 votes 96% of respondents are in favour of a year round walk-in clinic.
We asked Withey how it is possible that Bracebridge operates a hospital and two walk-ins. He said that in 2004 the Bracebridge hospital was set to close due to these clinics.
"In Bracebridge there exists an 'every man for himself' mentality which resulted in the opening up of year round walk-in clinics. This drove down the volume of patients which cause the province to announce that the ER in Bracebridge will be closing. This was in 2004. The intervention of “The Rosedale 6” stopped the closing by threatening George Smitherman, then the provincial minister of Health, with his political future, as Rosedale was his riding. The story goes that “The Rosedale 6” were a group of ladies that all owned lake mansions on the lakes surrounding Bracebridge who were not having their local community hospital ER closing. He physically drove the cheque to Bracebridge the next day. Soon after, maximum pressure was brought on both hospital boards to amalgamate. This occurred in 2005," Withey said.
So we asked Bracebridge Mayor Graydon Smith how his town has managed since the bail out of 2004 to maintain a hospital and walk-in clinics. Smith said that he's "not an expert on hospital funding formulas in detail, but there is some volume component to it. Of course, both sites in Muskoka are funded as a single entity."
"At the same time, the often stated goal of the health system (in general) is to get people out of ERs that don’t need to be there and to find them a source of primary care, hence programs such as Health Links and now Ontario Health Teams. I’m not aware that the presence of walk-in clinics in Bracebridge has had any appreciable negative impacts on the hospital. If a rostered patient visits one it may have a negative impact on their existing primary care provider though," he said.
Smith is correct in the assumption that walk-in clinics do in fact have an impact on physicians. Let's dive back into a brief history; Walk-in centres originated in the United States as free standing emergency centres in 1973, bridging the gap between “family physicians and overburdened emergency departments, by providing a non appointment service.” These centres crossed into Canada in 1979. Early literature on Ontario walk-in clinics indicates they were used by patients who considered their symptoms too serious to wait for an appointment with their family doctor but not serious enough for an ER visit.
In the late 90's and early 2000's there was a shortage of family doctors in the province and as a result walk-in clinics assisted in filling in the gaps. It seems that if they had a filled a shortage gap in the past they would do the same in Northern Ontario now where we especially lack physicians. Let's then get back to how an area walk-in might negatively affect a physician. Walk-in doctors are paid by OHIP on a fee-for-service basis, while family practice physicians are paid a flat fee for a "basket" of services a patient is considered likely to need. If a patient who is already rostered with a physician makes a $100 walk-in clinic visit that patient's family physician is charged that same fee for not being able accommodate the appointment for a rostered patient. Yes it's complicated, however, it all relates back to being able to provide a patient with timely appointments. It's been said that this system also creates competition between family practices and walk-in clinics. Though given the amount of Muskokan's without a family doctor and with an overwhelming amount of Huntsville residents in favour of access to a 12 month walk-in clinic perhaps the district and town council could at the very least have a discussion on how best to support such an addition in Northern Muskoka. Huntsville continues to grow, it is in fact the largest in population within the district of Muskoka, so while we offer extra health care to the town's summer visitors, perhaps we could extend this same equal service to full-time residents.
Huntsville mayor Karin Terziano admitted that she's "not sure how or why Bracebridge is positioned to have two year round clinics but my understanding is that walk in clinics are organized and operated by primary care physicians. Huntsville is well served by the continuity and consistency of primary care provided by local physicians and the Nurse Practitioner Led Clinic . The Nurse Practitioner Clinic in Huntsville is an addition that I don’t believe Bracebridge has. I am grateful that there is a team of family physicians and nurse practitioners providing primary care in Huntsville and that recruitment of new providers to Town continues to be an important focus for all."
So while Terziano is correct about the Nurse Practitioner Clinic being in Huntsville and not Bracebridge, this clinic is not a walk-in clinic and is by appointment only for rostered patients. As for the statement of "well served" yes for those who are lucky enough to be rostered with a local primary physician. Unfortunately, from our poll it looks like a great many of us are not being "served" at all. Perhaps the focus on recruitment could use some more zooming in. It seems the correlation between hospital funding and walk-in clinics is a little murky to some of our local politicians, but what is clear is that Northern Ontario is under serviced in the health care department. Any and all initiatives to bring more doctors as well as clinics should be supported. If a system change is required then as elected officials start supporting that in conjunction with your support for more health care. As elected officials working within the system speak out for your constituents who are in need of better access to health care. Push the envelope of change from the local levels as local politicians have the distinct pleasure of having boots on the ground. If you feel the system isn't working for all then your duty as a public official is to strive and advocate to equal out the playing field as oppose to passively sitting back and passing the buck on a health care system few have complete comprehension of. Bring some noise to the issue and start demanding a progressive re-strucutre. If we have learned anything in the last two weeks is that getting your demands heard loud and clear sometimes requires a disturbance in the bureaucratic force. Your local politicians should be advocating for more access to healthcare and if that means advocating for more walk-in clinics to bridge the gap or more physicians or a better funding formula then that's what they should be doing passionately and loudly.
Consider that in 2019 Health Quality Ontario stated that the 800,000 people living in Northern Ontario are more likely to have worse health, poorer access to health care and die earlier than people in other parts of Ontario. The life expectancy of Northern Ontarians is 79 versus the provincial average of 81.5 years. This report also states that people are much less likely to report being able to see a primary care provider like a family doctor or nurse practitioner when they’re sick in Northern Ontario. If you are a resident of Northern Ontario your life expectancy is 1.5 years shorter than that of a GTA resident due to the lack of proper health care. In 2020 ask yourself have and are your local politicians including MP's, MPP's, councillors and mayors doing everything they can to advocate for your healthcare needs in Muskoka?