The Ontario Medical Association released a comprehensive report today recommending creation of publicly funded Integrated Ambulatory Centres. These free-standing centres would work with local hospitals to provide OHIP-insured medical services, including surgeries and procedures, on an outpatient basis.

This would free up hospital beds and operating rooms, allowing them to focus on more complex, acute and emergency patients and procedures and reduce wait times.

“Ambulatory centres in other jurisdictions have shown to deliver a more satisfying patient experience,” said OMA President Dr. Adam Kassam. “In addition to shorter wait times, patients spend less time in ambulatory facilities than they do in hospitals and can safely return home the same day. This is combined with an improved physician and provider experience, while being able to realize efficiencies in both acute and community care.”

Wait times were an issue in Ontario before the COVID-19 pandemic put the spotlight on the cracks in the health-care system, with waits for many procedures longer than recommended.

A new analysis released by the OMA today found that on top of those existing problems, the pandemic has created a backlog of more than 21 million patient services that will take months and in some cases years to clear. This includes a backlog of more than 1 million surgeries as of the end of 2021, but also preventative care, cancer screenings such as mammograms and colonoscopies and diagnostic tests such as MRIs and CT scans.

The numbers will grow when we learn how many surgeries and procedures were cancelled during the pause on non-emergency procedures due to the Omicron variant and when the unknown number of “missing patients” who did not engage with the health-care system during the pandemic are included.

Dr. Kassam said the health-care system must now clear the backlog while implementing the new Integrated Ambulatory Centre model, which could take five to eight years.

With the growing sophistication of surgical tools and techniques and new pain management and anesthesia options, many less-complex surgeries and procedures could be moved from hospitals to Integrated Ambulatory Centres. Examples include cataract surgeries, hernia repairs, hysterectomies, hip and knee surgeries, endoscopies, ear, nose and throat surgeries and breast reconstruction after breast cancer.

The OMA proposal fully complies with the Canada Health Act and there would be no user fees or queue jumping. The centres would be fully integrated within the publicly funded, publicly administered health system.

Experience in other provinces and countries, as well as the Kensington Eye Institute in Ontario, shows that ambulatory centres can work under this model. They also have faster recovery times, lower infection rates and efficiency gains ranging from 20 to 30 per cent compared with inpatient hospital care.

Ontario’s doctors believe this new model of care, the most significant change in ambulatory care in 30 years, would have widespread public support.

A recent Ipsos survey conducted for the OMA found that Ontarians want the government to prioritize clearing the backlog of health-care services built up during the pandemic, even if it means a short-term impact on economic recovery. In that same poll, 96 per cent of respondents said they supported the five pillars of the OMA roadmap to improve the health-care system over the next four years, Prescription for Ontario: Doctors’ 5-Point Plan for Better Health Care. The first of the five pillars is reducing backlog and wait times.

“Wait times for surgical procedures are a major problem for patients in Ontario,” said OMA CEO Allan O’Dette. “Ambulatory centres provide an opportunity for government to help reduce them and get patients the high-quality care that they need sooner.”

SOURCE Ontario Medical Association

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Just over one-third (34.6 per cent) reported either persistent symptoms of burnout or feeling completely burned out in 2021, up from 29 per cent in 2020.

A sweeping new report released by the OMA today found many causes of burnout. Topping the list were technology and the fact that many physicians spend more time completing required documentation than caring for patients.

“Burnout and its symptoms have impacted so many physicians, which unfortunately has been exacerbated by COVID-19,” said OMA President Dr. Adam Kassam. “Tackling this epidemic is one of the most urgent needs facing the profession. The system-level changes that are needed require bold action by our health-system partners. I am proud of the work done by the OMA and the Burnout Task Force, which continues to demonstrate leadership and provide solutions to support our colleagues.”

The OMA created a Burnout Task Force in 2019 to drive system-level changes and provide support to members. Even before the pandemic, nearly one-third of physicians in Canada were reporting high levels of burnout. Many other health-care workers are also experiencing burnout, especially nurses.

The pandemic has reinforced the need to find solutions, not just for the well-being of health-care workers but also to ensure there are sufficient health-care resources in place to address the deficit of care caused by the pandemic.

The OMA report includes five solutions to address burnout, starting with reducing and streamlining documentation. Studies have shown that physicians spend two hours on electronic documentation for every one hour of direct patient interaction. Primary care physicians spend about six hours a day recording patient information electronically, both during and after clinic hours.

The other top solutions are:

• More work-life balance through flexible work arrangements
• Making digital health tools a seamless part of physicians’ workflow, including by ensuring different systems can speak to each other
• Support for physician wellness at their workplaces
• Fair and equitable compensation for all work, including administrative work that cannot be reduced

Physician burnout has been associated with increased depression, substance use and even suicidal thoughts. It could also reduce productivity, increase turnover and possibly decrease patient access to care.

Despite being burned out and at risk of contracting COVID-19 and transmitting it to their loved ones, Ontario’s doctors have provided the best possible care to their patients throughout the pandemic.

The OMA surveyed its members twice: once just as the COVID-19 pandemic was hitting North America in March 2020, and again in March 2021.

“Physician burnout is a system-level problem that has been worsened by the global pandemic,” said OMA CEO Allan O’Dette. “It needs to be addressed both for physician well-being and to ensure the health-care system can address the pandemic backlog of medical procedures. The OMA plan, in development since 2019, has actionable solutions to help solve this problem.”

It’s time to change Ontario’s health care for the better as the post-pandemic recovery begins. Complete their survey at betterhealthcare.ca and help shape the future of health care.

SOURCE Ontario Medical Association

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The survey, at Betterhealthcare.ca, will be used by the OMA to create recommendations to improve health-care services locally and across Ontario as the province emerges from the pandemic.  The recommendations will address immediate health-care priorities as well as long-term care, the backlog of health-care services built up during the pandemic, access to mental health and other issues that have not had the attention the past 15 months or so has shown they deserved.

“This is a huge province and health-care priorities here can be very different from those in other regions like Toronto,” said Dr. Sohal Goyal, chair of the local OMA district. “As we create a plan for the future of health care in Ontario, from the grassroots up, we are asking everyone across the province to provide their input to ensure local health care needs are considered.”

Doctors in every region of the province have been meeting to discuss what changes are needed to address the issues they experience first-hand every day, working on the front lines side-by-side with nurses and other health-care providers to save lives during the pandemic, and what issues need to be addressed as we emerge from it.

More than 8,400 Ontarians have died during the pandemic, including more than 3,900 seniors in long-term care. We have built up a pandemic deficit of more than 15.9 million missed patient services, roughly one for every Ontarian. The government’s own Financial Accountability Office says it will cost $1.3 billion and take 3-1/2 years to clear the backlog of surgeries and diagnostic procedures.

“It starts with hearing from our patients, their families, friends and neighbours about their health-care priorities. Doctors are listening,” Dr. Goyal said. “It’s time to fix the cracks in the health-care system that COVID-19 has exposed here in Muskoka, the surrounding area and across the province.  By completing the survey, we will help identify the first steps that need to be taken as the health-care system refocuses its efforts beyond the pandemic.”

For the next few months, the OMA will be consulting with the public, members, health-care stakeholders, community leaders, elected officials and government parties to inform its health-care recommendations.

For more information and to complete the survey go to: Betterhealthcare.ca

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