No family doctor means tough times for emergency rooms


A new study suggests that chronic illness patients who don’t have a family doctor may be putting an unnecessary strain on the province’s emergency rooms.

The study, released Wednesday by the Institute for Clinical Evaluative Sciences (ICES) in conjunction with the Ontario Medical Association (OMA), says that more than 118,000 emergency room visits and more than 17,000 hospital admissions could have been avoided in the past year if patients with chronic diseases such as heart disease, asthma and diabetes had a family doctor.

OMA President Dr. Ken Arnold said he expected the numbers to be high, but was still not prepared for these kinds of results.

“It”s a little more than we expected,” he said. “We did the study because we expected to find problems, but perhaps not quite to that extent.”

Arnold credits the province’s shortage of family physicians as part of the cause for ER backlogs, saying the situation is even worse for chronic illness patients than it is for the general public.

“Five to 10 per cent of patients in Ontario don’t have a doctor, but that number goes up to 15 per cent for patients with chronic diseases,” he said.

“So we’ve got the sickest patients in the province as the ones who are less likely to have that continuity of care, and that’s really worrying.”

Even more distressing is the possibility that the study’s chosen parameters have actually skewed the data to paint a rosier picture than what is most likely the reality.

According to Arnold, chronic disease patients could need as many as four to six doctor’s visits a year, as opposed to someone who is healthy and may only go to the doctor once every two years. However, the parameters of this study only included patients in need of three or fewer visits over a two-year period, a fact Arnold said should be taken into account.

“There are lots more people out there who aren’t getting their four or six visits a year who really weren’t included in this study,” he said.

“The figures are fairly conservative and I’m concerned that the situation might be significantly worse.”

Here at the Cornwall Community Hospital, CEO Jeanette Despatie said officials have already identified the shortage of family doctors for chronic illness patients as an issue, and have taken steps to help steer patient flow away from the emergency room.

“Over the past two to three years we’ve implemented what is known as a Hospital Avoidance Program for patients with chronic heart failure and chronic respiratory problems,” said Despatie.

“We have clinics staffed by a nurse practitioner and a respiratory technician, and they will take referrals both from doctors and the emergency room.”

Despatie added that though the clinic was originally set up as a way for both the hospital and patients to better manage chronic illnesses, it has evolved into a place where those without a family doctor can get the care they need without having to waste time and hospital resources in the ER.

“With chronic illnesses, half the battle is education,” she said.

“In the clinics we have specialists who are a bit more familiar with these patients and their histories than an emergency room doctor would be. They also have more knowledge about these kinds of illnesses so that they can work with the patient to better manage their chronic problems, and limit the amount of time they have to spend in a hospital.”

Dr. Wayne Domanko is a physician with the St. Lawrence medical clinic in Ingleside, and though he agrees that programs like the one at CCH are a great way to manage the problem right now, he insists the real solution is more doctors. “We have a doctor shortage in Ontario,

this is not something new,” he said. “But at the risk of sounding overly optimistic, I think we’re actually making progress on that front.”

Domanko, who splits his time between the clinic and the Winchester District Memorial Hospital, said he’s encouraged by relationships like those forged between the Winchester and Cornwall hospitals and the University of Ottawa medical program, saying it gives students a taste of how important family medicine is.

“Winchester is now officially considered a teaching hospital, which I think is phenomenal,” he said. “It’s good for med students to get out of the sterile, ivory tower setting of the medical school, and come into more of a rural setting where they can really get into the community and see the impact of the care they’re providing.”

Domanko also added that increased enrolment in medical schools and placing more emphasis on the benefits of going into family medicine are all hopeful signs that the doctor shortage will be short-lived.

“I would say that as soon as even five years from now we’ll start to see that balance being restored and more doctors coming out of or back into Ontario, and wanting to stay here,” he said.

This week CCH was also commended by the University of Ottawa for becoming a teaching hospital location, allowing third-year medical students the opportunity to complete a four-week core rotation at the hospital.

“We’re very honoured to be part of this program,” said Despatie, who accepted a plaque in commemoration of the partnership.

“It’s well-established that we have a shortage of doctors in this community, and we feel the best way to deal with that is to invite young doctors here so that they can get to know the community, and hopefully find something that keeps them here.”

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