Ontario’s Family Physicians in the Spotlight
We’re speaking to family physicians across the province to understand what they love about their practice, the challenges they are facing, and the impact they are having on their patients and communities. If you would like to participate, contact firstname.lastname@example.org.
Family Physicians shaping change in primary care
Showing biography of Dr. Joan Chan .
The start of a new year often sets the stage for what’s possible in the year to come. For Dr. Joan Chan, a family doctor in Guelph, there is immense joy that stems from providing care to her patients. From forming human-to-human connections, bearing witness to their stories and experiences, and being a source of compassion, empathy and validation for patients. Prioritizing what brings her joy and finding ways to delegate or decline other parts of the job (e.g., paperwork and tasks downloaded by specialists) keeps family medicine joyful and sustainable for her.
Dr. Chan is certain that in order for family physicians to provide the best care for their patients, they themselves need to be well. To do this, she believes that focusing on how we treat ourselves and each other and recognizing that we are all humans, with limits, is key.
“Give yourself permission not to take everything on and remember that you are not solely responsible for the health of your patients.”
For many reasons, the job of family physicians across the province has become more difficult, especially as the healthcare system is dealing with gaps and more work is being downloaded on family doctors who regularly have to increase their scope of practice to meet the needs of their patients.
Dr. Chan encourages physicians to focus on the parts of the role that matters most to them.
“It can be scary, but when you start to realize that the expectations set upon family doctors is too high and instead ask yourself, ‘what does family medicine mean to me and how do I want to practice it?’, it can be so liberating.”
Showing biography of Dr. Warren Lewin .
Throughout a physicians’ medical training and residency, communication skills training to learn how to discuss what matters most with patients and families who are facing serious and life-threatening illnesses is minimal. Dr. Warren Lewin, a family physician with a focused practice in palliative care at Toronto Western Hospital is looking to change that.
“These are not palliative skills, they are core communication skills to support everyday conversations that all clinicians need to have to help them to deliver high-quality care.”
Through the creation of The Conversation Lab, Dr. Lewin is helping to ensure that all clinicians, regardless of their speciality are prepared to have these critical conversations with their patients and their families.
The Conversation Lab is a multipronged education initiative at University Health Network (UHN) that includes in-person and virtual half-day workshops, one-to-one bedside coaching sessions and practical conversation guides adapted alongside patient partners that provide clinicians with strategies and structure for leading these important conversations. The tools provide a framework for health care professionals to confidently discuss a new diagnosis, progression of disease, patient and family values, uncertain prognoses and respond with empathy to build trust between the patients, caregivers, families and their health-care team.
Currently, more than 450 clinicians, including family doctors, neurosurgeons, critical care physicians, nurses and allied-health professionals have been trained through this program by educators affiliated with the Temerty Faculty of Medicine at the University of Toronto and frontline health care workers at UHN. In addition, over 600 people have accessed the online modules or program tools.
In terms of what is next for The Conversation Lab, Dr. Lewin’s aspiration is that every clinician that is onboarded at UHN will be trained through this initiative and will develop these critical skills.
“Our goal is to have every single person in our hospital network trained in some capacity. Although we know that the hands-on workshops often work best to consolidate learning, the online modules that clinicians can access anytime, teach the most important skills that we want all our clinicians to have, and is a great place to start to build foundational skill.”
Dr. Lewin’s vital work was recently recognized through the OCFP’s annual awards program. He was one of five family doctors awarded the 2023 Award of Excellence by the Ontario College of Family Physicians.
Showing biography of Dr. Ali Damji .
“Here sitting in front of me was a patient who needed an advocate. He needed a person in the health-care system to ensure that they got the care that they needed, and the piece that was missing was the family physician.”
As a resident, Dr. Ali Damji was exposed to the to the dire consequences that can occur when people do not have access to primary care. During a rotation of a subspecialty of general surgery, he met a patient with late-stage lung cancer who did not have a family doctor. Rather, he had to rely on episodic care.
It was the moment that led to his decision to pursue family medicine.
Dr. Damji is also a champion for his colleagues across the province as he appeals for changes that would help family physicians stay in their practice.
One thing Dr. Damji is particularly driven to change is the forms that family doctors must complete for their patients’ employers and insurance companies. Currently, the time physicians take to fill in these forms is not covered by OHIP, and it is the patient’s responsibility to pay for this service. What often results is an uncomfortable interaction between the patient when the doctor is left to rationalize the fees. Instead, Dr. Damji is calling for regulations that would require insurance companies to bear these costs and create more streamlined and standardized forms.
While discussing the value of family medicine, Dr. Damji notes, “The nature of our work is quiet and behind the scenes. Prevention is valuable, but not as visible as other specialties. The care we provide takes time but has a significant impact on our patients’ lives.”
Showing biography of Dr. Jonathan Fitzsimon .
Across Ontario, there are more than 2.2 million people without a family doctor. In Renfrew County, an area west of Ottawa with semi-urban, rural and remote areas where Dr. Jonathan Fitzsimon practices has a high number of residents who are unattached to a family doctor.
“The options for the thousands of people without a family doctor or without access to their family doctor was to either go to the emergency department or go without care.”
The substantial number of residents without access to a family physician coupled with the lack of walk-in and urgent care centres in the county has caused a historic overreliance on their emergency departments. This is something that Dr. Fitzsimon has seen firsthand.
Born out of the need to further safeguard the emergency rooms during the early days of the COVID-19 pandemic, Dr. Fitzsimon helped to plan and create a hybrid form of care known as the Virtual Triage Assessment Centre (VTAC).
VTAC is team-based form of care where residents of Renfrew County can set up an appointment with a family physician who works remotely. Most encounters are dealt with using virtual care, but if an in-person assessment is required, a paramedic can see the patient in a nearby clinical assessment centre or for vulnerable housebound patients, in their own home. Integrated Virtual Care (IVC), grew out of VTAC and goes a step further. Patients are permanently attached to a named family doctor who works predominantly remotely but is also part of a local physician group supported by a family health team.
Through IVC, almost 3,000 patients in Renfrew County are now enrolled with a family doctor and have comprehensive team-based care ̶̶ many for the first time ever.
Although innovative, Dr. Fitzsimon sees VTAC as both a safety net for unattached patients and a bridge to long-term solutions to the crisis. “As we recruit more doctors and our rural residency program grows…we will be able to match all unattached patients to a local family doctor and the need for VTAC will diminish,” he says. “Unfortunately, even though IVC has been a huge leap forward, we are still a long way from that end point and so VTAC will continue to play a crucial role in our healthcare system for the foreseeable future.”
Showing biography of Dr. Dawn Yew .
Dr. Dawn Yew is a family physician who provides home-based palliative care in Kitchener-Waterloo.
“My role is to treat anything reversible that is aligned with the patient’s goals, help individuals enjoy their lives and give them time before they pass away.”
Often misunderstood, Dr. Yew explains that the care she provides focuses on delivering compassion for patients with a life-limiting illness as they near their final days.
While the passion she has for her work is evident, Dr. Yew shares that a challenging aspect of providing this specialized care is determining if the patient’s expectations are the right fit. “It’s always a best guess of who needs palliative care,” says Dr. Yew. While a patient may receive palliative care in a hospital, hospice, long-term care facility or in their home, a referral and consultation is encouraged when a patient has a prognosis of less than one year.
While simultaneously providing care to their patients, another important consideration is for families and caregivers. Not only do they help inform decisions, but the patients’ caregivers receive counsel and support from the care team while navigating their own feelings of loss and grief.
“Our goal is to provide holistic care,” says Dr. Yew. “We are a multidisciplinary team, which includes nurses, care coordinators, social workers and occupational therapists, who work to manage patients’ symptoms, provide physical care and support to the patients and their families during a difficult time.” This is just one example that highlights how all patients could benefit from receiving team-based care.
For Dr. Yew, the importance of this work is centered on time— the time that allows her to care for her patients and make them comfortable, and the quality time her patients share with their loved ones.
Showing biography of Dr. Emily Chen .
As a third-year family medicine resident, Dr. Emily Chen is already thinking about her future and how she can support primary care physicians in their daily practice.
At the beginning of her residency, Dr. Chen’s mentors modelled the unique value family physicians provide their patients, including treating the whole person, providing lifelong care and building relationships. It was during this time that she realized that this was the type of doctor she aspired to be.
“Being able to grow that physician-patient relationship is so special. It’s so rewarding to see how that relationship presents itself and grows over time.”
Throughout her clinical rotations she also was witness to the amount of administrative duties family doctors are responsible for, and the significant time tasks such as sending referrals, writing sick notes and reviewing lab results takes away from time intended for developing her practical skills and learning from her mentors.
“I was surprised by how the administrative tasks impede our ability to learn at a stage where we should be sponges and learning about approaches to care and keeping up with clinical guidelines.”
To help alleviate some of the burden placed on primary care providers, Dr. Chen, and a group of three medical learners co-founded Hippo AI. Powered by generative artificial intelligence and large language models, Hippo AI is a decision-support tool, which within seconds provides doctors with concise clinical guidance from up-to-date Canadian care standards and reputable international organizations.
Dr. Chen is hoping that this tool will help improve physician’s productivity, so that that they can spend more time providing care and continue to build relationships with their patients.
Showing biography of Dr. Arieg Badawi .
Ensuring all Ontarians have access to a family doctor is an essential part of health equity. However, across the province there are over 2.2 million people who lack access to primary care. Even more concerning, in some areas of Ontario the most vulnerable, including low-income families, residents of marginalized communities and those with mental health issues are disproportionately without a family physician.
Dr. Arieg Badawi is a passionate family doctor in Milton who believes that the future of healthcare lies in integrated team-based care, which will bridge the gap between patients and the primary care they desperately need.
“If we take someone who has schizophrenia, they come to my clinic, and I see them for 20 minutes, maybe half an hour. The rest of that [care] happens in the community,” says Dr. Badawi of the lack of basic mental health support available to her patients.
By assembling diverse healthcare professionals, including social workers, dietitians and nurse practitioners into a multidisciplinary team, family doctors will have additional time to see patients who need their care. “At the end of the day, it takes a village to raise a child and it is the same for a patient.”
“I’m hoping that the system changes and that we have more family doctors, because every patient deserves one.”
Overall, Dr. Badawi’s plea for reform is to ensure that all Ontarians have equal access to care from a dedicated healthcare provider.
Showing biography of Dr. Nicole Nitti .
Throughout her career as a family and emergency physician, Dr. Nicole Nitti has seen first-hand many significant changes in primary care. One of the most notable has been the increase in the scope of care that family doctors have assumed responsibility for, even though they are working well beyond their capacity.
“Certainly, I was expecting baby care, prenatal, episodic care, and even chronic disease management, but now the complexity of care I provide includes assessing for attention deficit disorder in adults and transitioning transgender patients. Because of the lack of specialized care in these areas, it comes to me,” says Dr. Nitti.
“As a family physician, I’ve had to broaden my knowledge and skill set to meet that need.”
Without family doctors like Dr. Nitti stepping in and expanding their scope of practice to provide this vital care, it would leave patients without the support they need.
Over the years, there have been process improvements that have been implemented to enhance physicians’ workflow, including electronic medical records (EMRs), and expanding duties for pharmacists. Although Dr. Nitti notes that paperwork and administrative work will always be part of her job, much of the added burden stems from authorizing limited use codes, following up on referral requests and navigating the complex challenges of the EMRs.
“EMRs have contributed to quality of care, but we really need to look at how we can allow family physicians to offload work through them.”
Since the beginning of her career, what has remained the same for Dr. Nitti is the sense of joy that comes from caring for her patients and the privilege of watching her patients recover.
“Patients come in looking for help and it’s not necessarily a quick fix, but overtime when you see someone recover, it feels so good.”