The Current - Why some cities are hiring doctors — and taking on the paperwork

Episode Date: February 12, 2025

Some Canadian cities are hiring family doctors as municipal employees, taking over the paperwork so the physicians can focus on their patients. Could this novel model help to ease the family doctor shortage across Canada?

Behind every statistic is a person, a family, a story. This year alone, over 30,000 Canadians will hear the words, you have breast cancer. Breast Cancer Canada is driving groundbreaking research across the country, because every discovery brings us closer to understanding, treating, and one day ending breast cancer. You can join the progress. Donate today at breastcancerprogress.ca.

And if you don't think it will make a difference, we have the science to prove it does. This is a CBC podcast. Hello, it's Matt here. Thanks for listening to The Current, wherever you're getting this podcast. Before we get to today's show, wonder if I might ask a favor of you if you could hit the follow button on whatever app you're using. There is a lot of news that's out there these days. We're trying to help you make sense of it all and give you a bit of a break from some of that news too.

So if you already follow the program, thank you. If you have done that, maybe you could leave us a rating or review as well. The whole point of this is to let more listeners find our show and perhaps find some of that information that's so important in these really tricky times. So thanks for all of that. Appreciate it. And on to today's show. Okay, this is going to be the call with Neville Coquen. If you build it, they will come.

They are family doctors. You know, the words I keep on hearing is innovative and you know this is a crazy idea which makes so much sense. That's Doug Kobayashi. He is the mayor of Colwood BC near Victoria and that crazy idea he's talking about is the city's new medical clinic, the first of its kind in Canada and the hope is it will address the community shortage of family doctors. Colwood Medical Clinic will not be run as a private practice,

but by the city itself. The city will hire and pay the doctors and take on the administrative workload, leaving doctors to focus solely on patient care. Dr. Cassandra Stiller-Moldovan found the idea so appealing that she recently relocated her young family from London, Ontario to Colwood to become that clinic's first doctor.

As family physicians, we have two full-time jobs. We have the job of taking care of our patient roster, but also the job of running a small business. So having the two-year-old and my partner here at home, when I come home at the end of the day, I'll put my daughter to bed, we'll have dinner together, but I need to still do all the administrative aspects related of the day, I'll put my daughter to bed, we'll have dinner together, but I need to still do all the administrative aspects related to the day.

Mayor Kobayashi is calling on other municipalities to step up and help address the shortage of family doctors. This is what we should all be doing as municipal leaders. You can't say, well, it's not our problem because that's the provinces. Well, the province doesn't have enough people to even try to implement something like this. Across this country, Orillia Ontario, north of Toronto heard that call. That town is planning to do the same thing now. Hire family doctors and

pay them as municipal employees. Don McKisick is the mayor of Orillia. Mayor McKisick, good morning. Hey, good morning, Matt. Good to be with you and your thousands of listeners. Great to have you here. When you ran for mayor of Orillia in 2022, you went out on the street and you asked people a question. What was the question that you asked them and what did they say to you? The question was, what are your priorities

and what's important to you? And the answer in spades was certainly that finding a family doctor was a number one issue. There was no question about it. How many people in Orillia don't have a family doctor? Well, we've got 34,000 population, about 12,000 don'ts. 12,000 people, so almost, that's a lot. It's a third.

And you know, a woman said, Hey, I moved from another town, I put my kids in school. That's easy, but I can't get a family doctor. How come? And I didn't have an answer. What is the impact of that many people without having access to primary care on, on the healthcare system in Aurelia and in, in, in the

area around Aurelia as well? Well, it overburdens the system because people don't have a doctor. They go to the emergency ward, that's their doctor and that's just not acceptable. And so are you seeing those emergency departments overrun? They are. I'm director of the Solis Memorial Hospital as well. I'm not speaking for the hospital, but they dive in catches all the time. I mean, it's overburdened.

There is, I mean, this is a familiar story across the country and there is somebody in, in your region, a physician recruiter whose job it is to attract doctors to the community. And we've heard stories of, you know, the, the, the incentives that are offered, people, you know, offering bonuses, people offering childcare, everything in between. Why has it been so hard to get doctors to come to a beautiful community like Aurelia? Well, there's a limited supply. Doctors get out of school, they have significant debt.

I mean, doctors go to school, they know how to fix a broken leg and they can give you stitches if you need them, but that administruvia, that back office stuff is foreign to them and detracts from their real role as serving patients. So we're trying to alleviate that as best we can. How is this going to work? Tell me how this new hiring plan

for family doctors in Orillia will work. So our plan is we've identified a space that will handle six to eight doctors. We plan to hire six to eight. If they each take 1,500 patients, that will alleviate the problem in Arillia of the 12,000. So that'll add to the supply. We think it's an attraction to a doctor because we can offer pension, we can offer holidays, vacation. We can offer them an office

to work in and equipment, and they don't have to make that investment. Arillia is willing to make that investment and we will have a payback within the first couple of years. And so Arillia will hire the doctors directly? That's part of the plan is we're currently looking at, this is exploratory, but we're looking at hiring the doctors directly. Another option would be to provide the space and hire, you know, the doctors would pay for the space, but the initial plan is to hire them directly. And so in doing this, it's not just hiring them, but you are going to look at taking some of that administrative burden off of the doctor's table?

That's correct. We're willing to put skin in the game. We will set up the back office. We will set up the systems that they can do the billing on, that will provide the equipment, will provide the space, will provide the nurse practitioners, the receptionists, all that sort of stuff will be provided. And the doctors can focus on patient care? Yeah, what they do best. Is this going to cost the taxpayer in Orillia anymore, for the city to be able to pick this up? Well, we will invest initially in terms of building and equipment, but

by recovering through the fees that the doctors bill, we will get that payback. So the, the net sum will be zero. There will be an investment initially, but then we'll recover that over time. How much is that initial investment? I'd read somewhere close to $500,000. Is that what we're talking about? We set aside $500,000 and we're going through the analysis right now. We felt we could equip offices for much less than that in terms of getting them

done, there'll be some renovations we have to do to the building. Uh, so we don't have a number yet. We some renovations we have to do to the building. So we don't have a number yet. We're required to report back to council by the 24th of March, and we'll have a full report by then. And if doctors are doing this, just focusing on patient care

and not having to do all the other stuff, will they be paid any less than they would if they were doing all the other normal things that a family doctor would be doing? I think they'd be paid the same or more, and they wouldn't have all the headaches of all the administrative, worrying about whether the nurse shows up, whether worrying about where the equipment's coming from or the investment they have in the practice. How much of an inspiration

was what was going on in in in Colwood, BC? We heard this earlier in terms of the you know what they're doing creating this clinic and they've managed to lure a doctor from Ontario to British Columbia. That was certainly part of it. We had talked as council set priorities as we established the council in 2022. This was one of the things we thought of. We didn't know how to do it. Call would come up with a great idea and we thought,

well, we could do that as well. When are you hoping to have the first doctor in this clinic? This year. And there are doctors, is your sense that doctors are interested in this? Are there doctors that are willing to make that move and willing to, it's not a gamble,

but plug themselves into this new program, this new idea? Our sense is that it is. I've had doctors in town approach. We don't wanna cannibalize and take a local doctor because that just moves the problem from one side of town to the other. But there are doctors who, as I mentioned, get out of school,

they have significant debt. They don't want to take on that additional investment, but this plugs them in right away. They're, you know, they get paid from day one and they don't have an investment. So it's quite attractive to them. You wonder whether there are also doctors or doctors to be from Arillia who perhaps this would allow them to stay,

give them further incentives to stay in their home community. Well, it would, but again, we don't want to cannibalize. Like to take a doctor's got an existing practice of 1,000 or 1,500 patients and move them to our clinic that abandons 12 or 1,500 patients, so it cannibalizes. But if they come from outside the system, like outside of Ontario, outside of the province, outside of the country, then that's added to the system

and provides more practitioners. Have you talked to leaders in the province, outside of the country, then that's added to the system and, uh, provides more practitioners. Have you talked to leaders in the province of Ontario about this plan? Uh, yes, several. Um, in fact, uh, one of the first, uh, contacts I had was with minister Silvery Jones, just asked her if this was possible. She encouraged it and said it was.

She's the health minister. The health minister, correct. And in fact, funny story, the premier of Ontario, Doug Ford, uh, texted me on Sunday and said, Hey, you're a champ. This was a great thing. And of course I showed my wife and the first thing she said is no, it's a typo.

He meant you're a chump. I did not reach back to him to ask for a clarification, but we're getting a great support on this. I asked this in part, in part because we had a conversation last month with a woman who was part of this enormous line in the freezing cold in Walkerton, Ontario.

It was like a thousand people waiting to try to get access to a family doctor. There was a doctor that we spoke with in the wake of that who said, it's like the hunger games. You must talk to other doctors, other mayors in and around your community about what's going on right now. There's a provincial election underway in Ontario. This is one of the issues that people are thinking about.

When you talk to those other mayors, what do they say about what they are up against in their communities? They're up against exactly the same thing, and I invite them to do better. I mean, the province has done a lot. They've allowed pharmacists to prescribe stuff. That helps.

They've let more nurse practitioners, that helps. We can each do what we can do. We've got space, we've got equipment, we can help with the back office administration. That's what we can do. I ask the others what they can do and then do it. I mean, each little bit helps. Is your sense that other mayors, other communities

will seize upon what you have done, will seize upon what Cal call what has done. I believe they will. A lot of people are watching very carefully and they'll watch our experience and they'll learn from it and hopefully this helps sharpen the debate and gets people to move forward on it. You said in some ways just finally that you have skin in the game here.

Both of your parents were the mayor of Orillia, your father in 1969, your mother in the 1980s. You have deep, deep roots in this community. What do you think is at stake for Orillia, your father in 1969, your mother in the 1980s. You have deep, deep roots in this community. What do you think is at stake for Arillia if this primary care crisis continues there? Well, it's something we need to solve. I mean, it's a large problem. I think what is at stake is people's healthcare.

I mean, people want to have access to primary care. Our commitment is to get everyone in Irelia access to primary care within the year. Do you worry that if they don't get that access, they'll leave? I mean, that's part of the, what's at stake is whether people will, it's a beautiful community,

but people may not want to stay because as they get older or have children or what have you, that they may just not feel that they can stay there because they don't have access to primary care. That's quite possible. I mean, people need to be taken stay there because they don't have access to primary care? That's quite possible. I mean, people need to be taken care of. They need access.

They need primary care. We think it's a great place to live, work and play, but people need access. There's no question about it. And you're trying to change that. Yes, absolutely. Don McKisick, it's good to talk to you about it. Thank you very much. Okay.

Thank you for your interest and being so generous with your time. Don McKisick is the mayor of Orillia, Ontario. Behind every statistic is a person, a family, a story. This year alone, over 30,000 Canadians will hear the words, you have breast cancer. Breast Cancer Canada is driving groundbreaking research across the country because every discovery brings us closer to understanding, treating, and one day ending breast cancer. You can join the progress donate today at breastcancerprogress.ca. And if you don't think it will make a difference, we have the science to prove it does. I'm Dena Temple-Reston, the host of the Click Here podcast from Record of Future News. Twice

a week, we tell true stories about the people making and breaking our digital world. And these days, our digital world is being overrun by hackers. I was just targeted by a nation state. And they range from reflective. It's a crime, bro. And I live with that every day.

To ruthless. Do you feel guilty about it? No, not really. Click here from Recorded Future News. You can find us wherever you get your podcasts. Around six million Canadians don't have access to primary care. The ripple effects of this extend deep into this country's healthcare systems. As you heard, Dr. Marion Dove is chair of the Department of Family Medicine at McGill

University, also a practicing family doctor in Montreal. Dr. Do Dove is Chair of the Department of Family Medicine at McGill University, also a practicing family doctor. In Montreal, Dr. Dove, good morning to you. Good morning to you and thank you for inviting me. What do you make of what's going on? Municipalities like Orillia and Colwood, hiring doctors directly, paying them directly, taking over those administrative costs and letting the doctors take care of the patients, which is what doctors want to do. Well, there are a lot of things that I like about these proposals, these innovative ideas.

I think that the Mayor of Irelia was talking about trying to relieve family doctors of the administrative burden and the small business burden of running a medical practice. And that is exactly what we need to do. We need to focus across the country on allowing family doctors to do medicine and to do less of the administrative duties that are increasingly

associated with practicing in family medicine. Can you just talk about what those administrative duties are for those of us who aren't doctors? And we heard earlier, the doctor who is moving to call with Dr. Stiller-Moldovan say that in some ways it's like having two full-time jobs. Explain that for us.

Absolutely. So the way that healthcare is set up varies across the country, but in general, a lot of family doctors are practicing in single practice offices where they have to do all of the rental hiring of the office staff, ordering medical equipment, transportation of samples, booking of patients

and so on on their own as a small business. And this is really not a sustainable model. What we really need to move towards now in modern times is group practices where there is a multidisciplinary care team that cares for patients, where focus can be on preventative medicine, and so on. So yes, the doctor who moved to Colwood is absolutely right. It's not sustainable for young doctors now

to enter this small business model. Has that administrative burden increased? I mean, we hear a lot more about it, but has the burden actually increased in recent years? It absolutely has increased. Here in Quebec, our Family Doctors Federation did a study and showed that family doctors spend about 25% of their time doing administrative work. So

for every three hours of clinical care, there's about an additional hour of administrative work associated with that, whether that be sending faxes or sending requisitions, responding to requests, a lot of insurance forms. For example, a form for a federal tax benefit is 16 pages long. There has just been an explosion of administrative work, I would say, in the last 20 years or so. Who's going to do that work if it's not doctors? That's an excellent question. I think what really needs to happen is that we need to consider do doctors really need to do this work. But if you're submitting an insurance

form and it's 16 pages somebody or something I mean maybe it's artificial intelligence but something is going to have to go through that 16 page form right? Well why do we need a 16 page form is the other question and do we really need it to be done every year? So a 16 page form certainly responds to the needs of bureaucrats who are trying to save money in a system, but it's really they're downloading a lot of work onto family doctors and this has happened across all sectors over the last 20 years and it's exploded with the advent of the electronic medical record because now we have multiple forms for

everything. So I don't have the answer to who's going to do that. For sure the information needs to be gathered somehow, but I don't have the answer to who's going to do that. For sure, the information needs to be gathered somehow, but I think what has been invisible to the public and to the government is how much work has been downloaded onto family doctors. And the doctors, if they weren't doing that administrative work, is the sense that they could see, they actually could see more patients?

Absolutely. Yes. Certainly if I had somebody who would find the form for me, uh, in the electronic medical record and make sure it was there attached to the patient's file. And I didn't spend five minutes doing that when I have a patient in front of me, I could

definitely see more patients. I mean, I'm not a doctor, but that from the outside feels like low hanging fruit in some ways. Absolutely. Do you know what I mean? That if you were able to achieve that, we keep talking about this crisis. We've had, it feels like a dozen conversations

in the last few months about this, that if you were able to deal with, with, with that process part of it, the thing that, that is creating the crisis, the people don't have access to care could be addressed in a meaningful way. So this is one part of what's creating the crisis in care. The other part is that about 25 or 30 years ago, politicians made the choice to cut admissions

to medical school. And so when I was training to be a family doctor in the 1990s, there were fewer and fewer medical students and residents because the feeling at the time was we have too many doctors and doctors were forced into retirement. So now 25 or 30 years later, we're feeling the effect of those cuts to medical school admissions and we don't have enough doctors who are sort of mid-career at this point. We're now training more and more doctors, but you can't train doctors very rapidly. It takes a long time to train a doctor and for all the medical students and residents that we are teaching about family medicine that also

takes away from our practice time. So the more that we're training them the less we are available to practice ourselves. So you know you could say well let's just train more but somebody has to do the training and certainly in my role as chair of an academic department I see how much family doctors are stretched also by the new requirements to train more and more physicians. Do people who are entering medical school want to be a family doctor? We hear a lot about physician burnout. We hear about this administrative burden and we have been speaking with people like yourself,

who are administrators in medical schools who say that they'll often find that young students are not interested in family medicine because they don't want to end up burnt out because they have to do all of this other work. So certainly many, many students who do their family medicine training love family medicine. There's an incredible connection with patients.

The relationship that family doctors have with their patients over years is extraordinary. I have been practicing for 30 years in the same place and I'm now taking care of babies of people who were babies when I started my practice. So students really love family medicine and what turns them away often is exactly what you talked about. The administrative work, the feeling that I'm going to be burnt out, the feeling that your remuneration is much lower than that of a specialist. A specialist can look at a patient and say, well, your problem doesn't fit into my system that I'm taking care of, so go back and see your family doctor. And so family doctors are increasingly caring for people with complex disease, many different health conditions, lots of medications,

and mental health challenges also. And we don't send people away when we don't know what's wrong with them. We keep taking care of them. What about the bias within medical schools? We've heard about this through this commentary in the Canadian Family Physicians Journal as well, against family medicine at med schools.

This idea that, well, you're just a family doctor. You're not a specialist. So this is a phenomenon known as the hidden curriculum, and it definitely exists all around the country, not just our country, but certainly family medicine is often seen as the specialty that you do if you're not smart enough to be a specialist. I was certainly told that when I was in medical school.

You're too smart to be a family doctor. In fact, what we need to do is change our thinking. It's not a question of being smart or not smart. It's a question of having different skills. Family doctors are generalists and we take care of every patient of all ages with all conditions, and those are different skills than knowing a lot about one particular part of the body. I have to let you go, but just going back to where we started, are you than knowing a lot about one particular part of the body. I have to let you go, but just going back to where we started,

are you encouraged that at the sharp end of this crisis, it's these jurisdictions that are facing the crisis that are being creative and taking the lead in terms of how to address it? I am very encouraged that people are trying to attract family doctors to their communities. I think that the spirit behind the decrease in administrative burden for family doctors is excellent.

I'm afraid that it needs to be a much broader scale and more concerted effort in order to have a lasting effect across the country. We'll see whether people pick up on that. Dr. Dove, good to speak with you. Thank you very much. Thank you very much for having me. Dr. Marion Dove is chair of the Department of Family Medicine at McGill University, Associate

Professor of Family Medicine, also a practicing family doctor. Your thoughts on this welcome, you can email us at thecurrent at cbc.ca. For more CBC podcasts, go to cbc.ca slash podcasts.