Pandemic, funding woes take toll on clinics
Revenue dries up as patient visits drop in pandemic
The closure of an Orléans medical clinic over the weekend is a wakeup call that Ontario’s system of funding primary medicine is broken, say Ottawa family doctors.
And they warn more closures are inevitable if something doesn’t change, potentially leaving tens of thousands of patients without family doctors.
For many, the pandemic has been the last straw.
The Asclepios Medical Centre and walk-in clinic in Orléans closed over the weekend after owner notified patients that it could no longer afford to stay open. The clinic served more than 9,000 patients, the company said in its statement.
“The closure is the result of the clinic simply not having the resources to sustain the increased operational costs and decreased revenues caused by the COVID -19 pandemic,” it said in a statement.
Owners of the clinic told patients they will remain with their family physicians and that they are “working with them to transition their practices and files.”
In a statement, family physicians said the owners do not represent them and they were only told of the closure with short notice.
“We have not had the capacity or the timeline to notify our patients of next steps, but we intend to do so as soon as possible.”
Dr. Alykhan Abdulla, who is chairman of the Ontario Medical Association’s section of general and family practice and runs a feefor-service family medicine clinic in Vanier, warns that more family medicine practices in the city will close if some action is not taken by the province to offer them more financial stability.
“I know personally of almost a dozen clinics that are contemplating this over the next days, weeks or months.”
Physicians getting paid under the fee-for-service model — per patient visit — were already struggling, said Glebe-based family physician Dr. Nili Kaplan-Myrth. The loss of patient visits during the pandemic has turned an already difficult situation into a crisis.
The province has taken some action to stabilize doctors’ incomes after a delay meant they weren’t getting paid for telehealth patient visits, their main access to income during the pandemic. The province is offering loans of up to 70 per cent of doctors’ normal incomes to help them, but doctors say they would not be able to afford to pay them back. Seven other provinces have put doctors on salary during the pandemic to prevent them from closing clinics.
Abdulla said his clinic in Vanier has seen a 50-per-cent drop in patients during the pandemic. It serves between 8,000 and 9,000 patients. The drop at the Orléans clinic was higher, he said, as has been the case elsewhere with family physicians and specialists.
“People have been so overwhelmed that they have not been coming into the office and are not even accepting phone calls,” he said. The result is that patients with chronic health issues are not being looked after, children are not getting immunized on time and more issues are going untreated.
Abdulla says the situation is similar across Ontario, with up to one-quarter of all family physicians who rely on fee-for-service payments struggling. And doctors who rely on payment per patient visit to pay rents and overhead are unsure how they can continue their practices.
He estimated that as many as two million people could lose their family doctors if all the physicians currently struggling are unable to continue their practices.
The issue, says Kaplan-Myrth, is the way doctors are reimbursed in the province. About 35 per cent of family physicians in Ontario work on a salaried model, meaning they earn a certain amount of money per day for every patient in their practice. The remainder are paid per patient visit. If there are no visits, as during the pandemic, they receive no pay, although they continue to be responsible for office and staff payments, which is why so many are now contemplating losing their clinics.
Kaplan-Myrth said more doctors would like to be part of a salaried rather than fee-for-service system, but there are strict limits set by the province, which means it is unavailable to the majority of family doctors, especially those in urban areas.
She runs a busy practice in the Glebe that serves many vulnerable patients. She said she might be able to work at a salary-based clinic in suburban or rural Ottawa or Eastern Ontario under government guidelines, but that would leave most, or all, of her patients without a doctor.
She said the pandemic has revealed long-standing problems with the way the health system operates in the province.
“The underlying problem is really that we lack the infrastructure to keep our practices going. We were struggling before COVID -19. All of these things were problems before.”
Abdulla said he fears that doctors’ offices will quietly begin closing over the summer.
“And when September comes, with influenza season and school back in and COVID and doctors offices closed, that is what I worry about.” epayne@postmedia.com