It's hard to be a FFS or FHG doctor. In this already stretched health care environment, though every other supporting structure means well, it often can feel that you are the last to know about changes and programs and the least able to take advantage of the levers that do exist in the system.
FFS and FHG doctors like FHO's, FHTs and nurse practitioners need to procure access to services for our patients through collaboration with local health organizations. There is a broad consensus both inside and outside the FFS and FHG models that there has been a decade long lack of inclusivity in the current primary care ecosystem. The concern is that this lack of inclusion in access has lead to an inability to deliver equitable care.
When we try to advocate for adaptations that accommodate our practice models historically we have done so ad-hoc. As individuals, we have had to pass these requests through a filter chain that is becoming increasingly complex.
Typically primary care practitioners that occupy key decision-making positions come from other practice models. There are many reasons for this. FHT and Nurse Practitioner models are better funded with supports that allow for administrative time. They tend to be more closely connected to academic institutions. They tend to be directly connected to hospitals were many of the most important issues are raised and dealt with. Their closeness means they hear about leadership opportunities before we do. Also at times, these opportunities are not offered outside of closed circles. Like us, these individuals and collectives intend to strike a proper balance when it comes to equal access to care. However, inevitably, the over-consolidation of decision-making abilities and organizational capability coupled with the natural human tendency towards cognitive bias and otherization opens the door to compartmentalized economies of access.
These anomalies can lead to systems of entrenched imbalance and privilege. Once formed and benefited from they then like any other organizational body would need to be bolstered and protected if they are to endure.
FHT doctors are bolstered and protected by AFHTO.ca
Nurse Practitioners are bolstered and protected by NPAO.org
Currently, FFS and FHG doctors do not have a legitimate, monetized, focused equivalent in place.
When I have raised this as a concern up the filter chain typically one of the responses back is a variation on ’Well you have the OMA’. I think very highly of the OMA and am thankful for the tireless dedication of the physicians who contribute. I would never consider moving from under their aegis. However, despite their goodness, there is a creeping logical error in stopping there. Many of the primary care members in the OMA come from advantaged models. It is human nature that unconscious bias can enter into the process. Because FFS and FHG doctors are not organized in our messaging back to them the OMA may be missing out on valuable observations collectively gleaned by our group. This is the more subtle risk to the OMA in not reverse engineering this dynamic. If there is a negative resource and access based change coming in primary care it will likely be felt first in the disadvantaged models then make it's way to more advantaged ones.
If you are an FFS or FHG doctor reading this, like me you are likely exhausted. I get the ’not my fight’ head in the sand temptation. After all, wasn’t the trade-off for accepting less pay and privilege, assuming you had the choice, that others would use their privilege to look after the health equity needs of all primary care models?
Paraphrasing Jerry Garcia a late guitarist from the Grateful Dead…
"Somebody had to do something. It is just incredibly pathetic it has to be us."
If we do not organize we will never have ’agency’ in the processes that matter to our patients and stabilizes our ability to deliver care. This is why I am starting FHGTree.com (editors note - FHGTree.com was rebranded to PrimaryON.ca in March 2020 coinciding with a more inclusive focus). It really comes down to your responsibility to advocate for your patients. If you have identified a dynamic set of processes that are contrary to the interests in of your patients you cannot pass on addressing it.
I invite other FHG and FFS doctors inside the MH LHIN region and beyond to join in the conversation and the ... *gulp* work that is coming.