At the weekly Tuesday meeting of The Rotary Club of Picton, guest speakers Debbie Korzeniowski, Executive Director for Prince Edward Family Health Team (PEFHT) and Dr. Anne Nancekivill, Physician Lead, Physician Recruitment and Retention Program (County Docs) spoke to the group about the past, present and future of primary healthcare in Prince Edward County (PEC) via Zoom and in-person.

Going back to the days of Canada’s socialized medicine pioneer Tommy Douglas, primary care was provided by family doctors who each acted as private contractors and individual business owners.

“This system is called Fee for Service,” Dr. Nancekivill said to Picton Rotary. “The physicians billed the Ontario Health Insurance Program, a set amount for each type of patient visit/service and out of those funds, independently managed their own office overhead, including staff and expenses. These same physicians also covered the hospital inpatient ward, Emergency Department and Long Term Care facilities.”

Family Health Networks were proposed late in 2002 as part of theprovincial primary care reform initiative. This was a new payment model for physicians called blended capitation.

“Focus was more on preventive health,” said Dr. Nancekivill. “If you can reduce the risk of someone getting sick or of progression of existing chronic health issues, you reduce the burden on the health care system overall. Patients rostered to a specific physician and that physician was paid a set amount per year to provide care regardless of how often they saw those patients during that time. In this model, in addition to to the annual payment, the physician can also bill for visits and procedures but is paid only 15 per cent of the OHIP fee. Almost everybody in town quickly signed on and in fact we were the 4th and 5th FHNs in the province.”

In 2006, Family Health Teams were proposed. These represented a new patient care model as the second component to the primary care reform strategy. The two FHNs in the County, applied quickly and were successful in becoming one of the first 50 FHTs in the province.

“Our physician leads, looked at the needs of the County at that time and what stood out then were the high incidence of cardiovascular disease, COPD, rates of smoking and diabetes,” Dr. Nancekivill stated. “At that time they also thought we had a terrible problem with 1200 unattached patients. The initial application took aim at these problems, asking for 2 NPs to absorb the unattached patients, smoking cessation and COPD resources, a diabetes program and mental health resources.”

PEFHT is a not for profit corporation which was established in 2006 as one of the first of its kind in the province.

It has bylaws, a board of directors, holds an annual AGM, is funded by the Ministry of Health with $3.3. million, employs close to 40 people both clinical and administrative, has five different clinic locations with four sites in Picton and one in Wellington and operates in close partnership with PEC family doctors.

PEFHT was formed to provide integrated, team-based, patient-centred primary care to local patients.

PEFHT: What is it?

• PEFHT offers the first point of care, in the community where people live
• It’s the place where a person first identifies they have a health issue and then contacts a healthcare professional for an appointment or consultation
• In the PEFHT model, that is most often a family physician
• The appointment begins the journey across the healthcare system.
• We SHARE care in a team-based environment

“It’s the place where a person first identifies they have a health issue,” said Korzeniowski. “Then contacts a healthcare professional for an appointment or consultation In the PEFHT model, that is most often a family physician”

At PEFHT there are 10 administrators, 23 family doctors(16), physician office teams, four nurse practitioners, six nurses, four counsellors, two dieticians and one pharmacist.

Program and services directory includes:

• Cardiac Rehabilitation
• Clinical Nutrition Service
• Coordinated Care Program
• COPD/Asthma Mngmt Program
• Diabetes Education Program
• NP Clinic Service (on pause)
• Health Promotion
• Higher Risk Foot Care Program
• Maternal Infant Child Program
• Memory Clinic Program
• Mental Health Program
• Palliative Care Program
• Pharmacy Service
• Smoking Cessation Program
• Specialists
• Wound Care Program

Where is PEFHT at currently?

“Our population is growing and aging,” Korzeniowski expressed. “There is a shortage of medical professionals, including family physicians who provide essential care and support for our community based programs and hospital services. A growing number of our population does not have access to a local primary care provider, which has an impact on our hospital emergency departments and specialists, as well as on the overall health of our community. We know that individuals with access to a primary care provider are less likely to require emergency or hospital care. Lack of robust primary care in the end, impacts the Health Care system much more both in human and financial costs.”

Prior to 2020 PEFHT had no issues with physician recruitment and most local residents had access to a primary care physician. There are now seven vacancies in PEC with more departures confirmed for this year.

How did PEFHT get here?

• A large proportion of our current physicians have reached retirement age
• An aging population with more complex medical needs
• A tendency for new graduates to delay committing to a practice
• COVID-19 interrupted engagement opportunities
• National shortage of family physicians
  • Declining number of graduates choosing family medicine, even fewer choosing rural practice
  • 2,572 active full time postings
  • 1451 graduating physicians

These factors have resulted in competition for diminishing human health resources and necessitated the County Docs program.

A timeline for the County Docs recruitment strategy from commencement to its current stage :

• Feb 2022 – Council approved 100K physician incentive and 50K in recruitment operations.
• July 2022 – Recruiter hired, development of recruitment and retention program begins.
• Sept 2022 – Community Partnership form, PECMHF provided 25K for YR1 operations, secured a one-year locum.
• Jan 2023 – In person recruitment events ramp up, secured new physician to start in the Fall of 2023.
• Feb 2023 – Council approved request for sustained program funding for YR2, website goes live.

For more information on County Docs please visit https://www.countydocs.ca/

For more information on PEFHT please visit https://www.pefht.ca/