Tackling the pandemic backlog
and future-proofing against wait times
The COVID-19 pandemic created a backlog of almost 16 million medical services – or more than one medical service for every Ontarian, from the youngest to the oldest.
These delayed services include preventative care, cancer screening, surgeries and procedures, routine immunization, and diagnostic tests such as MRIs and CT scans, mammograms and colonoscopies. Doctors are seeing sicker patients because of serious conditions left undetected or untreated because of the pandemic, including some 25 per cent fewer cancer diagnoses.
Sick patients don’t have time to wait. However just catching up on the pandemic backlog ignores the bigger problem. We can’t solve the long-term problem of wait times and hallway medicine if the health-care system remains inefficient and disconnected.
Ontario doctors recommend:
Fixing doctor shortages
Ontario continues to experience doctor shortages in many regions – especially in the north and remote and rural communities—and in certain specialties such as family medicine, emergency medicine and anesthesia.
At least one million Ontarians don’t have a family doctor. Family doctors are at the forefront of patient care. They help patients stay healthy, prevent disease by identifying risk factors, manage chronic disease, and get their patients access to specialists and other health-care services when needed.
Without access to doctors, many patients needlessly suffer. We need robust about our physician workforce, and we need to use that data wisely to plan for our future population needs. We also need to recruit well and support them to stay healthy so that all patients can get equitable and timely access to the care they need.
Ontario doctors recommend:
Expand mental health and
addiction services in the community
In any given year, one in five people in Canada experiences a mental health problem or illness. But that was before the pandemic.
A survey by the Conference Board of Canada and the Mental Health Commission of Canada found that 84 per cent of respondents reported their mental health concerns worsening since the start of the pandemic, with their major concerns being family wellbeing, their future, isolation/loneliness and anxiousness/fear.
More than one-third of those with a COVID-19 diagnosis may develop a lasting neurological or mental health condition.
A study by Deloitte using modelling from past disasters suggests Canada will see “a two-fold increase in visits to mental health professionals and possibly a 20 per cent increase in prescriptions for antidepressants relative to pre-COVID-19 levels.”
Psychiatrists, primary care doctors, pediatricians and addiction medicine specialists continue to provide excellent care for these patients. But they do not have enough hours in the day to accommodate the tsunami of new patients asking for help. There must be greater accessibility to affordable and publicly funded services in the community so everyone can get the treatment they need.
Doctors and other front-line health-care professionals were experiencing high levels of burnout before the COVID pandemic. According to surveys conducted by the OMA’s Burnout Task Force, just prior to the pandemic in March 2020, 29 per cent of Ontario doctors had high levels of burnout with two-thirds experiencing some level of burnout. By March 2021, these rates had increased, with 34.6 per cent reporting high levels of burnout and almost three-quarters reporting some level of burnout.
Burnout is primarily caused by issues in the health-care system, so system-level solutions are needed to address it. And if doctors, nurses and others providing care burn out, this impedes access to care for patients.
Ontario doctors recommend:
Home is where many patients
want to be and can be
In 2019-20, there were 1.3 million hospital bed days used by alternate level of care patients. An alternate level of care patient is defined as a patient in hospital who is stable enough to leave but there isn’t a long-term care bed, hospice bed or rehabilitation bed for them to transfer to, or not enough home-care services available for them to return home safely.
When hospital beds are used by patients who don’t need to remain in hospital, this creates a major bottleneck that increases surgical wait times and leads to hallway medicine. And it doesn’t make financial sense.
According to the Ontario Hospital Association, “it costs approximately $500 per day to provide care for a patient in hospital, $150 in long-term care and even less for home and community care. More importantly, hospitals have less room to treat people who really need to be there, or to accommodate a sudden increase in patients during the winter flu season. Unfortunately, this means too many patients receive care in hallways and other unconventional spaces. It is impossible to end hallway medicine without addressing these rising [alternate level of care] rates.
Providing patients with more appropriate types of care outside of hospital will not only help reduce wait times, but could avoid hundreds of millions of dollars in costs to the health-care system every year.
High-quality home care provided by a team of doctors, nurses, therapists and personal support workers allows people of all ages to recover from surgery, injury or illness at home. It also reduces the number of emergency department visits and admissions to hospital, helps patients better manage chronic illness, lets seniors live safely and comfortably at home longer, and allows people to be supported if they choose to die at home.
A stronger, more connected and more responsive home-care system would also relieve family members and caregivers, who are too often underequipped and overwhelmed.
Ontario doctors recommend:
Long-term care
COVID-19 has taken the lives of more than 3,800 long-term care residents in Ontario, or approximately 40 per cent of all pandemic-related deaths. Our most vulnerable seniors deserve the best care possible in a safe and professional environment.
Ontarians agree. Twenty-one per cent of respondents to the OMA’s public survey said that improving delivery of long-term care is the single most important thing that can be done to improve health-care services in their community.
Ontario doctors recommend:
Palliative and hospice care
Palliative care is an approach that improves the quality of life of individuals and their families facing life-limiting illness, through the prevention and relief of suffering. This is by means of early identification and assessment and treatment of pain and other problems including physical, psychosocial and spiritual.
Hospices provide palliative care and offer a comfortable, home-like environment for patients nearing the end of their lives. Hospice is an alternative for those who can’t remain at home or don’t want to die in hospital. Without hospice care, homeless people and other marginalized groups often have no other option than to die in hospital.
Ontario doctors recommend:
Chronic disease management
Chronic diseases are defined broadly as conditions that last one year or more and require ongoing medical attention or limit daily living activities or both. Chronic diseases such as heart disease, cancer, diabetes and dementia are leading causes of death and disability. Cancers, cardiovascular diseases, chronic lower respiratory diseases and diabetes cause about two-thirds of deaths in Ontario, while on average, dementia affects almost one in ten seniors over 65 years.
Having the appropriate resources and mechanisms in place to manage chronic diseases will result in better outcomes for patients and reduce health-care costs overall.
Ontario doctors recommend:
Build on our system
and be prepared for what comes next
Public health preserves and defends the health of the entire community. In addition to combatting pandemics and other public health emergencies, a strong public health system led by specially trained public health doctors preserves health and prevents illness every day.
Local public health units track cases of more than 60 communicable diseases; inspect restaurants for health hazards; ensure the safety of private wells in rural areas; promote health in disadvantaged communities; lead routine vaccinations; operate supervised consumption sites; and respond to complaints of retailers selling tobacco or cannabis to children.
Ontario doctors recommend:
Prepare for the next pandemic
We need to plan and prepare for the next pandemic now. Ontario must have a robust public health system with the resources it needs to protect the entire population’s health, with clearly defined roles across local public health units, Public Health Ontario, Ontario Health and the Ontario Ministry of Health.
Ontario doctors recommend:
Team-based and
collaborative care
Patients do better when they have a team of care providers, including not only family doctors and specialists but also nurses, dietitians, physiotherapists and others. Where these teams exist, patients have faster and easier access to specific care they need so are healthier, have fewer hospital admissions and are more satisfied. System costs are also reduced.
Most family doctors across Ontario work in different types of practice models that each provide unique benefits to their patients, such as comprehensive care, preventive care and chronic disease management. However, not all practice models allow for the inclusion of other health-care professionals. Most doctors are not able to choose the model of care that is best for their patients and their community.
Ontario doctors recommend:
Virtual care
Virtual care is another way for patients to receive excellent care from their doctor using a phone or computer to communicate.
Doctors pushed hard at the beginning of the pandemic to enable more access to virtual care for their patients. Without virtual care, the pandemic backlog of almost 20 million delayed patient services would be much greater. Virtual care has literally saved lives and is especially valuable for those who are elderly or ill, those who have trouble getting to the doctor’s office, or those who live in rural and remote communities.
The temporary OHIP codes being used by doctors to provide virtual care during the pandemic expire in September 2022. These virtual care codes must be made permanent and more flexible for doctors to be able to provide their patients with the best care possible.
How we think about the future of virtual care is also important because it works best where it fosters a continuous relationship between a patient and their regular health-care provider. Research shows that patient outcomes are better when there is a trusted and familiar relationship.
Ontario doctors recommend:
Linking existing digital health records systems
Most people have experienced the frustration of repeating the same information to different health-care providers, or at the hospital or before a test. They’ve likely also been told by their pharmacist that a fax to renew a prescription will be sent to their doctor.
In Ontario, doctors, hospitals, labs and pharmacists use different digital medical records systems, and these systems aren’t all linked. That means nine out of 10 Ontario doctors still must use fax technology to share patient information with other professionals on a patient’s care team.
Connecting these different systems would reduce the administrative burden and free up time better spent on direct patient care. For example, if each of Ontario’s doctors could save one hour a day and see two additional patients, more than 60,000 additional patients would receive care each day, or one million more patients a month.
Ontario doctors recommend:
Accelerating innovation
Innovation in health care is important to Ontario's economic future.
Ontario doctors recommend:
Northern Ontario has unique health-care challenges
Northern Ontario spans almost 90 per cent of the province’s geography but has only six per cent of the population. Its distance, weather and infrastructure including reliable internet present barriers to health-care services.
The health-care needs of northern Ontario are growing. A greater proportion of its population is over 65. There are more complex chronic illnesses and mental health and addictions than in other regions, And the average life expectancy is 2.5 years lower than in the rest of the province. At the same time, the number of doctors dropped from 1,715 in 2018 to 1,700 in 2019. Almost 100 generalist family physicians are needed in northern Ontario’s rural communities.
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Ontario doctors recommend:
Equity and access, and climate change are major factors that influence our health.
Addressing the social determinants of health will improve equity and access
Ontario’s doctors believe everyone is entitled to dignity, respect and equity – no matter who they are, what they do or where they live.
Climate change is science
Doctors are trained to evaluate science, and science proves that human-made climate change is reality. Ontario is not immune, and has experienced double the number of forest fires in 2020.