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Prescription for Ontario
Doctors’ five-point plan to make health care better, for all of us.
A doctor-led, public-informed plan.
Learn how Ontarios’ doctors launched the largest consultative processes in the OMA’s history to create the right plan for all.
The vision and motivation behind the plan.
The OMA’s CEO and President share an important message about why this was needed.
The need for a plan starts here.
Watch video
Dr. Timothy Asmis, chair, OMA Section on Hematology and Medical Oncology, Ottawa
“Cancer isn’t waiting for the pandemic to be over.”
Reduce wait times and
the backlog of services
See recommendation 01

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.

of Ontario doctors say some of their patients have experienced worse health outcomes because of the pandemic backlog of medical services.

Ontario doctors recommend:

Adequate funding
to address the backlog of services in hospitals and community clinics.
Evolving the model
of surgical care delivery to include a far greater portion of services delivered in community-based specialty settings outside of hospitals.
IT infrastructure
to enable regional referral systems for surgeries and other services.
Enough nurses and technologists
to expand MRI and CT machine hours.
Greater efforts to educate
young people about healthy lifestyles and disease prevention to ensure better long-term health.
Adequate support
for hospital to home transitions.
Expanding the use
of home remote monitoring programs to streamline pre-and post-surgical delivery.
Ensuring sufficient
health human resources to meet community needs.
Enhanced data collection
and timely data sharing to support planning, measurement, and evaluation.
Better integration
of health care service provision with public health and other services, including palliative care, long-term care, home care, and community care.

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.

of Ontario doctors surveyed said the pandemic has caused them to consider retiring earlier.

Ontario doctors recommend:

Creating a detailed plan
based on high quality, that ensures that types and distribution of doctors meets population needs.
A set of best practices
around physician supports to help ensure Ontario has the right doctors in the right places at the right times.
Using best evidence
regarding forecasted population need, increasing the number of medical student and residency positions.
Supporting students
from remote, rural and racialized communities to go to medical school aligned with service to populations in need.
“Letting doctors be doctors”
so they can spend more time with patients doing the things that only doctors can do and less time on paperwork or other tasks.
Helping doctors
trained in other jurisdictions become qualified to practise here.
in more training and educational supports for practising doctors.
Dr. Sharon Burey, behavioural pediatrician and president of the Pediatricians Alliance of Ontario
“Only one in five young people who need mental health services receives them.”
Expand mental health and addiction
services in the community
See recommendation 02

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.

More than
of school-aged children surveyed reported deterioration in their mental health during the first wave of the pandemic.
Source: Hospital for Sick Children

Ontario doctors recommend:

Provincewide standards
for equitable, connected, timely and high quality mental health and addiction services to improve the consistency of care.
Expanding access
to mental health and addiction resources in primary care.
Specific mental health supports
for front-line health-care providers.
Ensuring that appropriate
resources are in place to provide virtual mental health services where clinically appropriate.
Increasing funding for
community-based mental health and addiction teams where psychiatrists, addiction medicine specialists, family doctors, nurses, psychologists, psychotherapists and social workers work together.
More mental health
and substance awareness initiatives in schools and in communities.
Making access to care easier
by defining pathways to care, navigation and smoother transitions with the system.
Building service capacity
for young patients moving into the adult system.
Reducing the stigma
around mental health and addiction through public education.
More resources
to fight the opioid crisis, particularly in northern Ontario where the crisis is having a significant impact and resources are limited.
the number of supervised consumption sites.
increase in opioid-related deaths in Ontario in 2020.
Source: Canadian Institutes of Health Research
Dr. Pamela Liao, family doctor and chair of the OMA Section on Palliative Medicine, Toronto
“Who gets palliative care should not be a postal code lottery.”
Improve and expand home
care and other community care
See recommendation 03

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.

of Ontario doctors surveyed said that increased access to home care would improve health outcomes for their patients or allow them to remain in their homes longer.
Source: 2021 OMA member survey

Ontario doctors recommend:

Developing provincewide
standards for timely, adequate and high-quality home-care services.
Increasing funding
for home care and recruiting and retaining enough skilled staff to provide this care.
Embedding home care
and care co-ordinators in primary care so patients have a single access point through their family doctor.
people without a family doctor can still access home care seamlessly
Enabling electronic sharing
of information between doctors, care co-ordinators and home-care providers.
a direct funding model so patients can customize their home care according to need.
Reducing needless
administrative paperwork so more time can be spent on actual patient care.
Providing tax relief
for families who employ a full-time caregiver for a family member.

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:

Strengthening the role
of medical directors, with doctors working with government and stakeholders to develop a clear role description and expectations.
a chief medical officer of health for longterm care for each Ontario Health region to co-ordinate efforts among sectors, liaise with public health and improve physician coverage over multiple long-term care sites during outbreaks.
Recruiting and retaining
more staff to care for long-term care residents, ensuring the proper staffing ratio of physicians, nurses, personal support workers, therapists and others is always maintained.
Building internal capacity
for medical care within long-term care homes, while also improving links between long-term care and hospitals.
Continuing and expanding
the use of virtual care in long-term care homes, and increasing virtual care linkages between long-term care homes and hospitals.
Cutting red tape
preventing doctors from moving quickly into long-term care homes during emergencies.
family caregivers are actively engaged and appreciated.
Aggressively shifting
societal attitudes so that caring for our frail, older adults is considered one of the most important jobs in the world.

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:

Ensuring support
and capacity exists to allow individuals to receive palliative care where they need it, including at home.
Supporting a robust
provincial hospice strategy by increasing the number of beds based on geographic areas of need, and providing consistent operational funding to hospices so they can focus on care and not fundraising.
Greater investment
in palliative infrastructure, based on geographic need.
there are separate plans to address pediatric and adult palliative care patients to reflect the necessary distinctions in services and needs for these patient demographics.
Increasing the number
of skilled palliative care providers, including physicians, nurses and allied providers by increasing opportunities for training.
Making palliative care accessible
24/7, including virtually, in all regions and for diverse populations including Indigenous, homeless and others.

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:

Increasing investment
in chronic disease management to enable a larger workforce, technologies to manage these diseases, and home services.
Dr. Michael Finkelstein, chair of OMA Section on Public Health, Toronto
“To respond to a pandemic, we need interconnected digital tools to help us manage in real time.”
Strengthen public health and
pandemic preparedness
See recommendation 04

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:

Enhancing local public health
to ensure it can be a strong local presence for health promotion and protection.
Providing a clear, adequate
and predictable funding formula for local public health units that returns to 75 per cent paid by the province and 25 per cent paid by municipalities.
Ontario’s public health system has highly qualified public health doctors with the appropriate credentials and resources.
Increasing the investment
in public health information systems so we can better collect, analyze, share and use information in more thorough and timely ways to improve decision-making, and asking the federal government to increase its investment in public health to provide the infrastructure to support standardized data collection and analysis across jurisdictions
Carrying out
an independent and unbiased review of Ontario’s response to the pandemic including the public health system, its strengths and weaknesses during pandemic and non-pandemic times, along with its roles and responsibilities, before considering any changes.
the ability of Public Health Ontario to carry out its mission/mandate which includes robust public health science and laboratory support, including providing increased funding for hiring of additional public health trained physicians.

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:

Requiring by legislation
a provincial pandemic plan, including a mandatory review and update every five years to reflect changes in local public health practice, medical science and technology.
a standardized pandemic plan across public health units that is sufficiently flexible to account for differences and inequities across this diverse province.
Sufficiently resourcing
Public Health Ontario to be the central scientific and laboratory resource during a pandemic or public health emergency, including ensuring it has the complement of public health specialist physicians needed to meet its mandate during a public health emergency.
Strategic investments
for pandemic planning for public health units so their resources aren’t drained from the other important work they do every day during a crisis.
Ensuring adequate
funding to recognize additional workloads during pandemics.
Dr. Mariam Hanna, chair, OMA Section
“If specialists could quickly access a patient’s history, this will save time and resources.”
Give every patient a team of
health-care providers and link
them digitally
See recommendation 05

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:

Increasing funding and support
for effective team-based and integrated care in all primary care models.
Letting family doctors choose
the type of practice model that works best for their patients and their community.
Opening up
the Family Health Organization capitation model of care to all doctors who wish to practice that way.
Increasing the number
of care co-ordinators to help patients access care more quickly and easily, and have these co-ordinators work directly in primary care settings.
team-based and integrated care settings not only around primary care, but around diseases or specialties.
Optimizing the currently
legislated Ontario Health Teams, including ensuring physician leadership in the process, as a way to integrate health-care services for the benefit of patients across the province.

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.

of doctors have patients with mobility, health or transportation issues that make it difficult for them to attend in-person visits.
Source: 2021 OMA member survey

Ontario doctors recommend:

Implementing permanent
OHIP fee codes for virtual care services provided by phone, video, text and email, ensuring that patients can access virtual care for any insured healthcare service that can be appropriately delivered through electronic means.
That the government partner
with internet providers so that Ontarians who cannot afford internet services (for example, those living in public or supportive housing, relying on Ontario Works or the Ontario Disability Support Program, and seniors receiving the Guaranteed Income Supplement) can get internet services at a greatly reduced rate, to ensure all patients benefit from virtual care.

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.

of doctors say they must use fax technology to share patient information with other physicians, pharmacists and health-care providers.
Source: 2021 OMA member survey

Ontario doctors recommend:

Linking doctors’
electronic medical records systems, hospital information systems, and laboratory and pharmacist systems so they can all talk to each other.
the approval, development, and implementation of new digital health technologies, including remote patient monitoring.

Accelerating innovation

Innovation in health care is important to Ontario's economic future.

Ontario doctors recommend:

Better connecting
Ontario’s existing innovation, incubator and accelerator investments with physicians and public health-care leaders.
Making government funding
programs for health and life sciences a priority, including economic development and research and development.
public and private sector financing, research, development and health-care expertise to spur the development and use of Ontario-made health-care innovations.
greater use of remote patient management technologies, which can be especially helpful in managing chronic disease.
Prioritizing funding
for data-sharing tools already in place such as Health Report Manager, Insights4Care Dashboard and provincial viewers such as ConnectingOntario ClinicalViewer.
Health care in northern Ontario
See northern Ontario recommendations

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.

90% of land mass 6% of the population Location Weather Infrastructure including reliable internet

Trending up

Larger proportion of 65+ than rest of Ontario

More complex chronic illness, mental health and addictions

2.5 year reduced life expectancy

Trending down

Total doctors (1,715 in 2018, 1,700 in 2019)

Some communities have half the number of physicians they need

Ontario doctors recommend:

That patients have
equitable access to care in their own communities.
Reviewing and updating
incentives and supports for physicians and allied health-care workers to practise in northern Ontario and other communities that are chronically underserviced.
Focusing on
education, training, innovation and opportunities for collaborative care to address physician (health-provider) shortages in remote communities.
resourced opportunities for specialist and subspecialist trainees to undertake electives and core rotations in the north.
Giving medical students
and residents the skills and opportunities they need to be confident in choosing rural and remote practices.
Focusing on innovative
culturally sensitive education and training opportunities addressing physician and other health-provider shortages in rural and remote communities.
Focusing on
the profound and disproportionate impact of the opioid crisis and mental health issues in northern Ontario.
More social workers,
mental health and addiction care providers and resources for children’s mental health.
Enhancing internet connectivity
in remote areas to support virtual care, keeping in mind that virtual care will not solve health human resources problems in northern Ontario and should not replace in-person care.
A recognition of
the specific need for local access to culturally safe and linguistically appropriate health care for northern Ontario’s francophone population and Indigenous Peoples.
A collaborative partnership
with Indigenous Services Canada and Health Canada to address issues of safe drinking water and adequacy of healthcare facilities and resources in Indigenous communities.
Using a harm-reduction
anti-oppressive lens, addressing the education gaps in Indigenous communities and non-Indigenous communities, as health is directly affected by education.
Equity and climate change
See equity and climate change factors

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.

  • Health-care planning should always be done through an equity lens, and in a culturally sensitive way that breaks down barriers for marginalized people, particularly racialized, Indigenous and LGBTQIA2S+ communities, and those whose first language is not English
  • Investing in the social determinants of health should be considered as important as investing in the health-care system itself as both improve the overall health and well-being of all Ontarians
  • Everyone should have access to a family doctor and a team of health-care providers regardless of their location, language or socioeconomic status

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.

  • A healthy population requires a healthy planet, and Ontario’s doctors are calling for positive action to be taken immediately on climate change to mitigate its severe consequences on human health and wellbeing.
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