Ontario looks to reduce doctors’ paperwork as it seeks to attract family physicians

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Ontario plans to reduce the number of sick notes doctors have to write and expand a pilot project to test artificial-intelligence note-taking software, all to cut down on a paperwork burden many in the profession say discourages medical students from going into family medicine.

The province’s Health Minister, Sylvia Jones, made the announcement on Wednesday, a day after a chorus of Ontario’s leading medical schools warned that more action is needed to stop an alarming decline in the number of students interested in becoming family doctors.

The province is expanding the number of spots available at medical schools – and is set to open a new school in Vaughan, north of Toronto, focused on family medicine – to address the growing gap that has left 2.3 million Ontarians without a primary-care physician.

Leaders in the medical profession blame the problem on the demands of the administrative work that primary-care practitioners face and the fact that other medical specialties, such as surgeons, are paid much more.

Ms. Jones would not comment on talks now under way with doctors about their compensation, or whether Ontario will try to shrink the gap in pay between family doctors and other medical specialists.

The average Canadian family doctor was paid $299,000 in 2022, before covering overhead costs, far less than the $507,000 paid out to surgical specialists, according to the Canadian Institute for Health Information.

Louisa Huband, president of the South East Toronto Family Health Team where Ms. Jones made her announcement, praised the moves to reduce paperwork. But she also said the government needs to follow B.C.’s lead and boost the compensation model for family medicine.

She said office-space costs need to be allowed to keep up with inflation and that family physicians should be compensated for now-unpaid administrative tasks. B.C.’s recent changes, she said, have resulted in an almost 20-per-cent increase in the number of active family doctors.

“We need to show our graduates that family medicine is a viable career option. We need them to see, beyond today’s announcements, ongoing change in how the government supports family practitioners in the community,” Dr. Huband said.

B.C. announced a new funding model for family doctors in 2022, increasing the pay of a full-time family doctor who signs on to about $385,000 a year, up from $250,000. As part of the changes, the province reached an agreement with doctors to move away from a fee-for-service model, which has been criticized for incentivizing short appointments, to one that compensates based on several factors, including the medical complexity of patients.

The Alberta government has also been working on a new funding model that is expected to focus on how many hours family doctors work, as well as the number and types of patients they treat. The province has not announced a timeline to finalize a new agreement with doctors.

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Andrew Park, president of the Ontario Medical Association, would not comment on its talks with the government over compensation. But he said the challenges facing the profession are both about money and reducing the burden of paperwork.

“If it’s just about compensation, I don’t know if you are going to get a swelling of applicants going into family medicine because the landscape of the job itself is still extraordinarily challenging,” Dr. Park said.

The initiatives announced on Wednesday are part of an existing “Patients Before Paperwork” program that has already seen Ontario pledge to expand computerization in the health system and scrap fax machines “over the next few years.”

They are aimed at reducing the 19 hours a week that the OMA says the average family physician spends on administrative tasks – time that could be better spent seeing more patients.

The AI pilot project, AI Scribe, is led by OntarioMD, a wholly owned subsidiary of the OMA, and will be expanded to 150 primary-care providers for use with patients who consent to have electronic medical notes. It will spare doctors from typing up their notes when seeing a patient. The government says the software could save enough time for a doctor to see an additional 12 patients a month.

The government also says it will introduce proposed legislation that would prohibit employers from requiring a sick note for the province’s three days of job-protected sick leave.

This practice often means employees either see a doctor to get the note while ill, or do so after they feel better – clogging up clinic time that could be used for patients with more serious ailments. Employers could still require “reasonable evidence” from sick employees, such as signed declarations, the government says.

Mekalai Kumanan, president of the Ontario College of Family Physicians, said both changes will help to lower the amount of paperwork family physicians face. But other changes are needed, she said, such as a centralized system for referring patients to specialists.

She has heard from colleagues that the AI scribe program can save doctors 45 minutes to an hour a day they would spend updating patient charts. She said reducing sick notes should also free up same-day and next-day appointments for other patients.

Opposition NDP health critic France Gélinas said the changes on sick notes do not go far enough, and that the requirement should be scrapped altogether for other kinds of sick leave.

Ontario Liberal health critic Adil Shamji, a former emergency-room doctor, said the announcements, though welcome, are not going to address the larger crisis with the shortage of doctors.

“Bringing in an AI, an artificial-intelligence scribe pilot project, sounds exciting, but it doesn’t strike at the heart of the matter,” Dr. Shamji told reporters at Queen’s Park.