The Rosedale Medical Group in Hamilton, Ont., has beat Roy Romanow to the punch by several years. Romanow's report on the future of medicare called for a $2.5-billion cash infusion to jump-start primary care reform, with a heavy emphasis on a team approach and 24-hour access to care (see Editorial, page 141).
And Rosedale is probably exactly what Romanow has in mind: this group practice has already brought physicians, nurse practitioners, nutritionists, mental health counsellors, a dentist and a chiropractor together in Hamilton's east end. The team approach allows the group's 6 family physicians to have fairly large practices — 3 have more than 2500 patients each.
“It's fun to come to work,” says Dr. Adrian Hornich, a cofounder of Rosedale. “I feel good at the end of the day.
“If I don't know what an answer is — if I'm not sure about a rash, for instance — I can walk down the hall and ask another doctor to have a look. We save the government a lot of money with these corridor consultations instead of automatically referring problems. And patients have a lot of comfort knowing we work together.”
The Rosedale family physicians are part of Ontario's Family Health Networks (FHNs), which are designed to keep care affordable and increase access to doctors. As of December, 22 FHNs were operating in Ontario, although the province says it hopes to have 80% of FPs practising in them by 2004 (CMAJ 2002;167[10]:1159).
The FPs at Rosedale, who are paid by capitation, share on-call duties. Another 21 physicians are available to provide clinics or evening and weekend coverage.
“It's great,” says Dr. Tony Opie, another partner. “I work only 2 weekends a year.”
Working with that number of doctors also makes it easier to find someone to cover staff holidays or attendance at CME programs. As well, a general psychiatrist visits every 2 weeks, and psychiatrists who treat geriatric patients and children provide clinics for a half-day every month.
Nurse practitioners help reduce the FP workload by seeing patients with minor ailments, such as some ear and throat complaints. On weekends, a telephone triage service staffed by registered nurses is available.
“Often, the nurse is the first person a patient talks to, and it cuts down a lot on calls to physicians,” says Opie. “It also keeps people out of emergency departments.” — Ken Kilpatrick, Hamilton