Business Retention and Expansion Study for Collingwood's
Medical/Health Sector

Final Report - July 2008

Forward

One of the most important activities undertaken by Collingwood Economic Development is to demonstrate support for local businesses and identify immediate issues affecting sustainability and growth. We are motivated to improve the local business climate and to broaden the discourse on economic development policies and procedures in order to:

• identify concerns that may result in the loss of local employers

• identify opportunities to help businesses expand their presence in the community

• build and strengthen relationships with individual employers

The BR+E survey offered Collingwood’s Medical/Health leaders with anonymous opportunities to rank the quality of community services; assess the workforce and identify key barriers to growth for the community.

The BR+E process used by the Town of Collingwood was developed by the Province of Ontario, through its Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) and is to be utilized with a web based BR+E application.

In presenting findings of Collingwood’s Medical/Health Business Retention and Expansion, it is important to consider how local health care is provided.

The types of health care and some of the key local health care agencies and providers are detailed below.

Primary Health Care (PHC) is the first point of contact between a patient and the health care system. Primary care in Ontario strives to provide for comprehensive primary health care to respond to the needs of the whole person, and ensure continuity of care, acute and chronic disease management, as well as health promotion and disease prevention.

The current core elements of primary health care are:

• comprehensive primary care

• expanded access through the Telephone Health Advisory Service and extended hours of practice

• voluntary patient enrolment with a physician

• patient-based funding

• inter-disciplinary care

• grouped or networked practices

• extended hours of access

• access to preventive care and comprehensive care incentives

Tertiary healthcare is specialized consultative care, usually on referral from primary or secondary medical care personnel, and provided by specialists working in a major medical centre offering special investigation and treatment. For example, specialist cancer care, neurosurgery (brain surgery), burns care and plastic surgery are examples of tertiary care services.

Presently, health care services throughout Ontario are fragmented with many health care providers working, planning and delivering care in isolation. Often, patients and their families are forced to make their own way through a very complex health care system, as they move from one health service provider to another. To address these problems and effect change, the Ontario Government passed historic health care legislation in March 2006, creating the Local Health System Integration Act, 2006.

The North Simcoe Muskoka Health Information Network (LHIN) is one of 14 local entities operating under that Act designed to plan, integrate and fund local health services, including hospitals, community care access centers, community health centers, long-term care homes, mental health and addiction programs and a variety of community support service agencies within our specific geographic areas. Collingwood is served through the North Simcoe Muskoka LHIN with its health needs and priorities best understood by people familiar with the needs of our community and the people who live here.

While the LHIN will not directly provide services, the North Simcoe Muskoka Health Information Network is mandated to create a patient friendly, integrated health care system focused on patients, clients and their families designed to support the macros of the entire health care system through a number of strategic directions.

Collingwood G&M Hospital is a regional Referral Centre serving residents of the Town of Collingwood and a population living up to 100 kilometers beyond the Town. They employ a group of family doctors with Active Staff Privileges who oversee and manage transient patients.

These doctors cannot accept “orphan patients” (those without a family physician) into their practice after their discharge from hospital, even though they cared for them during the period of their hospitalization. The transient patient care offers only a temporary ‘band-aid’ solution for the “orphan” patient problem, since they still remain “orphan” patients once discharged.

The G&M Emergency Department handled approximately 30,000 visitors for the period April 1, 2007 to March 31, 2008.

According to information provided to Collingwood Economic Development by the Chief of Staff and the Chief of ER of the G&M Hospital very few local people use ER for primary care or the After Hours Clinic. “Both the ER and After Hours Clinic receive a lot of visitors who don’t want to travel to their family physicians and local people who come for episodic reasons. They don’t use it for primary care.” (Email received 3/31/08)

In determining whether or not Collingwood is at capacity locally with Doctors, it has been reported that some local physicians retain their registration with the Provincial Medical Association, despite being retired. Further, it is reported that another segment of some local physicians do not carry a full complement of patients and, are in fact semi-retired, yet maintain fulltime registration with their Association. Consequently, it would appear the Province has an inaccurate count on the number of physicians who practice and service Collingwood on a full-time basis, when in fact that is not the case and a possible reason why Collingwood area is not identified as being an under serviced area medically.

Collingwood has been provided with a wonderful opportunity to serve as the Provincial headquarters of the Rural Ontario Medical Program (ROMP) for the 20 years of its operation. Funded through the Ministry of Health and Long-Term Care of Ontario, ROMP provides medical education, recruitment and retention to over 65 rural, regional and under serviced areas across south central Ontario.

According to Dr. Peter Wells, Executive Director from its inception, ROMP provides a local option for medical clerks, interns and residents to train and receive funding outside of the academic arena, through the Collingwood G&M Hospital as the teaching hospital.

ROMP’s local 8 person staff connects potential medical students with preceptors, with a number of G&M staff physicians acting as preceptors for medical students, interns and residents. ROMP learners benefit from the exposure of practicing medicine through one or more of their medical rotations in a rural or under serviced community in the south central area of Ontario, and the community is hopeful that after working locally, the learners will establish their practice in the Collingwood area.

According to statistical data provided, “between 2003 to 2008, the Rural Ontario Medical Program placed 128 learners for a grand total of 227.3 months in Collingwood.” In order to address our local health related needs, the Community Physician Retention and Attraction Committee, G&M, ROMP and private placements firms have collectively attracted 20+ doctors and specialists to move and establish practices in Collingwood from 2003 to 2006.

The face of establishing a career in medicine in Ontario is changing. The National Physician Survey is a joint effort of the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada. According to the 2007 survey findings, completed by 2,800 medical students and 730 second year residents, 60% of the medical students and 52% of residents report that achieving a balance between their work and professional lives as the most important factor when establishing a career in medicine.

According to Shaheed Merani, President of the Canadian Federation of Medical Students in his comments to CTV Canada on Monday April 28th, 2008;

“I think medical students, the medical residents and doctors alike will tell you that a good life-work balance is important in not only maintaining a healthy family, maintaining a healthy physical ability and maintaining a healthy mind, but it’s also important in the work you do and the quality of care you deliver to patients. So I think that the focus that medical students and residents are taking towards their work-life balance is very important and will result in better health care offered to patients across Canada.”

The changing patterns and their priorities in how physicians want to practice may impact on how government, medical schools and professional organizations address existing Canadian health care crises, such as doctor shortages, particularly in rural areas within Ontario and the long wait times currently experienced for certain medical procedures.

In this regard, the day is long since gone when doctors opened a practice solo after graduation. They must now be attracted.

Since its inception approximately seven years ago, and despite severe competition from other communities, Collingwood’s community based Physician Retention and Attraction Committee has been successful in working closely with the G&M Hospital in attracting 13 physicians to Collingwood, including 6 emergency room doctors, 3 Family Physicians, 2 specialists (anesthetist/E/R), an orthopedic surgeon, an internist and a general surgeon. Two doctors transferred from E/R with one assuming an existing family practice from a retired local physician and the second to start a family practice.

The Physician Retention and Attraction (PR&A) Community Committee remains dedicated to working closely with agencies including ROMP and G&M Hospital in the retention and attraction of physicians to Collingwood or to the catchment area of the Collingwood G&M Hospital. Its mission is to make Collingwood attractive to interested doctors and their families and to work with the Hospital and their physicians. This mandate remains increasingly important as we face a number of local physician retirees over the next five years.

For example, the PR&A Community Committee regular hosts “meet and greets” an initiative designed to introduce Collingwood to those physicians interested in relocating to the community. The PR&A Community Committee also acknowledges doctors must also be retained once they are here. To this end, local Physicians who serve Collingwood are honoured with an annual Physician Appreciation BBQ. Both activities have been well received by the physicians and their families.

The PR&A Community Committee also works with ROMP to encourage interns to return to Collingwood and open a practice. PR&A does a rigorous follow up on any prospective candidates e.g. partner in events, real estate, choice of educational facilities for youth, and employment or career opportunities for spouse.

The Georgian Bay Family Health Team (GBFHT) in Collingwood became operational in the fall of 2007. It serves a local area population of approximately 50,000, serving as a “collective” for its 36 member doctors. GBFHYT addresses the family physician shortage through the hiring of allied health care professionals that augments and supports local doctors. In order for their patients to access the augmented services, a physician must be a member of the Georgian Bay Family Health Team.

A Community Health Centre (CHC) is a not for profit organization that provides primary health and health promotion programs for individuals and families within a community. Established and governed by a community-elected Board of Directors, the Community Health Centre contributes to the development of healthy communities by working with individuals or families to strengthen their capacity to take more responsibility for their health and wellness. This is accomplished by improving access to primary health care. For example, a CHC can offer education and advice to assist families in accessing the resources they need from other community agencies such as self-help groups that provide peer education, support in coping, or are working to address other conditions that affect health.

In early March 2008, the South Georgian Bay Community Health Centre Executive submitted a formal request to establish a local Community Health Centre based on its findings that determined a need existed for the local area. At the time of writing this report, no decision or announcement had been issued on a local CHC location.

The Collingwood Walk In Clinic is located in the downtown core. It is open three hours daily including Saturday and Sunday. Presently, each GBFHT member doctor completes a minimum of one monthly rotation at the Walk In Clinic. As of the date of this draft report the total number of patients served by the walk-in clinic in 2007 was not available.



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