By Jeff Helsdon
Many Tillsonburg residents were left scrambling for a family doctor after two retirements and two re-locations within the last year.
Dr. Johnson and Dr. Makone had previously left town when Dr. Brian Holowachuk retired in early September, and Dr. Wil Cheng was done at the end of September.
Dr. Shameena Tamachi, primary care physician lead for the Oxford Ontario Health Team, said the situation will worsen with two more physicians expected to retire in 2026.
“That translates into 60 per cent of Tillsonburg residents being with a family doctor,” she said, or 11,000 people.
With doctor retirements, patients are sometimes moved to other doctors in the same town.
“They did discuss the possibility of some patients being transferred to another doctor, but the unfortunate part is everybody’s roster is full,” she said.
Although the situation seems dire locally, it is similar across the province.
“Tillsonburg is not alone in this situation, but the unfortunate part of this is it’s happening right across the province,” Tamachi said, adding that 2.5 million Ontarians are without a family doctor.
She called for more government funding for doctors to keep pace with inflation as one possible solution to the problem.
In Ontario, there are various funding models available to physicians. The doctors in Tillsonburg are members of Family Health Organizations (FHO). This model helps to provide after-hours care for all patients who belong to the FHO, which the Ministry of Ontario helps to fund.
Recent graduates and most family physicians now prefer a team-based healthcare system. With this model, the doctors are similar to employees of the team. The Family Health Team (FHT) is an example of this, where FHO physicians are able to align themselves with a FHT which provides their patients with access to a nurse practitioner, registered nurse, pharmacist, respiratory technician, social worker, occupational therapist, and other health care professionals.
Adding to the health care issue is the fact people live longer and have multiple and more complex health care issues. Tamachi explained this results in longer appointments with the doctor.
The recent hiring of a nurse practitioner for Tillsonburg District Memorial Hospital’s emergency department was intended to help alleviate the wait time for those without a family doctor who go to the hospital. Several other options are available, including the Tillsonburg Medical Centre Urgent Care Clinic on Saturday mornings and walk-in clinics in surrounding communities.
Tamachi believes the solution is emergency government funding to build a new clinic in Tillsonburg and funding for a team-based health care.
“If we can build that in Tillsonburg, it can draw physicians to Tillsonburg,”
Community Health Care Advisory Committee
The town formed a Community Health Care Advisory Committee in 2015. Since then, both the hospital and town have contributed funds to assist the existing practices to recruit family physicians. Both entities also contributed funds to hiring a physician recruiter for Tillsonburg, who was hired earlier this year. Unfortunately, that person left for another position.
The MPP’s viewpoint
Oxford MPP Ernie Hardeman acknowledged that more and more Ontario residents are going without a primary care provider. He said the problem is there aren’t enough primary care providers to meet demand, and although this situation is improving, he admitted it’s not improving fast enough.
“The problem we have in Tillsonburg is the doctors that become available are choosing not to come to Tillsonburg,” he said, noting there were recently two doctors who located in Woodstock. “The province doesn’t have the ability to tell people where to go to practice.”
Hardeman noted that the doctor number in Oxford County as a whole is not that low. The present problem is that there aren’t enough doctors to replace those retiring.
He echoed what Tamachi said, that doctors prefer to live where there is a team-based health care system, but he didn’t believe emergency funding was the solution.
“Emergency funding is not the answer when we have a lack of doctors,” he said. “Emergency is when we have the doctors but no way of paying them.”
Hardeman believes the FHO system for the existing clinics is part of the problem why doctors aren’t locating in Tillsonburg.
“One of the challenges we have had for a long time is Tillsonburg has had just family doctors (as opposed to a team-based setting), and doing a great job,” he said. “New doctors don’t want to be on call 24 hours.”
Hardeman has been pushing for a team-based nurse practitioner clinic in Tillsonburg, similar to the one in Ingersoll (see sidebar)
“That’s a small bit, it’s not enough, but it helps,” he said.
The MPP also disagreed more money for existing doctors was a solution to the problem.
“The challenge of giving more money to doctors we have won’t solve a problem. We need to find a way to get more doctors,” he explained.
While the province has a program providing incentives for doctors in rural and northern areas, Tillsonburg doesn’t meet the criteria for that program as it looks at Oxford County as a whole.
“On average, there is a good ratio of doctors to patients in Oxford. People in Oxford aren’t far from doctors,” he said.
Since Hardeman was interviewed, there have been recent developments in the provincial health care scene. The Ford government appointed Dr. Jane Philpott, a former federal health minister and doctor, to lead a new primary care action team. The provincial government will also introduce legislation requiring Ontario medical schools to reserve 95 percent of their spots for students from within the province.
Efforts to expand Nurse Practitioner-Led Clinic to Tillsonburg continue
In June 2023, the Ingersoll Nurse Practitioner-Led Clinic applied for funding to expand and open a second location in Tillsonburg, with the aim of providing primary care to 3,200 patients currently without primary care providers. However, the application was not successful.
The Ingersoll clinic, which already provides care for 3,200-plus patients, is a team-based model of care that integrates various services. According to Stephanie Nevins, executive director of the clinic, it is not a walk-in clinic; each nurse practitioner manages a caseload of enrolled patients.
“Our mandate includes providing team-based primary care access to patients without a primary care provider,” Nevins explained.
Oxford MPP Ernie Hardeman is continuing to push for an expansion of the clinic to Tillsonburg, and brings the topic up often with the health minister.
This application shouldn’t be confused with the nurse practitioner who recently started at Tillsonburg District Memorial Hospital in the emergency department, or the approval for one of the clinic’s community partners, the Oxford County Community Health Centre (CHC), which did receive funding for a nurse practitioner working from the Livingston Centre.Ox.
Looking Ahead: Collaborative Efforts
Nurse practitioners can provide primary care similar to that of family doctors, though they have some limitations, such as certain forms and nuclear medicine tests. Each nurse practitioner-led clinic may work with a consulting physician for this reason.
“Nurse practitioners are not meant to replace family physicians; instead, they offer a different model of care,” Nevins noted.
Despite the recent funding setback, the clinic remains committed to working closely with various community partners, the Oxford OHT and Ontario Health with an unsolicited approach for a Tillsonburg clinic. “We continue to work diligently to be a part of the local solution,” Nevins added, with hopes that the Tillsonburg expansion will eventually become a reality.
The main goal is to continue to foster partnerships with the local providers, and expanding the model increasing access to primary care and ultimately enhancing patient care collectively in the region. If the full application was approved, social workers and RPNs could work with doctors in existing clinics.
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