Dr Barnes https://drbarnes.ca/ Thu, 07 Nov 2024 13:44:57 +0000 en-US hourly 1 https://drbarnes.ca/wp-content/uploads/2024/01/favicon-32x32-1.png Dr Barnes https://drbarnes.ca/ 32 32 Macleans: “Why One Family Doctor Took a $250,000 Incentive in Rural Ontario” https://drbarnes.ca/macleans-why-one-family-doctor-took-a-250000-incentive-in-rural-ontario/ Thu, 07 Nov 2024 13:39:05 +0000 https://drbarnes.ca/?p=5675 As told to Marta Anielska by Dr. Corli Barnes   In 2022, I moved from Manitoba to Sudbury, Ontario, for my medical residency. I was drawn by the pressing need for family doctors in rural communities. During my time in Sudbury, I saw how short-staffed and underfunded rural hospitals and clinics were. Everyone ran double-time […]

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As told to Marta Anielska by Dr. Corli Barnes

 

In 2022, I moved from Manitoba to Sudbury, Ontario, for my medical residency. I was drawn by the pressing need for family doctors in rural communities. During my time in Sudbury, I saw how short-staffed and underfunded rural hospitals and clinics were. Everyone ran double-time to keep things afloat. Family doctors shouldered a huge burden and often fashioned themselves into pseudo-specialists to fill in critical gaps. For example, some patients I saw had advanced, undiagnosed endocarditis—a potentially fatal heart infection that often stems from untreated minor infections like UTIs. Most of these patients didn’t have a family doctor, so their condition went unnoticed until it became severe. By then, they needed a specialist, but they often had to wait for days. Meanwhile, their primary caregiver would scramble to absorb specialized knowledge and devise a treatment plan quickly. Sometimes, it was already too late. Once, a patient asked me what they could have done to detect their endocarditis sooner, and all I could say was, “It’s not your fault. The system is broken.”

 

My dream was to open my own innovative practice—one that would streamline admin work with new tech, foster strong patient-doctor relationships and give patients tools to monitor their own health. But about a year into my residency, reality hit: I’d need at least $100,000 annually just to cover operating costs. And that would be on top of the $300,000 in student debt I’d racked up over a decade of intense training to become a family physician. The City of Greater Sudbury offers new doctors a $20,000 signing bonus, but that would barely make a dent. Most doctors drawn to these incentives are fresh out of school, eager to get established but often needing great financial support to do so, like me. My only other option in Sudbury would be to work as a hospitalist until I could save enough to open my own practice—if I wasn’t burnt out by that point. I started looking for better incentives.

 

Around this time, I also became interested in the business side of running a clinic, especially billing—an essential skill for family doctors that’s never taught in med school. As a result, many of us end up billing incorrectly or inefficiently, wasting time that could go to patients and adding to our financial strain. During my research, I came across Adam Stewart’s website. He’s a doctor who practices in Madoc, Ontario, a small town of 2,200 people halfway between Toronto and Ottawa. I arranged to do an elective in his clinic in September of 2023, and it was a game-changer. The doctors had a refreshing energy I hadn’t seen in a long time, and the staff—many of whom had been there for over a decade—were paid better than in other clinics. Stewart’s electronic medical records were set up impeccably, and every process was streamlined. I found out Madoc was offering its own $100,000 signing bonus, plus another $150,000 from Hastings County over five years and about $86,000 from the Ministry of Health’s Northern and Rural Recruitment and Retention Initiative, or NRRRI. These incentives would help me cover my startup and operating costs. I couldn’t pass the offer up. In July of 2024, my husband and I sold our Sudbury home and moved to Madoc.

 

I didn’t expect the Ministry of Health to throw so many hurdles in my path. Bureaucratic red tape nearly pushed back my practice’s opening date. I’d submitted all the required paperwork in early July, and the ministry assured me it would be processed in time for my September 1 launch. But in August, my office manager received an email demanding yet another form, rehashing all the details I’d already provided and effectively delaying my start by a month. It was only after my office manager sent a strongly worded email to the ministry that they finally agreed to expedite their process.

 

I was also told by the Ontario Medical Association that I would likely not receive the NRRRI, even though Madoc is listed as an eligible community on their website—all because my clinic sits just 500 meters beyond a municipal boundary, a technicality not clarified anywhere online. When I applied for income stabilization, which helps new doctors get paid while building a patient base, I was again refused the additional $20,000 that rural doctors typically receive. The reason was the same technicality, despite the fact that I clearly work in a rural area and face the same challenges rural doctors do.

 

Financial pressure has been a constant. Affordable rentals in Madoc are practically non-existent, so my husband and I have been bouncing between Airbnbs for the last few months, trying to save enough for a down payment. Meanwhile, inflation has driven up the price of medical equipment. Exam tables alone can exceed $10,000 apiece now. It’s been hard to juggle these steep costs with the rising cost of living.

 

The work is tough but rewarding. Many of my patients have never had a primary physician. Some are grappling with conditions that should’ve been caught years ago. At least now I can help them. In Hastings County, about 25,000 people don’t have access to a primary care physician or nurse practitioner, and I’m determined to shrink that gap. I’m starting from scratch rather than taking over another doctor’s practice, so I’m constantly enrolling patients—a process that will take up most of my first year here. New patients are often more open-minded about what they want from a doctor, which gives me room to bring in new technology and processes.

 

The broken system feeds into a vicious cycle: fewer family doctors mean fewer early diagnoses of treatable conditions, which piles even more pressure onto hospitals and specialists who are already overwhelmed. That pressure inevitably shifts back to family doctors, which is why municipalities are offering incentives in the first place. But, as my experience shows, these incentives aren’t bonus money. They’re more like startup funds; they only cover the essential costs to move and set up a practice in a new location. They should exceed $100,000, especially since doctors are being asked to relocate, often to areas with limited housing options, outdated equipment and unreliable internet to essentially launch a new business. For more established doctors, the emotional cost is also high. Moving to a new town isn’t just leaving a practice—it also means leaving thousands of patients behind.

 

On a larger scale, the ministry doesn’t recognize the value of family physicians, which shows in their administrative red tape and our low pay: a family doctor’s expertise is valued at just $39 per patient visit. Investing in family doctors would save the province money in the long run. I want to spend more time on treating patients early, helping them before they need a specialist, an ER visit or face the lasting impact of an advanced illness. I also hope to develop tools that will help doctors save time, like an app to streamline billing or connect family doctors with nearby specialists for quicker referrals. But it’s impossible to invest my time or money into these ideas when I’m just trying to survive.

 

Family physicians are in crisis, and ignoring that won’t make it go away. We need to value the backbone of our health-care system by providing family physicians with the resources they need—financial and otherwise. The result will save lives.

 

https://macleans.ca/society/health/family-doctor-shortage-canada-rural/

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The Why Behind This Website, Annual Plans and this Way https://drbarnes.ca/the-why-behind-this-website-annual-plans-and-this-way/ Sun, 22 Sep 2024 23:08:31 +0000 https://drbarnes.ca/?p=5451 I’ve put a lot of thought into how I’ve chosen to structure my practice, and it all comes down to one central goal: providing the best possible care for my patients. Let me show you why this is true, annual plans and all. I’ll start by telling you two stories.   Imagine being a fly […]

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I’ve put a lot of thought into how I’ve chosen to structure my practice, and it all comes down to one central goal: providing the best possible care for my patients. Let me show you why this is true, annual plans and all. Imagine being a fly on the wall of a family medicine office. A patient comes in for a follow-up on a medication start and the doctor notices a mole on their leg during the visit. They biopsy it and it comes back as melanoma. A scary, potentially fatal disease process is interrupted early. All that’s required is a simple, small lesion removal and yearly skin check. Now you’re on the wall of an internal medicine ward in a hospital. You watch as a physician dawns a biohazard suit and passes through two doors to get to an isolated patient laying in a bed. They sit down on a chair by the patient and tell them that their persistent back pain, which they had sought care in walk-in clinics and emergency departments on multiple occasions, was, in fact, caused by an infectious disease. They explain that, unfortunately, it is now spread and while there is an aggressive treatment plan – the prognosis is poor. Being a resident is, in many ways, like being that fly on the wall. You see the stark contrasts, the missed opportunities, and the devastating consequences. Back pain with non-specific symptoms has a differential diagnosis as long as the list of things wrong with healthcare today. In a one-off evaluation (as in a walk-in clinic or emergency department), it’s almost impossible to diagnose back pain as this type of infection without an incredibly astute and descriptive patient. One who strikes a balance between sounding like they googled their symptoms and just providing the needed information. But what if you had the benefit of seeing the patient over time and multiple visits? What if the physician had the resources and staff to be available for appointments and weigh your patients at every visit? What if the physician had what is needed for organized, detailed notes and technology that makes seeing the change in weight over time easy? Imagine if the physician’s brain was sharp during their visit and not numbed from hours of redundant paperwork. Maybe then it wouldn’t be impossible to diagnose. Maybe that patient gets diagnosed a year earlier. Maybe that patient survives. And maybe I, when I was a resident on the internal medicine service, didn’t need to hold the hand of that patient’s family member while they shook with devastation and tears because their loved one was likely to die. Maybe I don’t have to look at them in the eyes without answers as they ask me why this was missed the other 10 times they presented for care. If you’re looking at this website, if you’ve seen my enrollment process, if you’ve read through my annual plans, maybe you asked yourself “why” – and that would be a very good question. Well, this story is, unfortunately, not unique in our system today. This is what happens when you don’t have a strong backbone of general practice physicians who have longitudinal relationships with patients. The logical thing is to ask, once again, why? Why are we here? More importantly, how can we change it? And, if you were me years ago, maybe you’d have also asked yourself “how can I help change this? What can I do?” I can run a practice where sending in a request or message isn’t hard, time consuming or scary. I can run a practice where technology is leveraged to help me be thorough and organized, where electronic health records make it easy to track changes in a patient’s condition over time. I can choose a clinic that doesn’t shy away from innovation. I can maximize my resources so that I spend my time doing what I was trained to do – medicine. I can be honest about what I need to keep doing this work for decades to come, rather than burning out in year five. And, if I find a way, maybe I can advocate for change. Change is not easy, but clearly, it’s necessary. By running a practice that prioritizes quality and efficiency, leverages technology, and values innovation, I believe I can make a difference. It’s not just about providing better care for individual patients, though that’s certainly at the heart of it. It’s about creating a system that supports and empowers strong family medicine. A system that would allow family doctors to do what they do best – to be there for their patients, to catch the subtle signs, and to prevent devastating outcomes. The reality is that having robust financial resources is what allows a physician to run their practice in the way that maximizes their care. Without it? Well, all you have to do is look around your local ER to see the result. And no, the recent 7-10% raise for physicians the Ministry of Health was recently unwillingly forced to pay doesn’t fix that a family doctor today makes 20-25% less than in 2002, despite increasing complexity in medicine. So yes, as much as I wish I didn’t have to, I have a website, and I have annual plans. Yep, these plans help cover costs for services that the government doesn’t pay for, but it also helps me implement systems that improve my quality of care. It helps me help you. It helps me trial different ways of doing things so that maybe in the future things can be better, for everyone.

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Why I’m Starting a Family Practice in Today’s Healthcare Landscape https://drbarnes.ca/why-im-starting-a-family-practice-in-todays-healthcare-landscape/ Mon, 12 Aug 2024 10:00:23 +0000 https://drbarnes.ca/?p=5487 As a young physician just completing my residency, I’m excited to announce the opening of my family practice here in Madoc, Ontario. In a time when many are hearing about physicians stepping away from practice or retiring early, you might wonder why I’m choosing this path. I’d like to share my perspective and vision with […]

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As a young physician just completing my residency, I’m excited to announce the opening of my family practice here in Madoc, Ontario. In a time when many are hearing about physicians stepping away from practice or retiring early, you might wonder why I’m choosing this path. I’d like to share my perspective and vision with you.

A Passion for Clinic-Based Family Medicine

First and foremost, I’m driven by a deep passion for clinic-based family medicine. I believe in the power of continuous, personalized care that family physicians can provide. We’re uniquely positioned to see the whole picture of a patient’s health, catch issues early, and guide people towards better overall wellness.

A Vision for Efficient, Patient-Centered Care

I have a vision for how family medicine can be practiced more efficiently and effectively in today’s world. This is why you’ll see some modern approaches in my practice, like an online waitlist and a comprehensive website. These tools aren’t just about convenience—they’re about creating a practice that can devote more time and energy to what really matters: patient care.

Facing Challenges Head-On

I won’t sugarcoat it—starting a family practice as a young physician in Canada today comes with significant challenges. The ongoing underfunding of family medicine by the government is a real concern. I’ve already encountered hurdles, such as being denied a rural income supplement due to being located 494 meters
from a municipal line.

These challenges mean I’m having to be creative and resilient. I’m building time into my schedule for alternative income streams to ensure the sustainability of my practice. But I want to be clear: my primary focus remains on providing the best possible care to my patients.

A Commitment to Community Health

Despite these obstacles, I’m committed to making this work. I believe that our community deserves access to high-quality, consistent family medicine. By opening this practice, I’m investing in the health of our community for the long term.

Looking Forward

I’m under no illusions—the path ahead won’t be easy. But I’m here because I believe in the value of family medicine and the difference it can make in people’s lives. I’m excited to meet you, to be part of this community, and to work together towards better health.

As we embark on this journey together, I welcome your thoughts, questions, and feedback. Let’s work together to create a healthcare experience that truly serves our community’s needs.

Learn More About the State of Family Medicine

To gain a deeper understanding of the current landscape of family medicine, I encourage you to explore the following resources:

  1. Ontario Medical Association on Primary Care
  2. No concern about ‘diminished supply’ of doctors: health ministry
  3. Number of Ontarians without family doctor reaches 2.5 million, college says
  4. Want more family physicians in Ontario? Pay them better, say physicians.
  5. Article on challenges new physicians face
  6. College of Family Physicians of Canada – Crisis in family medicine

These resources provide valuable context to the challenges in family medicine today. They can help you understand why your support and engagement with your family physician is more crucial than ever.

Remember, an informed patient is an empowered patient. Together, we can work towards a stronger, more resilient healthcare system.

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