Buy your own doctor (Globe and Mail article June 17)

[Guest macMDstudent]

I don't know if anyone else saw the article I'm referring to, but it struck me as being not entirely legit. It seems to me to be a clear a case of two tier medicine since the patients MUST pay a fee in order to access these family doctors and get access to OHIP covered services. The fee is not cheap either, at $2,500 PER YEAR to join the practice as a patient, although some other "lifestyle counselling and wellness care" is thrown in with the fee. I'm not against preventative health care at all, but it seems to be a bit of a "pay or else you may not have a family doctor" thing going on. The doctors only have 150 patients each in their practices, and once the patient joins, OHIP is billed for the services that are covered. Even if none of the patients came to the office in a year, each doc still collect $375,000! A patient who doesn't pay the fee can't join the practice. These seems to go against the accessibility part of the Canda Health Act. However, in the article the docs say that their system is just fine. Any thoughts?

 

Since the link will be removed from the Globe and Mail website in a few days, I have copied the text into this posting.

 

 

Buy your own doctor

 

 

By MARGARET WENTE

The Globe and Mail, Tuesday, June 17, 2003 - Page A17

 

Toronto human-resources consultant Lori Sone-Cooper has the kind of family doctor you and I can only dream of. Unlike the rest of us, she never has to cool her heels in the waiting room. She can always get an appointment right away, and the doctor is never in a rush. House calls? No problem. Phone calls?

 

No sweat. She can always get the doctor on the phone, even nights and weekends. And when she needs a specialist, her doctor will personally get on the blower and find her a good one.

 

Ms. Sone-Cooper, not surprisingly, loves her medical care. "Rochelle is a wonderful doctor," she testifies happily. "She's so patient-focused."

 

So what's the catch?

 

Ms. Sone-Cooper has hired her own private doctor's service. Her doctor works for her first, and the government second.

 

Drs. Rochelle Schwartz and Sharla Lichtman operate their business in a pleasant low-rise office building in North York, on the fringes of Toronto. Their business is called the Genesis Professional Group, and it offers what they call "personalized health care planning." The cost is $2,500 a year. For that, you get a detailed medical workup, a fitness evaluation and exercise program, a "lifestyle and emotional health assessment" by a social worker, a nutritional assessment by a dietitian, and a customized health care plan tailored just for you. You also get Dr. Schwartz or Dr. Lichtman any time you need them, 24/7.

 

"It's very reassuring for patients, says Dr. Lichtman, 43. "They say, 'You're my security blanket.'"

 

The two doctors haven't entirely opted out of the health-care system. Their patients don't pay a cent for "medically necessary" services. For those, the doctors are reimbursed by OHIP. But they aren't dependent on their OHIP billings. By charging money for what they call their wellness package, they've been able to opt out of the rat race that is driving more and more family physicians out of the profession. The average family doctor in these parts looks after more than 2,000 patients. Drs. Schwartz and Lichtman aim for 150 each. The average family doctor sees 30 or 40 patients a day. Drs. Schwartz Lichtman see a handful.

 

"This means I can be home for my kids at 4," Dr. Lichtman says.

 

As they tell it, it's not about the money. It's about having time for their families (they have five kids between them), and about being able to practise medicine the way they dreamed of when they went to medical school.

 

"This holistic approach was something we talked about for many years," says Dr. Schwartz, 48. They are big believers in wellness and prevention (the new mantra of the health-care system). No doubt they also like escaping from the bondage of a fee-for-service system, which breaks a patient down into billable bits and doesn't pay a cent for returning her phone call, renewing her prescription or finding a way to get her an MRI without an indecent wait.

 

And that is one of the advantages of signing up with Genesis. "We have more time to advocate for our patients," is how Dr. Schwartz puts it.

 

Dr. Lichtman tells the story of one of her clients. Recently he had a medical event that required her to consult with a neurologist. "Your guy needs an MRI," he said. But the SARS crisis had broken out, and MRI machines across the city were shut down. She persisted until she found one for him. "I was on the phone for eight hours," she says.

 

The doctors say they've had little trouble finding clients, who range in age from 13 to 92. By no means are all of them rich. As the mother of two, Ms. Sone-Cooper, 36, has to watch her money carefully. But she thinks she gets value for it. "I work very hard. I felt this was an investment in me." She also likes the fact that the next time she has to navigate the system, she won't be left alone in the dark without a compass.

 

Does all this amount to key money for access? Some people might look at it that way. Some people might also fret about the several thousand patients that Dr. Schwartz and Dr. Lichtman are no longer caring for, or the loss of two more family doctors from a public system that is already suffering from an acute shortage.

 

But Drs. Schwartz and Lichtman stress that they're playing entirely by the rules. And, after all, they're only offering the type of medicine already available to thousands of senior executives.

 

Other doctors aren't resentful, they say. "They want to know when we're going to franchise," Dr. Schwartz says with a laugh.

 

The moral of the story? When the public system can't deliver, people will always find a way around it. It's no surprise that these two doctors have found a way to deliver better medicine. The surprise is that thousands of others haven't stampeded to do the same.

 

mwente@globeandmail.ca

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