Peterborough's Turnbull Medical Building, formerly a retail store, is being renovated to house family health teams and the new Maternity and Infant Care Centre.

You’ll have to forgive Dr. Don Harterre for choosing a winged warthog as his office mascot. The diminutive porker suspended above his desk serves as a delicious metaphor in view of recent success implementing family health teams in Peterborough, Ont., — something one local physician predicted would only happen "when pigs fly."

In Peterborough, an idyllic city of 75,000 located 90 minutes northeast of Toronto, health care is something people love to talk about these days.

Little wonder. The sprawling, state-of-the-art Peterborough Regional Health Centre (PRHC) is slated to open in June, consolidating two outdated hospitals into one meticulously planned facility. The Peterborough Clinic has just moved into a new building adjacent to the PRHC, with its orphaned facility downtown tagged to house expanded vascular health services. Five family health teams are flourishing. And upwards of 14,000 people have come off the waiting list for a family doctor in the past two years.

Dr. Harterre, a driving force behind the family health team concept, says doctors tell him it’s fun to come to work again. But it wasn’t always this way.

In what is becoming a familiar refrain across the province, the number of doctors in Peterborough was dropping and the health-care delivery system was in critical condition. Family doctors were retiring, as did Harterre earlier in the decade. While he was fortunate to find someone to take his patient load, others weren’t so lucky — fewer med school graduates opting for family practice translated into a lack of willing candidates.

Displaced patients gravitated to an aging hospital for everyday complaints, clogging the emergency room. This drove the need for more hospital staff, creating a vicious circle — in an effort to escape low compensation rates and the high overhead inherent with family practice, many family docs closed their offices and took jobs at the hospital.

As for the newly trained physicians who should have taken their place, "Thirty years ago, 50 per cent of all graduating medical students were becoming practising general practitioners [GPs]," says Harterre. "By year 2000, that percentage was down to 2.5."

Better compensation rates in other disciplines served as the force driving med students to specialize. While 25 per cent of medical students trained for family medicine, Harterre says few were setting up a practice, opting to work in a clinical setting or as a hospitalist.

"The perfect storm," he says, with a pained smile.

Family health teams

It’s a storm being felt across Ontario and beyond, as governments and the medical community come to terms with an aging population and a chronic shortage of trained medical staff. The Royal College of Physicians and Surgeons predicts that by 2010, Canada will be short 10,400 doctors.

Ontario decided to try the concept of family health teams, in which doctors and other health-care professionals work together in a way that promises greater efficiencies. Peterborough is among the first communities to put the idea to work.

Within the old health-care framework, a patient could wait days to see a doctor, depending on caseload. The family health team model also starts with a call to the doctor's receptionist. However, in this context the receptionist can direct the patient to a nurse practitioner, nutritionist or other person who can address their issue immediately if it's not something that necessarily requires a doctor's attention.

"The consumer sees the most appropriate person, at the most appropriate time," says Bill Casey, the communications specialist who developed the business case for the new hospital.

Not all doctors are keen on the concept. Family doctors in general have been slow to grasp the benefits of sharing space, and ultimately their practice, with others. Practising medicine in much the same way as the generations before them, many doctors have been reluctant to embrace change. For these docs and their communities, the pigs have yet to earn their wings.

Casey notes that patients have had to get used to the team approach as well.

"Patients, initially, may not see their family doctor right away," he says, pointing out that they might see a nurse practitioner, social worker, dietician, or some other skilled worker acting as a conduit of the family doctor. "Even if you hadn’t lost your family doctor, this change had a lot of people feeling somewhat disenfranchised."

However, people have been discovering that care and wait times have improved, "and patients by and large have been very accepting," Casey adds.

Team approach

Peterborough was ahead of most other communities in terms of doing what was necessary to make family health teams work. Aware of the growing crisis, physicians and family doctors were pulled together in the spring of 2001 for a conference.

With fees clawed back by previous provincial governments, GPs were seeing their caseloads and costs balloon, while those entering the more specialized medical fields were enjoying increased levels of compensation.

"[Family] doctors were a pretty frustrated bunch, and it wasn’t without justification," Harterre says.

While much of the conference was a gripe session, the seeds were sown for what would become a new way to attack an old problem.

Cut to May 2003, when a meeting of the minds in the Peterborough medical and health service communities began formal discussions on how to reform the delivery of health care in the city and surrounding Peterborough County. If the community could not attract additional doctors, how might existing doctors care for more patients, and what supports might be brought to bear to allow that to happen?

Led by Dr. Harterre and Casey, the group addressed all the issues — from the incentives needed to sell the concept to doctors, to the need for clinical space.

With input from the hospital and health-care stakeholders, the nascent Primary Health Care Services of Peterborough (PHCS) worked through the summer of ‘03 and hammered out a framework for the Peterborough Networked Family Health Teams. When the newly-elected McGuinty Liberals announced the adoption of family health teams, it crystallized the PHCS concept. Ontario had a destination in mind, Peterborough supplied the road map.

In September 2004, the provincial government rolled out the Family Health Teams model and in January 2006, Peterborough City and County were fully funded for five teams. The smallest has five doctors, the largest 26 — the City of Peterborough has two fairly large health teams, a third is just northwest of the city in the town of Bridgenorth, and two more are spread throughout the remainder of Peterborough County.

The new model gives the family doctor new support, and levels of compensation for GPs are much, much better than a few short years ago. The waiting list is shrinking, and patients are able to access care more quickly, given the opportunity to be seen by a health-care professional qualified to address a particular health issue that doesn’t necessarily require a doctor right away.

Maternity centre

The next big push is toward outpatient services and a disease management strategy, bringing specialists into the mix to ensure that the burden of care on the family doctor is appropriate. The new PRHC, opening in a few months, is helping to attract the additional specialists.

In early January, it was announced that an empty heritage downtown building, constructed in 1888, would be re-developed into the Turnbull Medical Building. Expected to be open by the summer, it will provide even more breathing room for Peterborough-based family health teams, and space for the new Maternity and Infant Care Centre.

"If these concepts can take hold, and it works in a place like Peterborough … then it really sets a benchmark," Casey says.

"Nowhere in the country does the system function like a system … if we keep the patient as a focal point, we can do a lot innovative things," he adds.

Some call it evolutionary, while others see it as revolutionary. Those taking the middle ground state quietly that they have simply found a better way to practise medicine … with a nod to a little pig that’s earned its wings.

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