Mask shortage threatening family practices, doctors say
Family physicians cutting hours, patient care as pandemic response saps supply of needed protective gear
Some family doctors in Ontario say their practices are under threat because of the ongoing shortage of masks and other protective equipment caused by the coronavirus pandemic.
Nili Kaplan-Myrth, a family physician whose clinic is in Ottawa's Glebe neighbourhood, said she's had to limit her contact with patients almost entirely to phone and video calls because she doesn't have the gear she now needs to treat them in person.
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"We had to scramble to figure out how to provide the care that we need to provide," she said. "I have patients who need to be seen for their routine immunizations, and I can't get them into my office because we don't have personal protective equipment."
Among Kaplan-Myrth's approximately 1,400 patients are newborns, cancer patients and people in their 90s who are at greater risk of serious health complications from COVID-19.
Kaplan-Myrth said she's been able to procure two boxes of masks through a dentist in her family so she can continue to see her most vulnerable patients.
"That's 24 masks that allows me to see one baby a day for a month in order to provide their immunizations," she said. "But what do I do when somebody needs me to do a home visit or somebody needs me to to see them?"
Kaplan-Myrth said she normally sees about 25 patients per day. Now she needs to don mask, gown and gloves to see a single patient, then dispose of the gear and disinfect her office once they're gone.
She said she's also rationing the gowns and gloves, and has found someone to manufacture a face shield for her using a 3D printer.
Kaplan-Myrth is one of many doctors in the province who falls under the family health group model, which means she only gets paid a fee for services she provides to patients.
So in addition to her concern about her patients, she's also worried about her practice's financial viability because the shortages severely restrict the number of patients she can see.
"We don't know whether this is going to be sustainable, but our expenses month to month are enormous," she said.
Those expenses include paying for nurses, cleaning and access to electronic health records.
Kaplan-Myrth said other doctors who are paid a monthly rate based on the number of patients they have registered, or their association with a community clinic or hospital, will be more stable than family physicians like her.
"It's really like there's cracks in the health system, and this has let the light in. Family doctors, we are the least stable in terms of our businesses, and this is what just might do us in."
Concern about collapse
Javed Alloo, a family physician in Toronto, said his practice is closing on weekends and cutting weekday hours short as it braces for the impact of COVID-19.
"We don't have the [personal protective equipment] to keep things safe along the way. Staff are already getting burned out," he said.
Alloo said many doctors are having to buy their own equipment, sometimes at inflated rates, to make sure they can continue to operate.
Alloo has also moved toward more telemedicine, but he's worried payment for those services will be delayed.
"Without proper attention and support for that essential infrastructure that family doctors provide in the community, our hospitals and health system will collapse even faster," he said.
Alloo is worried more deaths could result in the sudden loss of primary care for patients than from the respiratory illness caused by the coronavirus.
'Feeling the pinch'
"Every physician in Ontario, just like every resident of Ontario right now, is feeling the pinch," said Dr. Sohail Gandhi, president of the Ontario Medical Association.
"We need to figure out a way to make sure those [physician payment] models are stable so that the nurses can get paid, the technicians can get paid and we can ensure that there's some health-care infrastructure available to the residents of Ontario."
Gandhi said the OMA is in talks with the Ontario Ministry of Health about income stabilization, and to ensure family doctors have "fair and equitable" access to personal protective equipment.
CBC News reached out to Ontario's Ministry of Health late last week, but has not received a response to our questions.
At a briefing Monday afternoon, Premier Doug Ford said the province is in the process of increasing its stock of personal protective equipment, but that the current supply could be compromised if there's a surge in cases in the coming weeks.