Dearest colleagues, friends, public (anyone who wants to know), I’m going to tell you about an urban family doctor’s job before & during #COVID19 Here’s my story as told in 16 tweets (1/17): #medtwitter #onpoli @ontarionurses @OntariosDoctors @OntarioCollege

I take care of 1400 patients in @ottawacity in a #patientcentredcare clinic with a rainbow flag and the words “Common Ground.” I have many #LGBTQ patients, and also #Indigenous patients and #mentalhealth and many who live with physical/cognitive disabilities. (2/17) @CBCOttawa

Before the pandemic, I’d start at 9am with #Pediatrics, immunizations, answering questions, addressing parental #depression and #anxiety. Then I’d see other patients with infections, injuries, #diabetes, chronic illnesses. My clinics ended at 6pm, then paperwork. 5 days/wk (3/17)

I also provide #psychotherapy to my patients who don’t have private coverage ( #mentalhealth is mostly done in #primarycare). I do a lot of #addiction counselling and advocacy for #DisabilityRights and #HumanRights for my patients. That advocacy is integral to family med. (4/17)

I’m stuck in a #feeforservice model of care because @ONThealth does not consider @ottawacity urban populations “in need” of services. Or, at least, not worthy of forming a #FHO (income stability via monthly capitation payments). (5/17) Read my previous thread about FHO policy: https://twitter.com/nilikm/status/1253506317462966272

If patients don’t show up, I don’t get paid. f I get sick or miss work for education or vacation, I don’t get paid. When patients ask for Rx renewals by fax, forms, doctors’ notes, I’m not paid. We are proud of publicly funded #universalhealthcare but GPs do a lot for nil (6/17)

When we see our patients, we have to bill @ONThealth codes for each visit, and those appointments have to be in person. When #COVID19 began, @OntariosDoctors told us we’d have new #ohip codes and should pivot to caring for patients by phone/video. So we did. Immediately. (7/17)

Now I work 8am to 8pm, phoning patients at home, to provide all the same #primarycare and advocacy as pre-pandemic, but I’m also triaging who needs to be tested, who needs to go to hospital, managing symptoms of #COVID19 and social isolation. More #mentalhealth crises. (8/17)

I have limited #PPE so I only open the office to assess infants, give immunizations, & other essential treatments (osteoporosis, allergies, contraceptive shots). Patients wait in cars while I gown, glove, mask, goggles. When they leave, I have to disinfect every surface. (9/17)

Bone weary at the end of work, it was demoralizing that @celliottability didn’t program the telephone codes, so we won’t be paid for our work from March-June until maybe July. @OntariosDoctors arranged for income stabilization in hospitals but not in community. #onpoli (10/17)

So here’s why so many will close their clinics: we have no PPE, we’re unpaid, family docs who work in the city are frozen out of the FHO model (that provides our family medicine colleagues with income stability). The ingredients for #burnout and bankruptcy (11/17). #onpoli

I’ve been offered FHO positions in towns. Could close my clinic and move to where I’d be supported. However, I won’t renege on my commitment to my patients in @ottawacity. I care, but I can’t promise to stay forever if @ONgov doesn’t fix this. @OntarioCollege #onpoli (12/17)

Patients keep asking how I’m doing. I don’t want to freak them out, so I say “Don’t worry.” But I’m not sure how we’ll get through #COVID19. Who has our backs? Patients dropped off letters offering to fund the clinic. That’s not their role. #medtwitter @ONThealth #onpoli (13/17)

I don’t know what will happen to my clinic. How long do I work myself into the ground without income stability? The 25 docs in our group care for 35,000 patients in @ottawacity. If we close, there’s nobody to take care of our patients. (14/17) #onpoli @JoelHardenONDP @CBCOttawa

The public was duped into thinking that @celliottability supports #HeroesOfCovid19 We’re unpaid and @ONgov offered loans in lieu of income stabilization. Can’t double our workload to repay loans! Clinics will still close (15/17) @TheCurrentCBC #onpoli #medtwitter @CBCOttawa

As our last ditch attempt to save family practices in cities, we created a petition: Open Capitation model funding (FHO) to all Family Physicians in Ontario - please sign & share (16/17) http://chng.it/zYPQLrJv  via @CdnChange @OntarioCollege @OntariosDoctors #medtwitter #onpoli

Thanks for reading/sharing. I’ve been in practice for 9 years. I have another 25 years of care & advocacy to provide, if @fordnation doesn’t cause the health system to collapse and destroy #primarycare (17/17) #familymedicine @OntariosDoctors @OntarioCollege #onpoli #medtwitter