How Ontario’s new health care changes affect patients

It may not be the most glamorous of specialties in medicine, but it’s becoming the most needed: Canada is facing a shortage of geriatricians while the country’s population is aging. Rex Features/CP Images

TORONTO – Residents in Ontario may be caught off guard when they head to their doctor’s office for an annual check-up this year.

Just before the end of 2012, the province and the Ontario Medical Association reached a deal that changes the annual physical exam, among other services patients head to their doctors for.

A new system for check ups

For most healthy adults between 18 and 64 years old, the annual physical will be replaced with a “personalized health review,” according to the OMA, which represents the province’s doctors.

This single change garnered some media attention prior to the new year, but family physician Dr. Doug Weir, also president of the OMA, says patients will still receive the frontline care they need.

“For people who are healthy and going in on an annual basis, they don’t need an annual physical. There’s no evidence of any benefit,” Weir said.

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The review will be “periodic,” which means every year, Weir said. Children under 18 years of age and seniors won’t be included in these changes.

Anyone with a certain diagnosis, such as diabetes, asthma or a cancer history to name a few conditions, will have a full head-to-toe yearly physical like they always do. The personalized exam applies only to healthy adults.

Instead of the traditional check-up in which doctors listen to patients’ lungs, check on nerves, muscles, joints and take a look at the body from head to toe, a health review will be faster.

“The doctor will talk to you about what you need to be doing to stay healthy, find out how you’re doing, if there’s anything you need to get done,” he said.

“That’s the part that’s changing. Otherwise, in many ways the visit will be exactly the same.”

A patient in her late 20s, for example, might be asked if she’s sexually active, thinking of having children, smoking, and then assessed based on her responses.

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Because the physical review is shorter than a full physical exam, it’s $27 cheaper under OHIP fees. Doctors can bill the province $50 per visit compared to a $77 physical, Weir said.

Still, if patients present any symptoms or call later for an appointment because they feel under the weather or notice anything particular, doctors will still look into any issues, Weir said.

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The changes went into effect as of Jan. 1.

The organization says the move from traditional annual exams to “personalized” reviews is based on research that shows that annual physical exams do little to reduce deaths from cancer or heart disease.

In a recent study, Danish researchers studied 180,000 people – half of which were assigned to regular checkups and another half that only saw the doctor as needed.

After long follow-up periods, results showed that both groups fared the same, pushing the researchers to conclude: “General health checks are unlikely to be beneficial.”

Ontario officials, for their part, suggest the change to personalized health checks will reduce “unnecessary” monitoring.

Doctor suggests agreement will shortchange patients

A Toronto-based doctor heading a small independent physicians’ organization that’s strongly opposed the agreement says physicians and patients alike are being shortchanged.

Since the deal was in the works, Dr. Douglas Mark, president of the Coalition of Family Physicians and Specialists of Ontario, has been steadfast in his opposition of the OMA-government deal.

The COFPS says it represents about 1,000 doctors in the province.

The doctor who has been a family physician for the past 26 years says annual checkups offered him an opportunity to look through a patient’s complete history, listen to current complaints and examine a patient’s condition from top to bottom.

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“It’s about checking all the parts,” he told Global News.

Other changes outlined by the Ontario government and the OMA include: reducing “unnecessary” pre-operation cardiac testing for low-risk, non-cardiac patients, and limiting the number of colonoscopies and cervical cancer screening tests patients get so they match Cancer Care Ontario guidelines.

So women who have gone to the doctor’s office every year for a pap smear test will only be required to go every three years.

Meanwhile, certain testing, such as routine chest X-rays, pulmonary function tests which look at lung capacity, among other tests, won’t be included in what can be billed to OHIP in some cases when deemed “unnecessary.”

Mark suggests these changes hurt his ability to take care of patients and assuage their concerns. If a patient smokes, for example, and they wanted a chest x-ray, the patient may not be able to get this done.

“The government says what doctors can provide. They’re forcing (patients) to comply to fit into their cookie cutter, and (doctors) can’t use their intuition,” he said.

Weir told Global News that procedures such as chest X-rays done generally for minor surgeries weren’t benefitting the majority of patients and can provide more harm through false-negatives or radiation.

“Don’t do a chest X-ray just for the sake of doing it,” Weir said.

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Mark urged doctors to reject the new Physician Services Agreement, but it was ultimately ratified in December following a vote that included 25,000 doctors.

The deal, which physicians receive their salaries from, is worth $11.1 billion a year. It runs until March 31, 2014.

It cuts half a per cent of payment to all Ontario doctors under OHIP fees in a series of cost-saving measures.

Mark alleged the changes will force further cuts to doctors’ salaries as Ontario’s population ages.

Other changes in the works

The Ontario government says its “modernizing” health care services through e-consultations. That way, patients can get in touch with their doctors more easily.

“Priority” investments will also be funneled into care for seniors, including an expansion of house calls.


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