National Post
Tuesday, August 05, 2008
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Ont. doctor uses lotteries to pare down patient list
Tom Blackwell, National Post Published: Tuesday, August 05, 2008
In the latest jarring illustration of the country's doctor shortage, a family physician in Northern Ontario has used a lottery to determine which patients would be ejected from his overloaded practice.
Dr. Ken Runciman says he reluctantly eliminated about 100 patients in two separate draws to avoid having to provide assembly-line service or extend already onerous work hours, and admits the move has divided the close-knit community of Powassan.
Yet it was not the first time such methods have been employed to determine medical service. A new family practice in Newfoundland held a lottery last month to pick its caseload from among thousands of applicants. An Edmonton doctor selected names randomly earlier this year to pare 500 people from his heavy caseload. And in Ontario, regulators have heard reports of a number of other physicians also using draws to choose, or remove, patients.
"It was just my way of trying to minimize the bias ... rather than going through the list and saying ?I don't like you, and I don't like you,' " said Dr. Runciman. "It wasn't something that I wanted to do."
The unusual practice seems to be a symptom of the times, said Jill Hefley, spokeswoman for the College of Physicians and Surgeons of Ontario. A paucity of medical professionals has left an estimated five million Canadians without a family doctor.
Ms. Hefley cited a family practitioner in Chatham, Ont., who recently informed all the patients he had not seen in the previous two years that he was dropping them from the practice so he could take on new patients with more medical need.
"There's all kinds of ways that doctors are trying to deal with their patient loads," she said.
Although the college opposes doctors cherry-picking patients who are easy to care for, it is not against lotteries and other random systems for cutting back, Ms. Hefley said. Not all regulators see the situation the same way.
The B.C. college would view a draw as "highly inappropriate," said Susan Prins, a spokeswoman for the organization.
"You can't hack patients out of a practice, even if it's a random selection," she said.
Dr. Runciman founded his Powassan practice in 1988, before leaving to work at the University of Toronto, then practising for 10 years in the United States. He returned to take over the clinic from a colleague in 2005, and soon discovered the caseload of well over 2,000 patients was much bigger than he had been led to believe.
He held two lotteries, the latest one trimming about 25 patients, with letters going out in July.
Dr. Runciman said he is not willing to rapidly rotate people through for five-minute appointments, virtually the only way to handle such a large caseload. He prefers to give patients 15 to 20 minutes of holistic care.
"There is only a certain number of people I can see in a day. My day is already 11 hours and I don't care for it being longer," he said. "I realize that, at 47, I can't run my ass off like I did 20 years ago."
Janet Gauthier, 53, was one of those patients who received a letter last month informing her she was being cut from the roster. Some of the others are quite elderly, she said yesterday.
"Everybody was kind of mad about it," Ms. Gauthier said.
She managed to find another family doctor in Callander, about 18 kilometres north of Powassan, but said she is not relishing the prospect of driving there in the middle of a harsh Northern Ontario winter.
In Gander, Nfld., two new doctors setting up practice held a lottery last month to choose patients from among approximately 4,000 applicants, hoping to avoid the mob scenes that greeted the last new physician to arrive in town.
Last March, an overworked Edmonton family doctor who was also chief medical information officer for the local health region picked names randomly to cut 500 people from his practice.
Dr. Trevor Theman, registrar for the Alberta College of Physicians and Surgeons, said yesterday that the physician opted for the fairest way to shrink his practice, and did so for legitimate reasons. Patients can expect more of the same, he said.
"We have the Baby Boomer bulge of physicians and they're ageing," Dr. Theman said. "I would think over time we will see physicians who cut back their practices or elect to do other things for a variety of reasons, and they'll need some method to manage that."
National Post
tblackwell@nationalpost.com
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