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After hours, Manitoba MDs are out

City doctor suggests money might make them more available

Manitobans not only rank "dead last" in access to doctors after hours, but the impact on the province's emergency rooms is compromising a system where traditional, lengthy doctor-patient relationships are badly in need of a checkup, according to a high-ranking medical spokesman.

Findings from the 2012 Commonwealth Fund international health-policy survey show not only does Canada lag behind other countries in rapid access to doctors outside working hours, but Manitoba ranks at the bottom compared to other provinces.

"That isn't satisfactory," said Dr. Michael Moffatt, a Winnipeg pediatrician and member of the Health Canada Council, which released the report. "The public actually owns the system, and they should be getting better service."

Moffatt said doctors have "drifted away" from feeling responsible for their patients on a 24-hour, year-round basis, adding emergency rooms have become a "default system" for both physician and patient. Between 85 and 90 per cent of patients who visit emergency rooms have personal doctors, he said.

The survey found Manitoba doctors are among the least likely to have arrangements for after-hours care for their patients.

Moffatt, who also serves as executive director of research and applied learning for the Winnipeg Regional Health Authority, suggested physicians be offered financial incentives to develop support systems and link practices that could share patients. Most practices average between three and eight doctors, said Moffatt, addding "that's not enough to provide 24-hour, year-round coverage."

Moffatt said resurrecting the house call is another option. The report said 58 per cent of Canadian doctors make home visits, compared with between 90 and 100 per cent in the Netherlands, Norway, Britain, France and Switzerland.

"Maybe it (the house call) isn't dead," Moffatt said, noting there are no incentives for doctors to visit their patients. "Maybe it's something that needs to be looked at (reviving)."

Continuing to rely on emergency wards is not the answer, he said. "We've got a lot of congestion in our emergency program," he said. "At this point, we're at a stalemate."

Ultimately, he said, as health issues in an aging society turn to more chronic care, the need for long-term doctor-patient relationships will become more acute.

"It works much better if you have an ongoing relationship with people... who can take care of you over time. They know you, they know your medical history."

Moffatt acknowledged "it's hard to get your own physician if you don't have one."

Manitoba has the lowest availability of resources (doctors and nurses per 1,000 population) in Canada, according to a Fraser Institute report on health care.

Conservative provincial health care critic Cameron Friesen said the NDP government's failure to retain doctors -- more than 1,800 physicians have left Manitoba since 2001, he said -- is only exacerbating the pressure on emergency wards.

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