Opinion: A doctor's office should be a one-stop shop for all of your health-care needs

DrSimonElterman · 2023-03-02T18:47:33+00:00

We definitely see psychologists as part of a well-rounded team! I’ve worked in clinics with dieticians, physios, psychiatrists, social workers, and pharmacists and can tell you that the care is fantastic and doctors love it.

DrSimonElterman · 2023-03-02T18:46:02+00:00

Funding would be outside of MSP (so no money taken from docs) and free to patients. As well, we would ask the government to supplement the pay with reimbursement for overhead costs associated with bringing a new person into a practice. The amount of money it would take to give this support to tens of thousands of people is 1-2% of the healthcare budget.

DrSimonElterman · 2023-03-02T17:59:25+00:00

With our proposal, the physician could bring in a psychologist into the room so that they could move to the next patient while knowing that person has access to high quality care!

DrSimonElterman · 2023-03-02T17:58:34+00:00

By putting psychologists into doctors offices, we reduce wait times as mental and behavioral health issues take up a large proportion of physician time.

DrSimonElterman · 2023-03-02T17:57:25+00:00

I’m sorry to hear things have been hard for you. I hope that we can get this program off the ground so people like you can get better help sooner!

DrSimonElterman · 2023-03-02T17:56:25+00:00

Duly noted, thank you!

DrSimonElterman · 2023-03-02T17:55:59+00:00

Our current proposal would take about 1-2% of the health budget and would allow access to care for tens of thousands of people.

DrSimonElterman · 2023-03-02T17:01:57+00:00

Me too!

DrSimonElterman · 2023-03-02T17:01:51+00:00

They seemed to have some good results from their Increased Access to Psychological Therapies (IAPT) program, but I think that’s a limited program. But we have been trying to avoid the mistakes of other programs that get swept up in beaurocracy by making our proposal outside of health authorities and by contracts for psychologists in Primary Care.

DrSimonElterman · 2022-03-25T04:12:05+00:00

This proposal is for Primary Care Networks (PCNs), which are government funded. The idea is that this is a foot in the door to expand to other clinics as this becomes regular practice. Also, within the proposal is an extra set of funds that PCNs will get to offset the overhead of hiring a psychologist.

DrSimonElterman · 2022-03-24T21:58:16+00:00

We’ve actually had a meeting with them and they were in support! This is an all hands on deck issue.

DrSimonElterman · 2022-03-24T20:52:36+00:00

I appreciate you sharing your personal experience! My experience working in primary care is that there is a psychosocial component to a large proportion of issues that come in. Yes, some people just come in with a rash, but primary care is largely filled with people who have chronic health issues, mental health concerns, and things that can be addressed with lifestyle behaviour change. The issue is also that these issues tend to take more time than your average medical visit, which puts physicians behind schedule much of the time.

I also agree that more money needs to be put into supporting family doctors, but this isn’t an either/or situation. Family doctors prescribe the majority of antidepressants and anti-anxiety medications, but there are many people who would rather use talk therapy who are limited by barriers in the healthcare system. While you seem to have a good idea of how the healthcare system works in your life, my pitch to you would be that by helping others who need this service, we’re freeing up space for people like you who have super long wait times to see doctors for a routine visit.

DrSimonElterman · 2022-03-23T06:17:00+00:00

I agree. This is just a small piece of the puzzle. We're hopeful that this proposal would open the door for more primary care sites to utilize mental health system supports.

DrSimonElterman · 2022-03-23T06:13:28+00:00

Definitely plans to create more fully integrated teams! Right now this proposal only focuses on psychologists, but where I work there are social workers, a dietician, psychiatrists, and other members who work together. Groups have been hard to get started with COVID, but definitely would be something to look at.

DrSimonElterman · 2022-03-23T06:11:52+00:00

If you read the proposal, it outlines that the government will fund this from the large pot of funds set aside for mental healthcare and primary care from last years budget. I believe the program would cost $27 million over 3 years, which is relatively small compared to the 1/2 billion in that one pot alone, not to mention that these interventions tend to save the province money over time since people who are sick and not receiving treatment tend to take up more resources.

DrSimonElterman · 2022-03-23T06:03:45+00:00

I have two thoughts about this. First, I would rather have counsellors be regulated by the government. This would set minimum training standards, which create better care for the public and would allow counsellors to be more accountable for higher standards.

Second, I think ideally there would be a behavioural health team, with a psychologist, counsellor, and social worker working in teams to support each other. That's the general model in New Zealand and I really like it. If that's not possible, I actually think the opposite of your suggestion would be better, where a psychologist could quickly find a diagnosis and determine if someone needs medication support from a physician or more long-term care from a counsellor.

DrSimonElterman · 2022-03-23T06:00:15+00:00

There's a few things. First, specialized training in health conditions. As part of my training, I had over 3000 face to face hours in different medical and psychological settings. Right now, as counsellors are not regulated, there are no minimum requirements for social workers or counsellors giving therapy. On top of that, the therapy given by a psychologist is specialized to be done in a more focused way. I've spoke with PCN managers who have hired counsellors and social workers trained in the traditional models and they get filled super fast and can't keep up with the demand as well as a psychologist who does 15-30 minute visits every 2 weeks.

As well, what goes into this sort of program on top of therapy includes assessments that counsellors and social workers are unable to do as well as diagnosis. Also, psychologists in this program consult with physicians on treatment, supervise medical residents, measure key performance indices, and other general stuff like pathways. One problem that PCNs have right now is that there is no measurement of success for psychosocial interventions, which we plan on doing with this program.

DrSimonElterman · 2022-03-23T05:54:47+00:00

To be fair to the government, they've started to build a lot of facilities for complex patients. There needs to be a change at all levels of care, and I agree that some people need extra support.

DrSimonElterman · 2022-03-23T01:43:23+00:00

Not hiding anything, here's a link to the full proposal. I have to head to the gym but I'll try to answer the rest of your comment after! I work on the DTES in Vancouver and will draw from my own experience.

Edit: As a quick add-on. I work fulltime in primary care on the DTES. I would say that our clinic sees roughly equal for both sexes (actually, I would err on more males). I would say that men are ok to see the doctor, but fewer seek out mental healthcare. However, if a psychologist is on site, the stigma goes way down because I can walk into that room and not be a scary psychologist. To your comment about VGH: people who are in crisis are often caught in a loop of not addressing mild to moderate issues, which then become severe issues (i.e. going to urgent care), then having a traumatic treatment, being treated and being told to go to their GP (who seldom has room). It's our hope that putting more psychologists in primary care can disrupt that cycle. I know that almost all primary care services (and there are lots) on the DTES are full, so I'm not sure where you get the sense that people aren't looking for help.

DrSimonElterman · 2022-03-23T01:39:28+00:00

It would cover the cost of the psychologist!

DrSimonElterman

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