The Ontario government announced its Plan to Stay Open to address the health-care crisis and to prepare for the fall surge of seasonal respiratory illness and ongoing pandemic and backlog pressures. The OMA has expressed its support for these initiatives and called for strengthening the collaboration with physicians and other stakeholders to address the unprecedented challenges in the health-care system.
The OMA has developed an initial summary and preliminary analysis of the government plan below. We will consult with the government to gain further understanding of the impact of these initiatives and we will share updates as they become available.
The Ministry of Health has agreed to extend a number of COVID-19-related physician funding measures to March 31, 2023. The existing criteria and guidelines will continue.
The following initiatives will be extended:
The previous agreement was slated to end on Sept. 30, 2022.
The government is continuing to provide access to testing for COVID-19, Paxlovid and Evusheld therapies for treatment for those who are eligible, with plans on expanding eligibility for Evusheld for high-risk populations in the coming weeks. COVID-19 and flu shots will also continue to be provided to Ontarians. Free rapid antigen tests will continue to be available to the general public at participating grocery and pharmacy retailers throughout the province as well as for workplaces, schools, and congregate settings.
The government indicates that by the end of this summer, approximately 300 long-term care beds that were set aside for COVID-19 isolation will be safely available for people on long-term care wait lists, with a potential of 1,000 more beds available within six months.
OMA analysis: Less isolation beds may further the spread of COVID-19 and other infectious diseases. More long-term care residents will likely mean an increased workload for long-term care physicians.
Ontario is introducing legislation that, if passed, will support patients whose doctors have said they no longer need hospital treatment and should instead be placed in a long-term care home, while they wait for their preferred home.
OMA analysis: We have reinforced to the government the need to ensure that this is done in a dignified and safe way for certain populations, especially those with language barriers. We also emphasized the need for this to be a temporary relocation that will not impact future transfer to a home of improved preference.
Ontario continues to fund community paramedicine to provide additional care for seniors in the comfort of their own homes before their admission to a long-term care home. These initiatives will free up to 400 hospital beds. Ontario is also expanding its 911 models of care to include additional ailments and is now giving paramedics the flexibility to provide better, more appropriate care.
OMA analysis: This is not a new initiative and is something the OMA has responded to in the past. While we are open to opportunities to strengthen patient care, we remain aware that paramedics do not have educational equivalency to physicians and maintaining patient safety is integral. We have urged the government to ensure that the alternate models are crafted locally with an appreciation of the local resources available. Meaningful physician engagement, including emergency physicians, is integral as they have a unique understanding of medical complexity and can identify which patients would be eligible for the program. Physicians also need to provide medical oversight of the paramedics while receiving liability protection for any errors/omissions that could occur by the paramedics. For patient-specific models (for example, palliative and mental health) it will be imperative to meaningfully engage the appropriate physicians who specialize in this care. We have been cautious regarding the expansion of these pilots. We have called for robust clinician engagement before any policy decisions are made; decision making should happen at the local level; physicians should oversee the models and be protected from liability.
The government is investing more than $300 million in 2022–23 as part of its surgical recovery strategy, bringing the total investment to $880 million over the last three fiscal years. The announcement also indicates that Ontario is working with hospital partners to identify innovative solutions to reduce wait times for surgeries and procedures, including considering options for further increasing surgical capacity by increasing the number of OHIP-covered surgical procedures performed at independent health facilities. The announcement also indicates Ontario will be investing more to increase surgeries in pediatric hospitals and existing private clinics covered by OHIP, as well as to fund more than 150,000 additional operating hours for hospital-based MRI and CT machines.
OMA analysis: This aligns with our policy paper on reducing the backlog of health services and calling for the creation of Integrated Ambulatory Centres to address Ontario’s wait time issues. Shifting low acuity procedures out of hospitals may enable physicians within hospitals to perform a greater number of cases as it will allow for the separation of acute and non-acute procedures and increase efficiency. There are potential impacts on recruitment and retention of hospital physicians if cross-credentialing requirements are not put in place.
The OMA and MOH have reached an agreement to extend the provision of temporary funding to hospitals to prevent northern and rural hospital emergency department closures due to physician shortages. The CTSLPE was first implemented in 2021 as a measure to respond to urgent looming emergency department closures. The program was expanded in 2022 to include: all 24-hour model Emergency Department Alternate Funding Agreement sites, all Rural Northern Physician Group Agreement sites, any site that does not fit into either of these categories but that is receiving support from the Emergency Department Locus Program. The 2022 program was intended to run from Wednesday, June 1 to Monday, Sept. 5. Given the rising number of ED closures in rural and northern Ontario, extending the CTSLPE until March 31, 2023 will provide each eligible hospital with additional funding to help maintain 24-7 ED service until the end of the year. Read the program guide and FAQs.
Given current challenges in low-resource, rural, remote and Northern Ontario hospitals, there is a critical need to support physicians staffing hospital EDs at risk of closure. Through Ontario Health’s new ED Peer-to-Peer Program, ED physicians from participating hospitals will be able to access an experienced “peer” emergency physician virtually. Physicians will receive immediate, on-demand, real-time collaboration, coaching, mentoring and support, comparable to a physician in a larger hospital having the ability to ask a question of a colleague on the same shift. Peer physician services will be accessible 24-7.
This program is to be implemented on a temporary basis.
Ontario is also launching a new provincial emergency department peer-to-peer program to provide additional on-demand, real-time support and coaching from experienced emergency physicians to aid in the management of patients presenting to rural emergency departments. Ontario is also adding 400 physician residents to support the workforce in northern and rural Ontario.
OMA analysis: Additional emergency doctor support may assist in reducing physician burnout and increase their capacity. This will allow for greater capacity in northern and rural areas and incentivize more residents to practise in these areas.
Ontario is working with the College of Physicians and Surgeons of Ontario to expedite the registration of doctors, including those from out-of-province who may want to work in rural and northern emergency departments, so they can start working and caring for patients sooner.
OMA analysis: Health human resource needs are critical. We need to explore enabling international medical graduates and physicians from other provinces to practise expeditiously and in a safe manner.
Beginning this fiscal year, the government will be investing up to $57.6 million over three years to further increase the number of nurse practitioners by up to 225 by 2024-25 working in long-term care homes to ensure that residents continue to receive safe, high-quality care. The government will also increase the number of personal support workers and nursing students getting hands-on experience in the field through the preceptor resource and education program.
OMA analysis: The OMA supports the incorporation of nurse practitioners as part of the long-term care team. However, it is important that it is implemented in a way that maximizes the role of both the nurse practitioner and attending physician working together to deliver quality resident care. Each role has unique knowledge and skill that must be used in tandem and one is not a substitute for the other. In addition, the retention of mid-late career health-care professionals (staff nurses, doctors and others) is essential to delivering high-quality care and supporting the mentorship of novice practitioners. This is especially relevant in critical care areas (emergency, ICU and others). While it is not within the OMA’s immediate scope, nor do we have a policy on this nursing matter, it is encouraging to see that work is being done to support our colleagues.