New OMA president tries to balance realism and hope

Family physician Dr. Dominik Nowak knows he’s taking on the presidency of the Ontario Medical Association at a fraught time. Significant inflation with fee increases that are inadequate to keep up are leading to financial unsustainability for many doctors. 

He began his one-year term at the association’s annual general meeting in Sudbury, Ont. in early May. Dr. Nowak practices at the Women’s College Hospital Family Practice Health Centre, a family health team. 

Dr. Nowak will collaborate with Dr. Cathy Faulds and Dr. Sharon Bal, who have been elected as board chair and vice-chair, respectively, by the board of directors. Dr. Faulds, a family physician from London, Ont., joined the board in 2021 and has held the position of board chair since 2022. Dr. Bal, also a family physician, hails from Cambridge, Ont., and was elected to the board in 2022.

OMA members also elected Dr. Zainab Abdurrahman, an allergist and clinical immunologist from the Toronto, as their president-elect.

Dr. Nowak, the 143rd president of the OMA, spoke with the Medical Post about the need for better funding to make healthcare sustainable and to restore the joy in practicing medicine.

Q: Ontario doctors really saw a wide margin between what the OMA is asking for and what the government offered when it comes to arbitration. What do you say to the members about the situation?

It’s very clear that the healthcare system is in crisis. If you walk in any emergency room, or hospital, or family practice, you can feel it. If you look at the numbers, the numbers tell the story: 25% inflation over 10 years with OHIP fee increases of only around 6%, and doctors are getting crushed. We’re feeling crushed with those numbers. So it is no surprise that were seeing clinics close.

A few years ago, I had to close my own family practice because we couldn’t make the numbers work. It’s happening across the province right now. So we have a healthcare system in crisis. And that’s why what we’re telling decision makers and the public is that we need to fund healthcare now. We need to put the supports in place to make things sustainable, to deliver on the promise of healthcare for everyone in Ontario. And for doctors to make the work joyful again, and to bring back that support to the important work that we do in caring for patients.

Q: So what happened there? You with other doctors started a primary care clinic fresh in Toronto?

Yeah, exactly. It was a small group of doctors. We set up a fee-for-service practice. We were dedicated to family medicine. We believed in that relationship-based longitudinal care. We found that meaningful but we couldn’t make the math work. And it was hard to get the supports we needed. Even things like taking time off, it was really hard for me to even take a few days off because all the work would pile up for when I came back. It was hard to connect in with the healthcare system. I remember feeling, back then, I had this question of, “Is this sustainable for me in the next few months?”

Q: And you had to close it?

Very quickly it became clear that it wasn’t going to be financially sustainable for us. . . . 

It was really a heartbreaking experience, actually. Where we spent years developing relationships, caring for people and we had to make this really difficult choice where we didn’t feel like the health system was financially supportive of that kind of care.

We all landed in different places. I ended up landing in a place where I love to work, at Women’s College Hospital. I took on a retiring doctor’s practice there. The work is hard. But I feel part of a team, and I feel supported.

Read: OMA and gov’t far apart in fee talks as binding arbitration begins

Q: So to return to negotiations, the very top of the ministry’s brief focuses on a few statistics and data trends that are things the government obviously finds concerning about the delivery of healthcare by physicians. I’ll quote from that section’s conclusion: “Costs per physician are increasing while average visits per physician are decreasing.” What’s your reaction to that?

I invite decision makers, or whoever wrote that, to walk into any hospital, or clinic, or emergency room. Or frankly, ask anyone in Ontario who’s experienced any part of the healthcare system in the last few years. Our population is older. It’s more complex. People are coming in with more issues on top of the added work of caring in a healthcare system that’s in crisis. 

I’m a family doctor, I see this every single day. The folks that we’re caring for are more complicated. They have more things going on, and it’s harder to do the work when we have a system that’s under so much pressure. That’s why we’re getting to this point that our healthcare system is not delivering on its promise to Ontarians, and we need to change that. We have a window of opportunity to do something, and restore a healthcare system, I hope, that we can be proud of again in the future.

Q: On top of that, there’s the admin burden. So you’ve done fee-for-service and now you’re in a family health team. What’s your take between those two?

There’s no question about it. When I’m in a team, I feel supported. I feel like the work is more sustainable. It’s still hard work. The medicine is hard, but that’s what I signed up for. I signed up to do the medicine. I am confident that I’ll still be able to do this care for years, or decades, in the future. It’s a completely different environment and experience, for me as an early career doctor, to have that kind of support. Again, the medicine is still difficult, and there are still challenges that we need to solve in teams including the administrative burden, the workload, and everything like that. But the spirit of care and letting me be focused on the work that a doctor needs to do, is just so much better in this kind of environment.

Q: Even the ministry’s brief talks to the binding arbitration panel talks about the value of team-based care. It’s one of those things that everyone seems to agree is important but certainly in Ontario the rollout of new Family Health Teams and other primary care groups slowed over the past decade or so. What I understand is the government became concerned about costs and I think, also, that they thought, ‘Oh, we’re going to get more evening and weekend coverage’ than happened from those teams. How do you respond to those concerns?

I want to call out the elephant in the room when this question comes up. This argument is one that puts blame on the individual doctor for health system challenges, and that’s unacceptable. When this kind of argument comes up, we need to name it, and put it away because it’s totally unacceptable to blame individuals for the failures of a healthcare system that’s in crisis. My experience is that doctors are working hard, and actually holding together a health system that’s under enormous pressure. It’s not surprising that our system is failing to deliver to people that it cares for, and can’t meet the demands of an aging population.

And a population that’s getting more complex, and has more medical needs. But that’s not the responsibility of a single individual or health professional. It’s a responsibility of decision makers to step up. Decision makers to support our system, and to do what it takes to get back to the place where we can be proud of our healthcare system again. I know we can do it. 

Q: What do you think is the main thing that needs to change to get more family doctors to practice longitudinal family medicine? 

I was meeting with a group of medical students and residents a few weeks ago, and they asked me, “We’re hearing all of this in the news about family practice, and how tough it is to do the work of family medicine. How important it is for the system, but how tough it is for the individuals that are holding together the system.” And they asked me, “Is there hope?”  I said, “Yeah. There is.” And what I mean by that is I like to think of things in terms of optimism. So optimism means realism and hope. The part that’s realism is acknowledging that we have enormous challenges ahead of us in terms of healthcare. We have family doctors telling us that they’re doing 19 hours of administration (paperwork) every single week.

For me, what that looks like is that often starts at 10 pm or 11 pm and I’m in front of my computer, and it feels like I’m staring into the abyss. That’s not what I signed up for. I signed up for caring for patients, and I find the care so joyful, but there’s so many other things that are pebbles in our shoes. So (we can) acknowledge that things are difficult. We have a lot of challenges ahead of us (and that) is the realism of optimism. But then, optimism also means hope, and it means hope for the future. It means that getting beyond those challenges means advocating together. It means bringing forward solutions and ideas of the things that we know work. Some of the things that would work in bringing back the joy in family medicine are some of the things that we’re talking about here.

So let’s support every family doctor with teams. Let’s make sure doctors can be doctors, and get that 19 hours of unnecessary administration and paperwork off our plates so we can focus on the care. And let’s do what it takes to get our healthcare system back on track because it’s really difficult to practice in a system that’s not delivering for patients. People see this with bounce backs on referrals (and seeing that) our specialist colleagues that are also feeling overwhelmed. . . . We know the solutions for these things and it’s putting forward those solutions, and saying, “Yeah. We can do it, and we can move beyond the challenges we have. And we can get to a place where we can be proud of our healthcare system again.”

Q: You’ve got a one-year term as president. What are you focussed on? 

It’s around two weeks in on the job, and I’m already seeing some successes in this. The one thing that I would say I’m focused on is optimism. (As I say,) optimism is realism and hope. Realism around what is. That this is a difficult time in healthcare and medicine for our patients. But then also hope, and hope means, how do we see each other? How do we build community in the profession? How do we bring forward the solutions to fix the challenges that we have?

If you think of the last few weeks as an example, I’d say versus a few years ago where some of these challenges were mostly shared by doctors in WhatsApp groups and in private groups now, they’re much more in the open. We’re shining a light on the challenges in our healthcare system. I have decision makers reaching out to me, and saying, “We’re worried about where healthcare is going, and we want to work on this together.” So that’s what brings me optimism, that people are ready for change. And we’re seeing that from doctors, from patients, but also from decision makers.

Q: We want to be optimistic, of course, but there’s a lot of anger in the physician community right now. To some people optimism can feel like toxic positivity.

Make no mistake, optimism to me is not misguided positivity. That’s where the realism comes in, and that’s where I’ve been really clear that we have a healthcare system that’s not working for patients. It’s not working for our colleagues. . . . 

A few weeks ago, I met with a emergency doctor whose emergency room was understaffed by something like 40%. They were asking all of the docs in that community to pitch in their spare time, on top of the regular workload that was full-time that they were already doing. We see so many examples of doctors pitching in to hold up the healthcare system, and it’s up to us as a profession to say, “Enough, we need a healthcare system that’s actually sustainable, and that works for patients, and is actually also supportive of the human beings behind the care.”

Q: What can the OMA do to cut back on red tape and paperwork impacting doctors?

It’s about looking at centralized referrals, and how we do referrals, and how we communicate with each other as professionals, and as a healthcare system. It’s about considering ideas like AI scribes or other team members that don’t have to be doctors, that support the documentation burden. So that doctors can focus on being doctors. Finally, it’s that doctors should be leading teams and teamwork is the future of healthcare. Doctors are trained to be leading those teams because we understand our patients. We understand the healthcare system, and we have the training to do that.

I dream of a world where we’re unshackled from our computers, and can focus on the care, and have a healthcare system that supports the kind of care that we want to give to our patients.

Q: Are there things we should be doing now, those of us in the physician interests community, as Ontario doctors, to create a better healthcare system in the future?

Three things I am focusing on this year that should be everyone’s first order of business in the healthcare system. 

One, let’s commit to finding everyone a family doctor. And doing what it takes to make those practices sustainable and supported. 

Two, let’s commit to letting doctors be doctors. That goes into the unnecessary administration, and paperwork, and the burnout that causes. (Surveys say) 60% of my colleagues are feeling that, and it’s crushing. That 60% is saying that they’re going to scale down practice, or retire in the next five years.

Number three, let’s commit to resourcing emergency departments, and hospitals appropriately. Then, also, move the care that can be done closer to home, and in the community back where people want it. I’m talking about home care, palliative care. The things that, where you invest in them, they actually save money for the health system in the long-term.

Q: And patients prefer it.

Yeah. I’m a family doctor who does home visits, and I do it despite that it’s not actually super financially sustainable. But I do it because it makes a difference for people, and there are many people who can’t make it to our office anymore. There are older adults. Oftentimes, over 90 with a lot of different things going on. When I visit them at home, and care for them at home, that makes such a difference in helping them avoid emergency departments. And helping them still maintain that relationship with me as their family doctor.