Scared For My Profession

The emergence of family health teams in the Canadian medical system has been a rather recent occurrence. Initiated by the Ministry of Health and Long-Term Care, a family health team has been defined as an interdisciplinary panel of professionals that have been brought together to share knowledge and resources during the patient care process. (Source: http://www.health.gov.on.ca/transformation/fht/fht_progress.html) It is a very simple concept, which is why it is difficult for some (including myself) to understand why it has taken this long to come into practice. Nonetheless, more and more family health teams are sprouting up provincially.

Since I have had no exposure to family teams whatsoever, I decided to do a little research for myself. While perusing the Ministry’s website on the topic, it appeared to me that family health teams were being touted as one of the most revolutionary changes in medicare today. The language used in the site included phrases that clearly would trigger emotional responses from the reader, such as: “patient-centered, primary care”, “better access to care”, and “state-of-the art technology”. Despite the overall positive message I perceived from the site, I still hold my reservations about family health teams because of negative feedback I have received from dietitians in the field.

I currently work as a receptionist for two dietitians in a private practice. The other day, I was speaking to one of them when we began discussing the future of dietetics now that family health teams have entered the scene. I had expected to hear a neutral response from my superior, as she had always maintained such an unbiased view of things. But the response I received in actuality held a more negative tone. From what I understood and with what she had told me, family health teams have actually divided the field of dietetics and pitted dietitians against each other. Those in private practice are fighting to justify their prices, while those dietitians in family health teams are guaranteed coverage and a constant source of clientele because they are instead covered by OHIP. Of course this was to be expected. Be honest with yourself: would you be willing to pay over $100 to consult with a dietitian, or just use OHIP to cover the costs? Although individuals may have valid reasons for choosing, current trends in the industry suggest patients have taken to the latter of those options. Private practice dietitians have seen large losses in both revenues and in clientele to family health teams across Ontario. What is most unfair about this situation is that not all dietitians have equal opportunity to working in family health teams. Seeing as these alliances are quite new, available employment positions are few and far between. And quite simply, when it comes down to it, one would need to be in the right place, at the right time, and know the right people. Not a very democratic system, is it? From what I myself have also heard is that paying dietitians on the OHIP scale will devalue the worth of our services, thus causing the average salary to decrease slowly over time.

Now let me make this clear before I move on: I cannot guarantee that the dietitian with whom I was speaking was fully informed on the subject. Maybe she was, maybe she wasn’t. I have absolutely no idea whether she read this information from somewhere reputable, or whether she was passing along talk from the water cooler. But for the purpose of this blog, let us assume that she is in fact correct.

One other thing that I find disheartening about the notion of family health teams is the existence of an underlying hierarchy. When I think of teams, I envision colleagues that are of equal status, working together towards a common goal. There is a sense of cohesiveness and unity that helps to keep the team together. It doesn't seem that the Ministry of Health and Long-term Care shares my vision. Note the wording in the following lines from the site:

- “Designed to give doctors support from other complementary professionals…”

- “Family Health Teams will have core health care professionals across the province, including doctors, nurse practitioners and nurses…”

- “Family Health Teams are a group approach to health care where your doctor will be able to focus on your complex medical problems but you'll have access to different health care professionals according to your needs…”

Each of these quotes reinforces the idea that the doctor is still top of the line, the leader of the pack. We as dietitians are merely here to ‘support’ the doctors. We are not considered part to be ‘core health professionals’ nor do we deal with ‘complex medical problems’; that’s the doctor’s job. When I read things like these, I feel both frustrated and infuriated. I can’t stop telling myself, “Stef, you’re an idiot. You should have just gone to med school.” I mean think about it logically: an extra four years of schooling wouldn’t be so bad, and in the end, I’d have a doctor's title, the recognition and the salary. So what’s keeping me here as a dietitian?

I would be interested in knowing more about family health teams from the perspectives of my peers. Has anyone had contact with a team or been a part of the team? What where the feelings you got from being around then? And is what I’m hearing from the field true?