A Staggering Statistic
More than one in five Canadian adults – 6.5 million people – do not have a family physician or nurse practitioner they can see regularly for care.
Primary care, the type of care provided by family doctors and nurse practitioners is foundational to any well-functioning health system. Family practices are the first place you should turn when you have a new health concern.
As the entry point into the healthcare system, family practices manage
ongoing health conditions and provide care to keep you well in the first place.
They also coordinate the care you get from others, including specialists.
Without dedicated primary care, patients are on their own
to navigate a complex system.
The situation is particularly bleak in some parts of the country. In British Columbia, Quebec and the Atlantic provinces, approximately 30 per cent – almost one in three adults – reported not having a family doctor or nurse practitioner. Contrast that to 13 per cent in Ontario.
New research shows that 2.2 million Ontarians, including more than 360,000 children across the province, do not have a family doctor, which could result in young people missing important care in the early years of life.
Contributing Factors & Impact
Family doctors nearing retirement amplifies Canada’s primary care crisis – nearly one in six family doctors in Canada are 65 and older. Add to this a dwindling interest in family medicine among medical school graduates and a critical shortage of doctors which often makes it difficult for retiring doctors to find younger colleagues to take over their practices.
Patients without dedicated primary care miss out on robust chronic disease management, support for serious physical and mental health issues and may not get to plan for the end of life or die with dignity.
This general shift away from primary care places further pressures on other areas of our overworked healthcare system including hospitals, emergency departments and long-term care facilities.
Questions to Address the Family Physician Shortage
- How can we support family doctors preparing to retire?
- How can we support family doctors currently in practice to improve primary care capacity?
- Family physician burnout tripled in 2021 from the previous year. What if we addressed family physician burnout?
- What if we connected patients to a family doctor and family doctors to a professional coach?
Coached Corridor Initiative
These are the questions that Dr. Aaron Sacheli, a caring and insightful family physician with Bridgepoint Family Health Team pondered in 2021, believing that there was a way to alleviate the family physician shortage in East Toronto, a neighborhood rich in diversity with high incidences of marginalization.
Working closely with the equally committed Tach Murray, Director, Operations and Finance at the East Toronto Family Practice Network, the Coached Corridor Initiative began to take shape. I was invited to be the coach and welcomed the opportunity to apply my specialization in physician burnout and leadership coaching as well as to contribute to a novel initiative that had the potential to build primary care capacity locally and beyond.
A Funded Collaborative Effort
In 2020, the East Toronto Family Practice Network and Michael Garren Hospital partnered to lead the East Toronto Covid-19 Response & Recovery Strategy. The Coached Corridor Initiative leveraged this existing infrastructure and integrated systems of care with partner collaborations established by the East Toronto Family Practice Network and East Toronto Health Partners to identify community members unattached to primary care.
Patients were connected to a community family physician who were in turn connected to coaching which took place throughout 2022. Primary care-focused community surge funding available for initiatives that increase capacity and local access to health, social and community services was utilized to fund the Coached Corridor Initiative.
Connecting a Community in Need
Through the Coached Corridor Initiative, the East Toronto Family Practice Network ultimately matched all patients who registered to a family physician.
- 179 previously unattached patients were connected to a family doctor
- Concerted effort to match patients to a family doctor in close proximity who speaks their language
- 12 family doctors at various stages of practice participated – 10 family doctors participated in coaching, two opted for a stipend
- Even with additional patients, doctors reported feeling more control over their workload
- Following the coaching, some doctors took on new community leadership roles
About the Coaching
The custom coaching program was designed to empower and hold participants accountable to achieve their personal and professional best. Individual goals and growth outcomes were established at the outset to address the specific needs of each physician. For example, burnout prevention strategies, work life balance, navigating the first five years of practice, managing multiple clinics and effective senior leadership.
Coaching Impact – Physician Feedback
Coached Corridor Initiative participants shared the following feedback upon completion of 8–10 one hour telephone coaching sessions:
“I was able to put the right clinic support in place and now provide clear instructions and delegate to others versus take on myself.”
“Understanding the difference between managing and leading helped me to be more thoughtful in my approach and actively engaged in supporting others.”
“I understand that the way you communicate is as important as the medical knowledge – as a result I’m reflective and intentional depending on the setting.”
“Focusing on my values has been extremely helpful to navigate the day to day demands of my time, especially at work.”
“I am more accepting, less critical and kinder to myself – I have more compassion and love for some of my weaknesses which are part of who I am.”
“I am sleeping better – I feel less irritable and no longer feel helpless and bound to unrealistic expectations.”
“I no longer have the sense of burden that I am entirely responsible for the success of my team.”
“I am more at ease setting boundaries in a considerate way and better able to delegate tasks.”
“I am more resilient and was able to add more leadership roles, yet still feel in control.”
“I am now listening with more empathy and eye contact – my patients feel heard.”
“I am less anxious and impatient for immediate answers and a way out.”
“I am able to recognize, acknowledge and manage my inner saboteur.”
There is a desire for wellness support amongst physicians. This verbatim feedback is reflective of the physician coaching benefits outlined in the Canadian Medical Association’s Physician Wellness Hub.
Healing Our Health System – Leadership for Renewal
Motivated by the success of the Coached Corridor Initiative in East Toronto, Dr. Aaron Sacheli, Tach Murray and I were pleased to be invited to present at the Canadian Society of Physician Leaders annual conference that took place May 2023 in Vancouver.
And to have the opportunity to share and seek feedback on coaching as a possible solution to build primary care capacity in other Canadian communities grappling with a family physician shortage.
A Captive Audience
A captive audience of about 15 family physicians and healthcare leaders from across the country participated in our session. They were curious about coaching (some had previously worked with a coach) but mostly seeking a solution to address the family physician shortage in their communities.
It is worth noting that professional coaching qualifies for physician continuing professional development credits for members of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada.
Several attendees were curious to know if the family doctors complained during the coaching about their additional patient load. This did not come up at all. In fact, even with additional patients, following the coaching, doctors reported feeling more in control of their workload. Some physicians also took on new community leadership roles, crediting the resilience associated with living and working in alignment with their personal values. My sense was that the doctors welcomed the opportunity to participate in coaching recharging conversations entirely focused on them and their current situation!
Coaching Can Build Capacity in Healthcare
Coaching can lead to permanent changes for individuals and organizations.
Since 2008, the Cleveland Clinic has been harnessing the power of coaching as a proactive approach to well-being and professional development to improve employee retention and reduce burnout among physicians. Officials estimate this has saved the health system at least $133 million USD in physician retention alone in 2020.
The Coached Corridor Initiative successfully connected unattached patients to established family physicians, even as primary care capacity is overstretched and continues to shoulder the heavy load of enduring pandemic and systemic challenges.
Dr. Aaron Sacheli believes that “the Coached Corridor initiative illustrates a pivotal future opportunity to weave coaching into the design of future health policy initiatives, not just as a strategic intervention, but also to support the resources driving the change: the community organizations and the physician leaders.”
Reflecting on the learnings and success of the Coached Corridor Initiative, Dr. Sacheli also notes the “importance of a commitment to collaboration among community agencies, health teams, primary care partners and physician leaders to adapt the program to their unique circumstances and empower community stakeholders to generate their own solutions.”
If this novel approach to build primary care and leadership capacity has sparked your interest, please do not hesitate to get in touch. Happy to share more about the inspiration for this initiative as well as a series of questions that can be used as an implementation guide for your unique community and circumstances. Where there is a will there is a way.
Acknowledgements
The Coached Corridor Initiative was a collaborative effort of the East Toronto Family Practice Network, East Toronto Health Partners and Michael Garron Hospital. A special thank you to the individuals I got to know and worked most closely with – Dr. Aaron Sacheli, Tach Murray, Prachi Patel and each of the family physicians who participated in coaching. I am truly inspired by your unwavering commitment to patient care and hope it will inspire others as well.
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