Medical homes can work, says doctor who ran similar practice in 2011

P.E.I.'s medical homes will help bring down the number of Islanders looking for a family doctor, says a doctor who left the Island 10 years ago when the province stopped supporting his efforts to work on a similar model.

In 2011, Dr. Robbie Coull closed his Phoenix Health Centre and headed back home to Scotland, leaving 4,500 patients without a family doctor. Phoenix was a collaborative practice, where a diverse group of health-care professionals worked together on patient care, using an electronic medical records system to help with co-ordination.

The P.E.I. government is proposing a similar system, which it is calling medical homes. It says medical homes can help cut the number of Islanders waiting for a family doctor — now more than 20,000 — in half. Coull, who is now running a practice in a small community in Scotland, believes the idea can work.

"Two years, I think that's possible," he said.

Coull goes further, saying 10s of thousands would not be on P.E.I.'s patient registry if the Phoenix model had been supported.

"I have no doubt that you would not be in that mess now," he said.

Sharing patient care

Collaborative practices help clear waiting lists for family doctors by making more efficient use of all medical professionals in the health-care system, by having them all under one roof.

"You can bring in some other expertise," said Coull.

"For example, the family practice nurses, they're really good with their diabetes care and bronchitis care and stuff. In many ways, they're much better than family docs because they can just concentrate their time on that and they can take a bit more time with the patients."

It does mean, however, that you are not necessarily going to see your doctor every time you go for a medical appointment. You might see a nurse practitioner, or go straight to a physiotherapist.

A big change

Having a team of medical professionals that buys into the system is key to success, Coull said, but equally important is selling the system to patients.

"We had a lot of patients come in and say, 'I don't understand this at all. What's going on?' It took them a while to adjust. Some of them became huge fans and some of them didn't like it," he said.

"One of the things we didn't do early enough is realize just how big a change it was for a lot of people on P.E.I., and how we needed to bring those people on board earlier."

It took the Phoenix clinic about a year to understand the importance of helping patients understand the system, said Coull, and that slowed down growth and acceptance of the practice.

That mistake, he said, was probably a big part of why the practice ended up being closed.

Coull called the closing of Phoenix — laying off 14 staff and leaving 4,500 Islanders without a doctor, in addition to taking personal financial losses — the absolute low point of his career. But he said he wishes the province the best of luck in establishing the medical homes, and hopefully cutting doctor waiting lists.