The Desperate Need for Centralized Referrals

Perhaps you’ve heard? Family Doctors are burning out and there’s a Primary Care crisis in Ontario.

There are innumerable reasons. But here’s one cause with a tangible solution.

Wait times for specialists and investigations are too long – or outright inaccessible. Family Doctor referrals are often being met with wait times of 18 months or longer. Or simply rejected.

We Family Doctors know what our patients need:

  • Needs an EMG and to see a neurologist.
  • Needs to see Ob/Gyn for bladder incontinence surgery.
  • Needs to see a child psychiatrist for severe behavioural concerns.
  • Needs an urgent MRI.
  • etc etc etc

We send the referrals accordingly. Only to later receive the reply “Sorry, we can’t help you. Please refer elsewhere.” What’s best is when you receive these rejection notices 6-12 months after the fact … /sarcasm. And what’s more, there is no “elsewhere.”

We Family Doctors are repeatedly banging our heads against the door, but no one is answering on the other side.

  • This itself causes morale burnout. Because we cannot do what we long to do: help patients.
  • It also causes excess administrative burnout and waste of resources within our clinics and staff. Having to fax, and refax, and refax, and investigate where on earth we can redirect the referrals each time.

The solution: centralized referrals.

But not just regionalized centralized referrals. I’m talking about provincial centralized referrals, as I’ll illustrate below.

The Drawbacks of Centralized Referrals

I used to oppose the concept of centralized referrals.

I’ll be blunt: if someone has a short wait list, there’s usually a reason – and it’s often a negative one.

I’d prefer to refer to specialists who I know and trust. And from whom my other patients have received great care.

But in today’s world, the burnout caused by rejected referrals far outweighs anything else. It’s time to move forward with centralized referrals.

Some Patients Will Travel Great Distances

Here is why I’ve suggested we need a cross-province, maybe even national, centralized referral system.

Imagine this hypothetical example:

  • My local wait time in the Belleville/Kingston area is 2 years to see a neurologist.

  • But let’s say that there’s a neurologist in Toronto or London who can see patients within 4-6 months.

  • My patient is able and willing to drive 2-4 hours for the much shorter wait time.

  • But because this option is outside of my local region, there’s unfortunately no way of me knowing about the availability of these shorter wait times elsewhere in the province.

  • So, the patient is never connected with an accessible more timely option.

If there was a provincial centralized referral system, this patient would receive more timely care.

Now, some patients may not be able to travel the longer distances. Or they’d just prefer not to. That’s fine too. Those patients would simply stick to the closer regional options, knowing there’s a longer wait time.

What the Ideal System Looks Like

It’s elegantly simple:

  • Family Doctor recognizes patient needs to see a specialist.
  • Family Doctor submits a universal, standardized referral to a single centralized entity. Let’s call it “Ontario Centralized Referral Centre”. (Family Doctor staff don’t have to be researching and digging across the province for options. We have one single contact point).
  • In that standardized referral, the Family Doctor includes the patient’s preference for geographical radius. i.e. the referral specifies if the patient would accept seeing a specialist within 50km vs 100km vs 200km vs 500km vs 1000km away.
  • The Ontario Centralized Referral Centre then connects the patient with the shortest available wait time within their preferred geographical radius.
  • And it’s the Ontario Centralized Referral Centre that notifies the patient, coordinates the appointment, and keeps the Family Doctor advised of the appointment details.

The same process would apply to all diagnostic tests too.

Dear politicians and provincial leaders: You want to put a dent in burnout? Create a system like this.

by Dr. Adam Stewart

May 20, 2023