Inside Midtown Kingston Health Home
A Physician’s First Month Reflections
Midtown Kingston Health Home, a new Health Home in Kingston run by FLA OHT partner Kingston Community Health Centres, recently welcomed Dr. Eileen Nicolle as a family physician. We’re pleased to share Dr. Nicolle’s reflections on her first month at Midtown, offering insights for the community into what it’s like for both providers and people rostered to the Health Home. Through her reflections, Dr. Nicolle sheds light on the day-to-day experiences of delivering care in a team-based setting, highlighting the strengths, challenges, and possibilities within our health-care system.
Dr. Nicolle brings a rich background to her role at Midtown Kingston Health Home. She previously worked with priority populations in Toronto, completed an Enhanced Skills year in Global Health and Vulnerable Populations, and earned a Masters in Public Health with a focus on Planetary Health and Health Systems. Her experiences span from clinical work in Malawi, Ethiopia, and Brazil to caring for diverse communities across Canada. Through her reflections, we hope our community gains a clearer understanding of the health-care landscape and a vision of the Health Home model we are building with our partners.
Dr. Nicolle’s reflections
The search for a family doctor or primary care provider is an increasingly familiar challenge for Canadians. Despite evidence that strong primary care results in lower costs and better health, and that Canadians value access to health care based on need, many people are unable to access timely, continuous care.
I have had the great privilege of interacting with multiple primary care models both in the Canadian context—in Quebec, Newfoundland, Southern Ontario and Northern Ontario—and internationally in Malawi, Brazil and Ethiopia. Every system I have interacted with has had their strengths and weaknesses. Over time, I have joined other colleagues with an interest in seeing how different existing system strengths can be optimized to address the concerns and needs of all Canadians.
I recently joined Midtown Kingston Health Home, a clinic that is premised upon meeting the needs of the large and increasing population of people in Kingston without a primary care provider. The Health Home is looking to provide dynamic, solutions-oriented care to both meet existing gaps in care, as well as provide high-quality, continuous primary care.
I wanted to share some reflections as our clinic takes flight, in the hopes that Canadians can better understand the system that exists and have a clearer vision of what the system should aspire to be.
Rostering people in our community
The first challenge in finding a primary care provider is to have someone “roster you” - in other words, take you on as a patient. There are different values and factors that can play into how this is done and finding someone to roster you can be a challenging and anxiety-provoking experience.
The needs in Kingston are great, with more than 1 in 5 people without a primary care provider and many family doctors poised to retire. Our Health Home realized that it could not meet the needs of all currently unattached people, and wanted to follow a model to attach people that would be equitable and reproducible.
Together with the FLA OHT, the Health Home made the decision to roster people registered with Health Care Connect - a provincial system that aims to connect people with primary care providers based on their postal codes. Like the school system, which prioritizes connecting students to a neighborhood school, this approach placed priority on the geographic region in the Health Home’s immediate area.
We have been also providing appointments to people in our community with non-emergent issues who do not have access to a primary care provider and do not meet our rostering criteria, so that they have access to primary care, including sexual health and cancer screenings.
Delivering primary care by a team of health-care professionals
Our model of team-based care at Midtown pairs each family physician with a nurse practitioner and we work together as a clinical care team alongside other multidisciplinary staff. The family physicians and nurse practitioners cross cover each other, which means that there is greater coverage for people rostered to us and someone in the clinic is always available to deal with urgent concerns. This collaborative model also reduces provider burden by providing the opportunity to discuss challenging cases together and combine clinical strengths in providing care. Furthermore, having a multidisciplinary team helps promote a model of care where people can see the right provider for the right problem, and not go through a family physician unnecessarily.
Meeting system challenges
Health systems across Canada are experiencing challenges and many have developed innovative and creative ways of addressing these. One of the ways our Health Home is dealing with the burden of administrative work for primary providers is through the use of artificial intelligence (AI) for documentation through an AI scribe. AI scribes use speech-to-text and AI technologies to transcribe physician-patient conversations, with consenting individuals, into detailed and meaningful content. Although there are still other aspects of administration work that need further innovation, this is one approach that helps ease some of the burden.
I could not end this reflection without briefly touching upon how satisfying the last month of work has been, which may be the most important reflection at a time where many providers are moving away from primary care. When issues such as administrative burden and cross-coverage are built into the care model, and there are ongoing efforts to provide care as a team and be solutions-oriented, the work can be immensely satisfying and feel sustainable. Being trusted with people’s stories—and having the ability to play a role in improving people’s lives by addressing physical concerns, mental health issues, or social determinants of health - is an amazing privilege.