Back to black bag and horse-and-buggy medicine.

pelling, particularly in an era in which treatment of chronic diseases is consuming more of the health care dollar and more senior citizens need care. But financial incentives for physicians to return to black bag and horse-and-buggy medicine haven’t followed suit. “The majority of family doctors don’t make home visits. So these seniors sort of slip through the cracks until there’s a crisis and they end up in the emergency department,” says Dr. Mark Nowaczynski, a mobile physician who leads a provincially funded team in Toronto, Ontario, that makes house calls. Their “needs are not being well met by our office-based, primary care model of delivery.” Seniors across the country are often released from hospital with no access to a family physician, he says. “It’s happening over and over again in every hospital in the country on a daily basis.” “Our population is rapidly aging and the number of Canadians over the age of 85 is now the fastest growing segment of the population and if we don’t deliver care in a more targeted way to this population, we’re simply going to continue to have these people come through hospitals, like coming through a revolving door,” Nowaczynski says. But College of Family Physicians of Canada President Dr. Robert Boulay argues that Canadian physicians are already making the shift back toward house calls. There’s been an upward trend in the frequency of house calls as physicians move toward “patient-centred care” and their patient pools age, he says. Results from the 2010 National Physician Survey indicate that “as physicians got older they were doing more house calls and I think that’s probably a reflection of the relationship aspect of our work so as you establish more of a relationship with people and follow them for a longer time, most of us would transition to doing house calls for them as they become more disabled or have terminal illnesses.” The survey numbers, though, don’t entirely support that proposition. The 2010 numbers — 42.4% of 6337 family and general physicians — are slightly lower than the 48.3% of 9930 physicians who indicated that they visited patients in their homes in 2007 (www.nationalphysiciansurvey.ca/nps/ 2010 _Survey/Results/pdf/en/national /Q15 /Q15i_FP.pdf). But Boulay says the survey did not inquire as to the number of house calls a physician made, so while the percentage of doctors making house calls seems lower, the overall number of visits has likely increased. Dr. John Sloan, a family physician in Vancouver, British Columbia who has been making house calls for 15 years, concurs. “There’s the usually cited idea that the doctor with the black bag and the horse and buggy is now returning and it’s not so much about that as it is about a better way of meeting the needs of a group of patients that we refer to as frail,” he says. Whether or not house calls are actually on the rise, they’ll have to be in the