Getting a doctor to your door is as easy as ordering pizza with a house call service that has just expanded to Hamilton and Burlington.

Patients can order up a doctor by phone or online through MD HomeCall. There is no charge to the patient as the doctors bill OHIP for the visit.



FLASHBACK: House calls in Hamilton

But local family doctors worry it will disrupt the continuous care normally provided by primary care and waste health dollars. Plus, they could lose money every time their patients use the service.

"Ultimately it's the patient's choice," said Lisa Ryan, general manager for the Ontario West branch of MD HomeCall which also runs out of Edmonton and the Greater Toronto Area. "We're not trying to replace family doctors. We're just trying to make sure patients get the best care."

The service also aims to keep home care patients out of hospital by working with the Hamilton Niagara Haldimand Brant Community Care Access Centre. It's in the process of creating a partnership that would see nurses and other home care workers contact MD HomeCall when their patients need to see a doctor, but don't require emergency care.

"Instead of them having to go to the emergency department, I can have a doctor go to the home," said Ryan.

The service is not meant to replace family doctors as patients could see a different physician each time. Instead, it's intended for occasional use when patients would otherwise go to a walk-in clinic or get no care at all.

Its main users have no family doctor or can't get in to see their physician in a timely manner.

It brings care right to the door of those with no transportation, such as seniors without a driver's licence or disabled patients who can't access bus service. In addition, it helps those who can't leave their homes, like a mom who has no one to babysit her other kids while she takes a sick child to a walk-in clinic or a patient with an injury that limits mobility.

"It's bringing the health care system to them when otherwise they wouldn't be able to access it," said Ryan. "It's definitely a service in need."

About thee patients a day, seven days a week have used the service since it opened in Hamilton on Feb. 23. It's expected to be available in Burlington March 17. The hope is to get to 10 patients a day between 4 and 9 p.m. on weekdays and noon to 3 p.m. on weekends.

The head of Hamilton's doctors calls it a waste of precious health care dollars.

"It is a misuse of the health care budget as patients use it as a service of convenience and the physicians charge a house call fee," said Dr. Sheilah Lamb, president of the Hamilton Academy of Medicine. "This extra charge will eventually come out of the pocket of all physicians in the province if the budget allocated is overspent."

In reality the opposite is true, argues the medical director of the Hamilton service, Dr. Craig Karpilow.

"If we didn't see them, they'd take an ambulance to the hospital or end up in the emergency department," he said. "It's being used correctly."

The Ontario Medical Association expressed concern about the service undermining primary care.

"These services should not replace the continuity of care provided by a family physician," said Hamilton's Dr. Ved Tandan, president of the OMA. "Residents of Hamilton are fortunate that many family physicians in the community currently perform house calls as part of the comprehensive care they provide to their patients."

In addition doctors who are part of a family health network or family health organization could lose money similar to when their patients go to a walk-in-clinic, confirmed Ministry of Health spokesperson David Jensen.

"MD HomeCall is definitely a problem for Hamilton physicians as a majority of our family physicians are members of a family health team," said Lamb. "We provide on-call services for our patients and discourage them from using walk-in clinics and house call services."

The service, started by a Toronto doctor, gets its money from the physicians paying an overhead cost to MD HomeCall which provides the patients, transports the doctors to the appointments and does followup calls to check on those using the service.

There are currently about five doctors signed up between Hamilton and Oakville, but the service is recruiting more.

Hamilton family physician Dr. Richard Tytus says there are plenty of family doctors looking for work because Ontario now only allows them to join family health teams in regions of dire need or when someone retires.

"They train you to work in teams, but when you graduate there are no jobs for you," says Tytus, who says their options are to open a fee-for-service practice, work for a walk-in-clinic or a home call service. "You're going to see big ramifications."

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He urges patients to stick with the doctor who has taken care of them for years over the convenience of a house call.

"When it comes to your health care, I think your family doctor is the one who knows you best," said Tytus, who represents this district at the Ontario Medical Association. "Your family doctor treats you as a person and not just the condition."