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Ontario Representative 

Paul Cano - Email

Grimsby ON

Dr. Cano practiced rural comprehensive family medicine in Niagara (Smithville office and Grimsby hospital) from 1990 to 2020.   He continues to provide Locum, Obstetrics, and Surgical Assists in his home community, and does intermittent family practice locums in the north, primarily Kenora ON.  

He served as a primary preceptor for the McMaster Rural Family Medicine Residency Program and was its Faculty Development Coordinator.  Paul is a local leader for changes such as implementation of an Alternate Payment Plan at the Grimsby Emergency Department, transition of his practice to a Family Health Network, starting a Hospitalist program, and Open access appointment booking.

He led his Family medicine group through EMR implementation (1999) and EMR migration (2006).  The committees he has served on included Primary Care EMR certification and Canada Health Infoway, and currently sits on Ontario Clinical Advisory groups for eServices, Patients Before Paperwork, and Patient Summary.  

Ontario physicians have been struggling in general over the past several years as they have gone without a Physician Services Agreement with the Ministry of Health since 2014.  In June of 2017, members of the Ontario Medical Association voted in favor of a binding interest arbitration framework. Arbitration was triggered by the OMA May 24th, 2018, while still dealing with the Wynne Liberals.

The lack of a shared view about how medicine in Ontario should move forward between the government and the physicians of the province has led to a great deal of acrimony and has affected rural and remote medical practice within the province. Burnout levels are high, and there have been no fee changes (except for unilateral cuts) for the past four years. This puts an extra burden on us smaller providers to continue to keep up with the costs of providing brick and mortar, traditional care (including skyrocketing electricity prices in rural Ontario since the privatization of Hydro One) but at the same time being unable to be paid in keeping with inflation to keep their practices open. Numerous examples of closures in smaller areas have been seen over the past four years, including the loss of many specialists to urban contraction, who had been operating satellite clinics in smaller centers to assist with patient travel.  We will see what the future holds in health care in Ontario as negotiation begins with the Ford Progressive Conservatives.

The opioid crisis that is become extremely evident over the past ten years has also not left Ontario unscathed. Like our western province counterparts, we have seen the rise of synthetic fentanyl hitting the streets, even in our rural and remote locations. There is no cohesive opioid strategy in Ontario, and Local Health Integration Networks have instead been tasked with trying to assess and institute measures that deal with the opioid crisis. This has largely been put in place without physician input due to the acrimonious relationship between physicians and the Ministry of Health. 

A large coup of the Society of Rural Physicians this year was our role in addressing the College of Physicians of Ontario original document regarding change of scope of practice to work in a rural emergency room. Along with the College of Family Physicians of Canada, we were able to persuade the College of Physicians and Surgeons of Canada to amend their original public document to be less deleterious to rural communities, who rely tremendously on competent family physicians to keep their emergency rooms operating fully.  Read more about this here.

There are lots of things to advocate for within rural and remote medical practice within Ontario, and we gladly welcome new members and their input to help continue to address these issues.  Please contact us for more information on how you can become involved.

Provincial and Territorial Representatives are volunteers elected by members as per the by-laws at the annual meeting. Representatives from across the country help to make the work of the Society of Rural Physicians happen. They are your contacts. Please feel free to share information, questions and concerns with them for discussion at quarterly meetings. The outcome will come back to you via the SRPC Newsletter, emails, the RuralMed mailing list, or directly via your representative. We can always use more human resources and ideas. If you have something to contribute, let us know!