Ritika Goel

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@DanyaalRaza @RitikaGoelTO @PQCHC @AllianceON @pqhc Complexity means that good care will require more time and more visits and the number of patients served will be lower. Vulnerable patients need and deserve to be in a system that recognizes complexity and provides care to those most in need
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@DanyaalRaza @RitikaGoelTO @PQCHC @AllianceON @pqhc This article points to the problematic nature of looking at number of patients as a measure of success in meeting community needs.
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Community Health centres are mandated to serve vulnerable populations such as the homeless, seniors, refugees, new immigrants & low-income individuals. We are shocked to hear that the largest CHC in Ontario is firing frontline medical staff w/o cause. 1/5 ottawacitizen.com/news/local-new…
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Two Ottawa family docs, an NP, and a nurse fired without cause, their long-term relationships with vulnerable patients shrugged off. Shame on the people who make these decisions. ottawacitizen.com/news/local-new…
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I cut my teeth at @PQCHC as a locum MD early in my career. Hard to understand this decision, especially when primary care is already under enormous strain, with high needs communities suffering most. I hope @AllianceON & the @pqhc Board address this. ottawacitizen.com/news/local-new…
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It’s hard to imagine that this CHC will be an employer of choice for physicians if team members are treated like this. twitter.com/RitikaGoelTO/s…
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This is alarming. Already >134k patients in the #Ottawa region without a primary care MD. It's especially critical that marginalized patients like those served by @PQCHC have care. Patients & the community deserve answers & action. @SapnaMahajan_ @ChandraPasma @JoelHardenONDP twitter.com/RitikaGoelTO/s…
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This alleged “restructuring” has been happening for years now with no explanation to why employees continuously get let go. The community has called numerous times for a deep investigation & financial audit into this multi-million $$ org @JoelHardenONDP ottawacitizen.com/news/local-new…
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Glad to see @JoelHardenONDP and @ChandraPasma are aware and involved. Hope folks at the @AllianceON are following this closely as well. CHC work is extremely hard work and providers must be treated with respect. /4
Pressure to see more patients must be understood within the context of what it takes to provide good care to marginalized communities. I wrote about this recently - time is the most valuable investment we can make to build trust. Firing people loses this work instantly. /3
Primary care providers of marginalized community members are not widgets. Longstanding relationships cannot be replaced, and too often people are given revolving door health providers putting them at risk. The quote from a patient losing her doctor here is heartbreaking. /2
Shocked to read this piece about two family doctors, an NP and a nurse getting fired from @PQCHC without explanation. I have worked with health providers from this CHC on advocacy for uninsured migrants and refugees. ottawacitizen.com/news/local-new… via @OttawaCitizen #onpoli
I would like to highlight as @cpso_ca EDI Lead “CPSO’s commitment to integrating (EDI)is also relevant to how we may conceptualize professionalism,given that traditional concepts of professionalism have often centred around the identities and cultural norms of dominant groups.” twitter.com/pat_health/sta…
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I am devastated, but I have to leave my PhD program. My family and I are simply too poor to continue on an embarrassing stipend with no benefits. The space on credit cards has run out, so the method we’ve been using to survive so far has run its course. 1/5
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I would love to hear your thoughts on the above - whether you're an Ontario primary care provider, other form of health provider, or someone accessing primary care in Ontario. 🙏🙏🙏
We want a system that incentivizes excellent care for those living at the margins: Black, Indigenous or racialized; queer, trans and non-binary; people who are unhoused; people who use drugs; people with severe mental illness; sex workers; migrants etc. This can be a first step./
4. Remembering that NO complexity indicator will completely address barriers to care that are about systems of oppression. We still need to address those structural barriers, and shift the culture of medicine towards anti-oppressive care practices.
3. Complexity must include medical AND social complexity - this can be done through postal code data, by weighting medical conditions associated with social complexity higher, by using social issues diagnostic codes, and thinking of alternatives to capture social complexity.
2. That billing data only captures NUMBER of visits not TIME in each visit which gives us more information about complexity. This is also important for equity as research shows women MDs spend more time with patients.
Hopefully this complexity indicator will take into account: 1. Those who are most high needs but *avoid* seeking care due to trauma, mental illness etc. so don't show up as medically complex based on visit data.
But now.. the recent physician agreement includes plans to ADD "complexity" beyond age and sex to calculate capitation payment. This could be a game-changer and could mean we incentivize serving marginalized communities who need primary care the most.
Until now, with capitation: You get paid the same to roster a 45yo new immigrant single mom in social housing with many serious medical issues as a healthy 45yo lawyer. One needs care more, but the other is easier to serve, leaving space to roster others and get paid more overall
- FFS - how most docs were paid in the past, can incentivize short, one visit appts - Salary or hourly - longer visits, works well for marginalized folks, but only in some clinics - Capitation - large shift towards this model in Ontario - BUT incentivizes rostering healthier ppl
Ontario pays family docs in a few ways: 1. Fee-for-service - paid based on what you do in a given visit, 2. Salary or hourly - in Community Health Centres and some shelter clinics, 3. Capitation - paid an annual fee to care for someone based on their age and sex
ICYMI: I wrote this piece about how taking into account patient complexity for capitation payments in primary care can make a *huge* difference for access for marginalized communities if done well. TL;DR below 🧵healthydebate.ca/2022/07/topic/…w… via@HealthyDebatee#onpolii#sdohh#cdnpolii
I wrote this piece on the recent physician agreement, the plan to add a complexity modifier to primary care capitation payment and what this can mean for marginalized communities if done well. healthydebate.ca/2022/07/topic/… via @HealthyDebate #onpoli #sdoh #cdnpoli
Oh my, sit tight & let's unpack how this case illustrates how medicine is an incredibly unsafe training environment for ppl with intersectional vulnerability. 1/9 #metoo #equity #psychologicalsafety #cardiology #MedEd twitter.com/picardonhealth…
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I just want to🚩that this issue of doctors not working directly for hospitals — in 🇨🇦, they're typically independent contractors who have privileges to work in hospitals but who bill the government directly for services — has now come up THREE times in recent stories I've done:
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This was us yesterday. Crammed into a line for almost 3 hours with two young kids late at night, lots of strollers and bikes, many dangerous situations with little ones getting pushed. This is what happens when we don’t invest in our public infrastructure, Toronto. #topoli twitter.com/LukewSavage/st…
I’ve waited a long time for this day. My book, Son of Elsewhere, is out today. It’s a joy and a privilege to get to share it with you. You can get it wherever you buy your books, so pop by an indie bookstore. Then, if you’re so inclined, mention it to a friend 💕r
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First day of MED SCHOOL after burning 71% of my body 3 years ago. 28 surgeries and more to come, 20 days in a coma, 2 months in ICU, more than 7 months in the hospital, and 3 years of therapies.Happy to finally be here.
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This is huge. Everyone has the right to healthcare. ✊🏽 Big congrats to the communities who have pushed for this change. 🙏🏽 Let’s see if we can follow suit, Canada. twitter.com/jakaralri/stat…Pub16
Really important illustration of how class privilege works. You may just see it as helping out a friend’s kid, but most people’s parents do not have the social capital of friends in elite institutions. Our actions can reinforce inequities or we could push for equitable policies. twitter.com/matthaeusware/…
We are the actors, stunt performers, and stable hands of Medieval Times in Lyndhurst, New Jersey joining together in union to create a fairer, safer, and more enjoyable workplace. With a supermajority of support, we are excited to be forming our union with the AGVA.
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Rather than thanking our lucky stars that we live in Canada, I hope we are getting ready to fight like hell to stop those salivating at the thought of outlawing abortion here too. #RoeVWade
Very important thread for potential implications of #RoeVsWade in Canada. twitter.com/1MikeMorris/st…
Its been 3 days since Roe vs Wade was overturned. @PierrePoilievre who constantly preaches about “freedom”, has absolutely nothing to say about it. We can only assume at this point that he agrees with it. So what kind of freedom exactly has he been preaching about all this time?
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General strike on Monday to protest this abomination of a Supreme Court Decision. Spread the word
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People often wonder what subtle racism looks like. I stopped at a moving sale today in Phoenix. I was in the middle of a conversation with the seller. This older white woman then walks in front of me, stands there, doesn’t acknowledge me or the fact that we were having a /1
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In the 90s, I was one of very few people in my community who were out and willing to do media. I did many CBC panels and call in shows where the producer invited some homophobe so that they could present “both sides”. 1/10
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Don’t confuse legality with morality. Today is a great reminder of why. #RoeVWade
Sending love to everyone impacted by the ripples of horror created by the Air India bombing. Here’s hoping we can honour the origins of this new National Day of Remembrance. 🙏🏽 🙏🏽twitter.com/NishaOttawa/st…orS3wP
The overturning of Roe v. Wade is a great reminder that we can never take social progress for granted. We can never stop fighting - to keep the gains we have, and to counter the backlash that will come for the new gains we’ve won.
I was just asked to be on The National to discuss Roe and abortion...and then I found out it would be a panel with a "pro-life/anti-abortion" voice. I am livid and sent this reply. I couldn't care less if this means I will not be asked back to the CBC. It needed to be said.
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BREAKING: The Supreme Court just overturned Roe v. Wade, ending our constitutional right to abortion. We know you may be feeling a lot of things right now — hurt, anger, confusion. Whatever you feel is OK. We’re here with you — and we’ll never stop fighting for you.
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Weird to blame Bernie for #RoeVsWade being overturned instead of Barack Obama who actually had the power to codify, but instead used his majorities in Congress to pass Mitt Romney’s healthcare plan, made the bush tax cuts permanent, and bailed out his Wall Street donors
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remember: it is the presence of racism which is unprofessional, not the naming of it. racism must be spoken about publicly - OUT LOUD - often. whispers and behind closed door conversations about the racism allows racism to flourish and that only furthers harm.
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