Small Changes Big Impact

Virtual care during COVID-19 and the patient-centered medical home with Dr. Ali Damji

May 13, 2020 University of Toronto - Department of Family & Community Medicine Season 1 Episode 27
Small Changes Big Impact
Virtual care during COVID-19 and the patient-centered medical home with Dr. Ali Damji
Chapters
Small Changes Big Impact
Virtual care during COVID-19 and the patient-centered medical home with Dr. Ali Damji
May 13, 2020 Season 1 Episode 27
University of Toronto - Department of Family & Community Medicine

In studio today, we have Dr. Ali Damji, a family physician at Credit Valley Family Health Team, assistant professor at the Department of Family Community Medicine at the University of Toronto. He works in many roles and wears many hats - including office based care, palliative care, home based care, addictions and is the QI program director at his site. Today, he speaks about transitioning to virtual care during COVID-19 and the idea of the patient-centered medical home.

Show Notes Transcript

In studio today, we have Dr. Ali Damji, a family physician at Credit Valley Family Health Team, assistant professor at the Department of Family Community Medicine at the University of Toronto. He works in many roles and wears many hats - including office based care, palliative care, home based care, addictions and is the QI program director at his site. Today, he speaks about transitioning to virtual care during COVID-19 and the idea of the patient-centered medical home.

Dr. Rezmovitz:

Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. Welcome to Small Changes, Big Impact. In studio today, we have Dr. Ali Damji, a family physician at Credit Valley Family Health Team, assistant professor at the Department of Family Community Medicine at the University of Toronto. He has many, many, many roles - many hats that he wears. He works in office based care, palliative care, home based care, addictions and is the QI program director at his site. Welcome Dr. Damji, how are you?

Dr. Damji:

I'm good, I'm good. Thanks. How are you doing today?

Dr. Rezmovitz:

Oh, I'm great. As always. How is COVID-19 treating you?

Dr. Damji:

Well, it has definitely been challenging across the board for everyone and it definitely has been really changing the way that we all work. And for me, I'm in my first six months or so of practice, so it was definitely a big adjustment, for sure, early on in my first year of independent practice to suddenly adopt to a new way of doing things and interacting with patients, building a practice, providing care and just very unique ways - adopting a new processes and leading a lot of change - both within primary care and then also with our hospital partners. It has also been in some ways a really a phenomenal learning opportunity and growth opportunity for me too. I've definitely learned a lot about - whether it's infectious disease, infection control practices, virtual care and novel technologies, connecting with partners from across the healthcare system and working with them in ways that have been so different - that's also been a really interesting opportunity for me as well. Fortunately, staying safe during all of this and hope you are as well.

Dr. Rezmovitz:

I think it's beyond safe. I mean, we're physicians, so we put ourselves at risk obviously for our patients. I think the bigger thing is to try to - I started telling people to stay sane because being on lockdown is very tough. In fact, I just came from the nursing home that I work at and one of the patients said to me - she's 91 - she said, "I'm done. Like, I haven't taken my medication for a month. I'm ready to go." And I said, "you know, is this an active suicidal thought that you're having?" And she's like, "no, I'm just ready for the world to take me." And so we had a conversation and you know, the best part of it was at the end of the conversation, I had her laughing. She thanked me profusely for coming. She's going to take some more medication. You know. So that's part of what we do is family medicine. Regardless of what I just went into, I'm curious to know about leading change. As an individual myself - and I'm going to tell you, you should probably look into this - I taught a course at the Dalla Lana School of Public Health and our graduate school about leading change in population health. So talk to me, tell me what you're doing to lead change because it's not easy leading change. And so tell me what the problem was, how you decided to get into this and what you guys are doing.

Dr. Damji:

Sure. So I think the large challenge that we're facing like many primary care practices is how do we provide care in an evidence based, effective, high quality way despite the limitations that exist right now of needing to keep people at home - really trying to avoid people leaving the home unless absolutely necessary - and maintaining that social distancing that we're all trying to do to beat this virus. And sort of the current state of the Credit Valley Family Health Team - which is where I trained as a resident and now work - was that we were in the midst of trying to adopt virtual care technologies and more so from a perspective of improving patient access, and trying to improve that, but it was a slow, kind of incremental process that we were doing because there wasn't really a large amount of pressure to rapidly expedite that growth. Of course, COVID-19 has changed all of that. And now with these new pressures, we need to be evolving and delivering care in a novel way in order to make sure that we're protecting our community, and keeping patients out of hospital as much as possible and providing exceptional primary care to them. So as the site program QI director and as someone that generally enjoys using technology a lot and likes being on top of sort of what's the latest trend that's going on in healthcare and in this space, I took it upon myself to be responsible for leading a lot of our virtual care work within our family health team. And so specifically that's involved looking into a bunch of different vendors. I've gotten several resident doctors involved too that were interested in this work to kind of work as a mini consulting team. And I'd done a bit of consulting work as part of my master's program as well. So trying to kind of use that part of my brain again and get in that mindset of looking at different solutions and then coming up with a recommendation and a deliverable at the end of it. So we've been doing that process over the past two weeks and are just in the midst of finalizing our platform, and finding one that's gonna work for our entire practice, including our interprofessional health colleagues. And throughout this process we've learned a lot about sort of what matters to physicians when selecting a virtual care platform and how does that differ from other healthcare professionals that we work with in primary care. And that's been really interesting data that's come from that. The other thing that that I've been up to as well in terms of leading change has been extending the work in virtual care outside of the walls of the hospital. So I'm really fortunate to have a close relationship with quality improvement experts and counterparts within the hospital too, and they were aware of some of the work that I was doing with virtual care. And so they offered me an opportunity to help the hospital develop its own virtual care capacity when facing the community. And I think that's an example of some of the great work that we can do as family physicians because we understand how the hospitals work, but we also have a amazing understanding of what the community needs are, and we can be that exceptional bridge between those two. And so I've been leading a large group of physicians using virtual assessment tools so that way when we have patients that may possibly be suspected COVID cases, they can be assessed over an app and that app integrates with the hospital assessment centres to try and expedite testing, give them booked appointments using the technology so they can just drive in and be tested, and avoid that potential exposure to other patients into the community. So those are some examples of the changes that I've been involved in.

Dr. Rezmovitz:

Yeah, it sounds fascinating. Do you have any like examples with actual patients yet? Have you had feedback from some of them yet? To let you know how it's working?

Dr. Damji:

Yeah, definitely. So for the virtual assessment centers in particular - that's been live for the past several weeks. Initially, the big challenge was with the volumes and just sort of when you're starting off with a process like that, you want to be careful that you don't sort of overwhelm the system upfront. Now we are getting increased volumes, especially with the increase of longterm care testing and wanting to test every single healthcare provider working in a longterm care home. The feedback that we've gotten from the patients thus far is they do enjoy the system in the sense that it works very seamlessly. They like the fact that they see the doctor, automatically that note is sent to the assessment center. They receive a phone call and they come in. So when the system works well, they do like that. I think a barrier with it, and I think that we're finding across the board with healthcare technologies is that patients across the spectrum have varying comfort with using novel technologies. And so we are needing to develop fail safe procedures and other processes to use in case a patient cannot use the app, right? Because some patients just are not comfortable with technology. Some patients don't even have a computer, some patients don't have access to a device that they could use. So we want to also make sure that in our sort of zeal and enthusiasm for implementing novel technologies, that we also don't leave people behind - and that's sort of where the equity lens comes into play. So that's sort of where we're at right now.

Dr. Rezmovitz:

So what do you do in order to make things equitable? How do you actually address a problem like that?

Dr. Damji:

So I think part of it is that making sure that we are looking at things from a variety of different perspectives and not just from our own perspective because I think for many of us who are young, tech savvy, really enjoy using these technologies - they seem perfect, right? But I think it's really important that, for example, we have geriatricians who are involved in part of our steering team and they can often speak to the experience of some of their elderly patients who may not be able to interact with these technologies. Making sure that we're regularly engaging with other partners that we work with regularly within the hospital leadership, such as patient advisors, working with other departments within the hospital that can make sure that we're trying to develop processes and procedures that are equitable for the community. And again, I think a great role and expertise that I bring as a family physician and being connected with other family physicians is that we're the ones who have that on the ground lens of patients in the community to a very personal level because of the relationships that we have. And so because of sort of this emerging role that I have and as a family physician embedded in the Mississauga community, I am able to hear from other colleagues from across the community and get their direct feedback. So if they run into a patient who has issues with this app system, they email me directly, they get in contact with me directly, and we're able to troubleshoot and find a way to make sure that patient can navigate through the system. And then also use that as a learning opportunity to improve the system so that we don't run into that same problem again.

Dr. Rezmovitz:

So what is it like in Mississauga these days? Is it like the rest of the world? Is it oppressive there to? Is COVID-19 oppressing you like everyone else?

Dr. Damji:

Certainly. So there are very strict social distancing measures that have been put in. And for me, Mississauga has been my my home for 27 years now. So I was born here - in fact, some of my preceptors actually were physicians involved in my care - like when I was a resident, I worked with the obstetrician who delivered me. I worked with the pediatrician who looked after me. So it's been a home for me. And there is a humongous sort of palpable difference that you can feel every single day. The roads are emptier you don't see people out and about anymore. It's fundamentally shifted and changed for sure. Just like everywhere else.

Dr. Rezmovitz:

Right. And so given that you guys are, you're working with the hospital to create more of a virtual care platform, have you guys adopted a certain platform in your own family practice?

Dr. Damji:

So yes. So we are on the Accuro EMR in our family practice. And so we already have a relationship with Medeo, which is a platform that integrates well with Accuro for several different functions - specifically online booking and secure messaging. And so those are initiatives that we had implemented prior to COVID, but I would say that we hadn't felt much of a push until COVID happened to really start ramping up our capacity with that. So prior to COVID, maybe a few of us were using the secure messaging capacity every now and again - almost like a pilot. But now I would say every single physician within our team is using that consistently because it's a very effective way to securely communicate with patients. For example, you know, I had a patient the other day who was being added into my practice who was describing rashes that sounded consistent with psoriasis. Through Medeo, I was able to diagnose that condition because they could snap a photo of it, send it directly from their smartphone securely to me in the EMR, and I could confirm that diagnosis and recommend treatment based off of that. So that platform has already been implemented and has been working quite well within our practice. But the new frontier is now video visits. So we haven't really explored that in too much detail. It was something that we were thinking about. But now with the COVID outbreak, we do feel that there are limitations with the telephone. It is nice to be able to converse like how you and I are right now and being able to actually see the person that you're talking to, and I think for patients it's really important for them too - particularly patients that are dealing with challenges with mental health, end of life - these are situations where that relationship is so key and you don't get that as much over the phone. So that's where we're at right now and that's sort of the process I was describing.

Dr. Rezmovitz:

So what do you think the biggest difference is from residency to now? It's been nine months? Since residency? What do you think some of the biggest lessons you've learned since residency? Like being a resident versus now having your own practice?

Dr. Damji:

So certainly I think the first thing that I learned for sure - and many of my preceptors told me this as well, but I didn't realize that until I started is that it's not that it actually gets any less busy. You know, I think everyone thinks that as a resident that "oh, I'm putting in the time now and then after that it'll be smooth sailing after that." But if anything I think it's actually much busier when you become a fully attending physician and you don't appreciate that until you're in that position. The other thing I've appreciated as well is the learning certainly doesn't stop. And I would say even in some ways, once you're the solely accountable person, you sometimes feel that you learn even more in that environment. And I know people describe the first five years of practice as that extension of training and in many ways and sort of building that comfort into your skillset and even in your own shoes mentally as being an independent family physician. The other important lesson that I've learned and I feel so fortunate to be working in a group based setting is to never be afraid to ask for help and to ask for an additional set of eyes. I've been really grateful for my colleagues to be able to do that as I've been starting out. And it's been interesting too, as a new grad to also find myself in a role too, where my colleagues who were previously my preceptors, sometimes will tap into my own skillset with addiction medicine, for example, and ask to consult on some of their cases as well. So that's been a really interesting transition too. I think the other aspect to that is a very unique change when you become a staff physician is all the time spent on practice management and the other aspects of running a practice that you don't necessarily have as much insight to as a resident. But when you become a staff physician, you suddenly realize this whole other level, which is really interesting for me. Like I really enjoy management and aspects around that, but it is also a huge sort of new commitment there.

Dr. Rezmovitz:

And so you're continuing learning. Where did you learn about all these systems and all this approach? What did - do you have any specific training in a system management?

Dr. Damji:

Yeah, so one of the programs I was involved in was was the LEAD program. So that was a program formerly in the MD program at the University of Toronto where essentially they selected about nine students per year to receive a scholarship to do graduate training with the Institute of Health Policy, Management and Evaluation, the Rotman School of Business and their MBA stream, and the School of Public Policy and Governance. This later transitioned into a program called the Masters of Science and Health System Leadership and Innovation or SLI, which is now run concurrently with the MD program. And there's also a companion program that I actually helped as part of the steering committee for the design of it, which is part of the residency program with the DFCM. So there's now a three year integrated stream where students complete that masters, and resident complete it concurrently when they're training. So for me, I was able to complete that program, both the initial LEAD program and then the MSC SLI program at IHPME. And that was a phenomenal opportunity to be able to learn about health system design, change management, learn about business strategies and healthcare financing, learn about the policy world in a really interdisciplinary fashion. So I gained a lot of skills from doing that. And a neat part about that program was also a large emphasis on practicums. So there were a lot of different projects that I was involved in as part of the masters. So these included change management projects at the Hospital for Sick Children, helping design awards and different processes for them, policy projects with Health Quality Ontario. I worked internationally in Sweden for about eight weeks doing a quality improvement study with them and learning from some of the experts in patient co-design and designing improvement initiatives in healthcare in collaboration with patients. And then I also did some projects related to addiction medicine and strategy around opioid prescribing. And then my capstone project at the very end of the master's was helping design a patient centered medical home, which is the new kind of a model being put forward by our College of Family Physicians of Canada. And this is a new model that's supposed to be sort of the exemplary gold standard for family medicine and how we should be practicing and organizing primary care and the broader healthcare system. And so I was part of a design project to pilot that model, which is now up and running in the Mississauga Halton region.

Dr. Rezmovitz:

So can you expand further on the patient centered medical home? What does it mean? How does it change from what people have been doing for the last 40 years?

Dr. Damji:

So what the patient centered medical home does is that it really defines what the profession of family medicine means. And also how does that profession of family medicine and primary care in general fit into the broader healthcare system. So for example, when we look at the design of it, we first of all look at the physical infrastructure, we look at the technology that exists within our practices right now as sort of the essential foundations within the practice. Then we look into what exactly is going on within our practices and what exactly are the gold standards that we want to meet and what is it that we want to accomplish? So these include things like ensuring that we have continuity of care, that we ensure that there is an interdisciplinary team working together in addition to the family physician, that there's connected care, that factors in the social determinants of health. So not only is there a family doctor's office or a primary care office, but that we're also in touch with the social agencies that exist within our community, that we're an embedded hub within the community that home care services are able to tap into, that social services are able to tap into, that the hospital is connected with an integrated with. And then we take that an even further step forward, which is where we also connect linkages throughout the community. So rather than having just solo practices or group practices that only work together and don't interact with one another, you now bring that forward and actually establish a network. So you make your patient centered medical home a hub within the community where doctors in different practices could interact with one another, where you centralize IT infrastructure so that rather than all the practices needing to be on different systems, you actually put all of us on the same system and you allow there to be that flexibility and connectedness of care. You allow practices to centralize quality improvement education and initiatives. So rather than saying every single practice needs to have their own QI expertise and need to develop that and work on that on their own, instead you develop a hub where all of that can happen together, where you send your own staff into this potential patient centered medical home that upscales them and then sends them back to their practices to lift that entire practice up. So it's really sort of a mentality of thinking more broadly about primary care and how do we fit that into what's called the patient's medical neighborhood. So integrating family medicine with the rest of the healthcare system, looking at things that - how do we integrate with social services? Housing agencies? Pharmacies? Hospitals? And all of these other different partners that we work with and really creating a truly integrated system and that's sort of the ultimate end state that we want to be in.

Dr. Rezmovitz:

Okay. So if you don't mind, I'd love to do a gap analysis right now with you. An impromptu gap analysis.

Dr. Damji:

For sure.

Dr. Rezmovitz:

So it sounds like the patient center medical home already exists before you called it the patient centered medical home. Examples of these in our system already include family health teams, family health organizations without separate funding for dieticians, psychologists, diabetes education nurses. So I'm at a loss. How is this different? What am I missing? Because like I used to work at Sunnybrook and we did all of that - through our family health team. First it was a family health organization, then we got funding and became a family health team and we did everything that you just said. And so where is the gap from? How do we take the family health team then to become a - or is it already a patient centered medical home?

Dr. Damji:

So family health teams in general are examples of patient centered medical homes. So they are at varying levels of sort of stages rather in the model itself. So some family health teams such as the one that you're describing seems to be at a very high level of maturity in terms of being that patient centered medical home, right? So if there is that integration with social services, with home based care, with the pharmacies, with the local hospitals, with specialists and sort of building that neighborhood around a patient where a patient is able to see their entire sort of healthcare journey and see their central home is being in primary care - that is sort of like a strong patient centered medical home model and one that would be considered sort of a very mature patient centered medical home. However that's not the case for all the family practices in our region, in our province and our country. Family health teams in general are very scarce and limited resource and in funding realities, the current spread of that model is something that's still a question right now. And especially looking at the economic situation that we're in right now with the coronavirus, it's going to be very interesting to see what the future of these models are like in our current funding realities. In addition to that, even within family health teams themselves, some of them may not be as fully developed on that pathway of the patient centered medical home as others. Some may not be embracing continuous quality improvement and have the dedicated infrastructure that your family health team or my family health team may have with having a QI program director who is responsible for sort of upscaling all of the staff and bringing us to the future phases of the patient centered medical home and making sure that we're continually evolving to the changes that we're seeing in our community. A lot of that infrastructure and development may not exist in existing teams. So you're right that there are examples right now that definitely live up to the potential of the patient centered medical home model, but I think what the College is trying to promote - and certainly they're far more experienced in describing this model than I am - that is not the reality across the board. And they want to see that across the board. They want to see it such that when a patient is able to describe "what is my medical home? That is primary care", and it is sort of that central place where they can go and receive their services and healthcare and the rest of the healthcare system moves around the patient rather than the patient having to bounce around the system.

Dr. Rezmovitz:

I understand that. Do you think there's a way that we can get the CFPC to create a report card almost? Without it sounding judgmental, but almost like where are you in your path to becoming a strong patient centered medical home? So you can see what you're missing? So you can create like your own gap analysis for your own practice? You know, like there's micro, meso and macro level system going on here and you're referring to the micro level patient centered medical home, right? Down to each patient, where do you feel is your medical home? And so I would love to see a report card or some sort of like - I don't know what the right term is - something that you can judge yourself and see where you're at so that you can improve. Now just by doing that, you'd be introducing continuous quality improvement, right? And I think a lot of people are afraid unfortunately of QI because they think of it as continuous PDSA cycles that require flow sheets and all sorts of metrics all the time. And it's hard to constantly improve. You know, you're on the QI team I guess? Through the Department of Family and Community Medicine? I've been there myself. There's a lot going on that we should be very proud of. But we should also remember that it's very simple to be a QI lead, if you have the attitude of continuous improvement. You know, just being better. Sometimes it doesn't mean having a metric, it just means being better for your patients in the context of the determinants of health. So just want to put that out there. I don't know if you know from the pilot standpoint if they have a report card or something that everyone can work on in the - during this coronavirus time and it may be a good time to say, "Hey, where are we? What can I do to improve my, my system right now?" Do you know if that's in the works at all?

Dr. Damji:

So I don't know for certain if there is a report card that exists. Certainly there is a resource - a website available - on the CFPC website. It is a website fully dedicated to the patient centered medical home. And so I would encourage checking out that website because it does have the information I've talked about in terms of what the model consists of. And -

Dr. Rezmovitz:

[inaudible]

Dr. Damji:

Sorry?

Dr. Rezmovitz:

What is the website?

Dr. Damji:

Here, let me - I'll find it for you.

Dr. Rezmovitz:

Let's just do it right now. We're going to both go.

Dr. Damji:

All right. So it is actually called just patientsmedicalhome.ca.

Dr. Rezmovitz:

Okay. patientsmedicalhome.ca - the future of family practice.

Dr. Damji:

And there is a toolkit that's available that does actually describe the actionable steps that physicians and their teams tend can take to align their practices with the principles.

Dr. Rezmovitz:

Yeah that's what I want. Where's that?

Dr. Damji:

So if you go to the resources section, you can go to tool kits. You'll see that there is a toolkit available and it's broken down by province.

Dr. Rezmovitz:

Alright. I'm doing it right now. Implementation kit. And do you think everybody knows about this?

Dr. Damji:

So I think it's at varying levels of where it's being promoted. Certainly within the College it is something that the College continually does promote, and they've partnered with the provincial colleges as well to regionalize the tenets of the model. So I think in the health system planning community and the design community and primary care, it is something that's talked about as the gold standard that we want to be working towards. I'm not sure on the ground and day to day family practice if it's always being discussed. And I think that there is sort of that challenge of how relevant is this to me and my current work environment, right? And I think we have to be mindful of the fact that the group based practices that we work in, the compensation models that we work in are not the reality for the majority of our colleagues working in family medicine. And there needs to be steps taken to ensure that this model is something that all physicians can buy into. So one aspect of the pilot that was really important that we made, um, a foundation of it, was that the allied health services and the interprofessional team had to be accessible to the entire community in the catchment area of the medical home, regardless of the funding model of the individual physicians. So as I'm sure you know, family health teams - at least right now - there are some initiatives [inaudible] where we're trying to change that. But in general, family health team resources and interdisciplinary care is restricted to the patients of the physicians who work in the family health organization that is embedded within that family health team. And that has caused a lot of challenges within our system. When we look at it from an equity lens in particular from a patient standpoint, it's not particularly fair if a patient happens to be in a doctor's office who was a fee for service clinician who now has to pay to access services like a dietician or a social worker. Whereas if they happen to be in my practice because of the fact that I'm in the family health organization embedded in the family health team, those same services are available to them at no cost. So one of the key components of this model and the one that we piloted in Mississauga Halton region is that the services of the team are available to all physicians in that catchment area, regardless of their funding model. And it is equitable access based on the need of the patient. So there isn't preferential access if you happen to be a physician working on site. We've adopted a similar initiative too within the Credit Valley Family Health Team as well. So we do have an entire dedicated team that's specifically for community outreach and working with physicians who traditionally have not had access to allied health resources and bringing those resources to them, to their practices.

Dr. Rezmovitz:

So you're saying as a solo practitioner now in the community, I could be part of - I could access FIT resources

Dr. Damji:

In a fashion, yes. So it is specifically what we've called an IPCT , which is an interprofessional care team, and that's an expansion initiative that's been run by Credit Valley Family Health Team and received funding from our LHIN at the time. And so we have dedicated resources so that community physicians like you're describing could access these resources so they can refer their patients into the interprofessional care team and they work directly with the MRP. So the plan is that as a family health team and as the physicians within the family health team, we would not take over that individual's care. We want the care to remain with the primary care provider who has that relationship with the patient and instead bring the resources to them.

Dr. Rezmovitz:

Well, hopefully now that we've just discussed it on the podcast, everybody will know about it because we know all the family doctors in Ontario listen to this podcast.

Dr. Damji:

Absolutely.

Dr. Rezmovitz:

So given that, I urge any family doctors who are not in a family health team to reach out to family health teams that are co-community? Co-located? What's the word I'm looking for here?

Dr. Damji:

I think co-located?

Dr. Rezmovitz:

Near.

Dr. Damji:

[inaudible].

Dr. Rezmovitz:

And reach out and see if there's a way that you can get your patients help. That's what I'm going to do when I get off with you is I'm going to go figure out - I seem to be in the epicenter. I'm equidistant between three different health teams. So I gotta figure out how I can access care for my patients now. So thank you.

Dr. Damji:

Of course.

Dr. Rezmovitz:

I was going to ask if you have any last words because we're getting near the end of the podcast today. Any last words you want to reach out to current residents, your former self, colleagues, anything that you want to - you know, any advice you want to give to people?

Dr. Damji:

Well, I just certainly would encourage to residents right now that I know the situation that we're in is so unprecedented. It's very challenging. It's caused a lot of disruption for everyone at all levels of training. But what I'd also encourage them to also remember is that as family doctors, one of the things that we're the best at is managing uncertainty and working through uncertain situations and finding really novel and creative solutions. And I would encourage them to tap into that and use this time as an opportunity to do just that. To broaden your skill set in ways that you maybe thought were impossible. You know, I have some colleagues for example, that are exploring how to become programmers during this time and learn really novel, interesting skills that will serve them really well in their future careers. And so I think that this is a really fertile opportunity for us to think innovatively as family doctors and how do we move towards enhancing our models of care to live up to standards like the patient centered medical home and provide exceptional care to our community. And yeah, that would be my message to everyone.

Dr. Rezmovitz:

Awesome. Thank you so much Ali for coming on the podcast today. It's been really, really informative and I look forward to working with you in the future.

Dr. Damji:

Thank you. It was a pleasure. Thanks for having me.

Dr. Rezmovitz:

No problem. Take care.

Dr. Damji:

You too. Bye-bye.

Dr. Rezmovitz:

This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva, and the whole podcast committee. Thanks for tuning in. See you next time.