Family medicine access in Canada drops since 2016, survey suggests
Family doctors are often the first place Canadians turn for medical care, but the proportion of adults with access to a primary care provider has declined, a new survey suggests.
The international survey was conducted in 10 high-in‐ come countries by the Com‐ monwealth Fund, a U.S.based non-profit foundation that funds surveys of patien‐ ts and health-care providers in multiple countries. A part‐ ner, the Canadian Institute for Health Information, re‐ leased the findings on Thurs‐ day.
More than 4,500 Canadi‐ ans were asked if they had a regular doctor or place of care, which may include a physician or a general healthcare clinic and excludes emergency visits and hospital care.
Lack of access to a pri‐ mary care provider nega‐ tively impacts the health of both individuals and the pop‐ ulation, the institute said.
"The percentage of Cana‐ dians who reported having a regular doctor or place that they go for care dropped from 93 per cent in 2016 to 86 per cent in 2023," said Cheryl Chui, director of health system analytics at CI‐ HI in Toronto, in an interview.
In comparison, 93 per cent of adults in peer coun‐ tries have a doctor or place they usually go to for medical care.
Respondents were also asked how difficult is was to get same- or next-day med‐ ical appointments. The 2023 results showed that Canadi‐ ans are still struggling with timely access to primary care, Chui said.
Variations and possible inequity in access
The researchers at CIHI found that not having a pri‐ mary care provider was more common among Canadians with lower levels of house‐ hold income, younger adults from 18 to 34 and men.
Chui said they're seeing variation and maybe in‐ equities in the data. Why isn't known, but geography could also play a role.
About 93 per cent of those earning more than $150,000 a year reported having a regular primary care provider such as a family physician or nurse practi‐ tioner. For those with a household income under $30,000, 81 per cent said they did.
Dr. David Barber, who chairs the section on general and family practice at the On‐ tario Medical Association, said primary care has often been shown in research studies to be the most im‐ portant factor when it comes to people leading healthier and longer lives.
WATCH | Worsening family doctor shortage:
But primary care isn't pri‐ oritized by governments, he said.
"It seems that the hospi‐ tals tend to run the show, and that's where the money goes."
Barber said other wealthy countries are spending 50 per cent more on primary care than Canada.
Barber fears staffing problems in family medicine will only get worse, pointing to Wednesday's results of the Canadian Residency Match‐ ing Service (CaRMS), which matches medical school graduates with program placements across the coun‐ try.
Ontario represents 40 per cent of the Canadian popula‐ tion, Barber said, and there were 116 unfilled family medicine spots in the province alone - that's almost half of Canada's unfilled family medicine placements up from 103 unclaimed spots last year.
The CIHI researchers also looked at other aspects of primary care, such as how the cost of prescriptions im‐ pacted Canadian responden‐ ts.
According to the survey, just over 10 per cent of Cana‐
dian respondents said that during the past year, they had either not filled a pre‐ scription or skipped doses of their medications due to the cost.
Dr. Nav Persaud, who holds the Canada Research Chair in Health Justice at the
University of Toronto, said the responses regarding not filling prescriptions because of cost is in line with other studies.
"Through seeing a family doctor, you might find out whether or not abdominal pain is due to cancer or indi‐ gestion," Persaud said, not‐ ing that's not something he wants people trying to guess about.
"What no one wants is for someone to be debating at home whether or not they should visit the emergency room or a walk-in clinic be‐ cause they have poor access to care, and then later find out that it would have been better if they had been seen sooner."
CIHI's team also found more Canadians were wor‐ ried about housing and food security compared to the av‐ erage among people in other high-income nations.
In Canada, 17 per cent of people surveyed said they were worried about being able to pay their rent or mortgage, compared to an average of 14 per cent across the 10 countries.
About 10 per cent of Canadians worried about having enough food or a clean, safe place to sleep, compared with an average of eight per cent across the 10 countries.