Can't find a family doctor? It might be because they're busy doing other specialties, report finds
If you're one of the esti‐ mated more than six mil‐ lion Canadians who can't find a family doctor, it might be because they're focusing on specialty care, the results of a new report suggest.
Nearly 30 per cent of Canada's family physicians predominantly provide ser‐ vices outside of primary care, according to the Canadian In‐ stitute for Health Information (CIHI)'s analysis of 2021 pay‐ ment data, released Tuesday.
That means they mainly perform services in specific areas, compared to typical primary care duties, like of‐ fice visits and assessments that don't require a referral. For example, a family doctor with a general surgery profile would focus on services like minor surgical procedures.
The main non-family med‐ icine areas were emergency medicine (14 per cent), psy‐ chiatry (nearly five per cent) and general surgery (two per cent).
"New trends in practice patterns reveal that many newer family physicians are less likely to engage in com‐ prehensive and continuous family practice," the report's authors wrote.
About 74 per cent of Canadian primary care physi‐ cians said they believe the quality of medical care has worsened since the COVID-19 pandemic began in March 2020, according to a report from last June. That's signifi‐ cantly more than the average of other wealthy countries of 63 per cent.
The report's authors and the Canadian Medical Associ‐ ation have noted family physicians have reported in‐ creasing challenges such as higher workload and admin‐ istrative demands.
Dr. Andrew Park, presi‐ dent of the Ontario Medical Association, said it is impor‐ tant for family physicians to advocate for patients to get medical tests, treatments and specialists, but they face bottlenecks trying to do so.
Park, who wasn't involved in the report, works in Lon‐ don, Ont., in an emergency department, one of the spe‐ cializations that the report's authors said attracts family physicians.
He said one reason why family physicians may like the field is because the hos‐ pital pays the costly over‐ head.
"Doctors are voting with their feet."
The OMA has called on the provincial government to fund primary care teams for all family doctors and their patients.
Park said the pressure has been building for at least a decade.
"The pandemic was the match to the dry tinder. It re‐ ally changed everything around this landscape. For the longest time, we were looked at as an item of cost, but we have to stop thinking that way."
Instead, Park said govern‐ ments should think of pri‐ mary care as an investment in prevention, or else they'll pay more later.
Exhausted and closing shop
Dr. Fan-Wah Mang, a family physician in Missis‐ sauga, Ont., has had her practice for 29 years, and once planned to work for up to another decade. Now, she's winding down her prac‐ tice on May 31, due to burnout from a huge admin‐ istrative burden.
Mang, who also was not involved with the report, said she sees about 20 patients a day, and makes less than $40 per visit. She feels she can't see double the number of patients without sacrificing quality.
"I'm in a group with three family physicians," she said in an interview. "We're all equally exhausted and we can't afford to hire the kind of allied health professionals that we need to sustain our practice."
WATCH | Patients charged for primary care:
Back in 2014, Mang's prac‐ tice included a registered nurse. Today, with the costs of electronic medical records, mandated secure messaging for patients and cybersecu‐ rity insurance plus inflation and rent, the bills eat up what used to go to pay some‐ one to help carry her patient load.
Mang is now saying good‐ bye to long-term patients and trying to help them find a new family physician.
"There needs to be invest‐ ment in primary care to sus‐ tain it."
'Nothing works'
After Erella Gagnon, 64, of Toronto, had four brain surg‐ eries and her adrenal glands removed, her long-time family physician retired. She said it was difficult to find a new one.
"Everything worked very smoothly, and now nothing works," Gagnon said. "If you need a refill on a prescrip‐ tion, you've got to get an ap‐ pointment when it's conve‐ nient for the doctor."
CIHI's data suggests the problems may persist.
Although Canada's popu‐ lation continues to increase, fewer people are becoming family doctors than before. The five-year growth rate of family physicians in Canada slowed from nearly 13 per cent between 2012 and 2016 to 7.7 per cent between 2017 and 2021.
Family medicine represen‐ ted 76 per cent of vacant res‐ idency positions in 2023.
The percentage of family physicians practising outside of primary care grew slowly from 2013 to 2018. Then, be‐ tween 2019 and 2022, there was a notable increase, from nearly 26 per cent to 28 per cent. The data excludes Que‐ bec, the Northwest Territo‐ ries and Nunavut.
Dr. Michael Green, presi‐ dent of the College of Family
Physicians of Canada, said their pay rate has been stuck for a long time. "Think about that like how much do you pay for a haircut, how much to do you pay when you take your pet to the vet, how much you pay when you go to the dentist?"
When more than 20 per cent of Canadians lack a family doctor, Green said he doesn't understand "why the public isn't marching in the streets."