Our critical family doctor shortage
6.5 million Canadians are going without
It’s a question Dr. David Barber gets asked all the time by neighbours knocking on his door and Uber drivers delivering coffee to the clinic: Could he take them on as patients?
“It feels awful to turn them down, it’s a terrible feeling,” said Barber, chair of the Ontario Medical Association’s section on general and family practice and a family doctor in Kingston, Ont., which last summer lost six family doctors to retirement over a span of six months, leaving 7,000 people suddenly “unattached.”
A colleague of Barber’s in Gananoque, Ont., would also like to retire but can’t find someone willing to take over his practice, “so he’s going to keep going, because he would feel too badly to abandon his patients” Barber said. “He just doesn’t feel he can do that.”
Family practice has become “unsustainable,” Barber and other doctors said at an OMA virtual press briefing Thursday. Family doctors are retiring, exiting early or moving into other areas of medicine. Many are abandoning the “cradle to grave,” comprehensive approach to family medicine and are focusing on one specific issue, such as chronic pain or sports medicine.
“Ridiculous” and crushing amounts of paperwork and administrative loads, preand post-pandemic burnout and demoralization, physician fees not keeping pace with inflation, rising overhead and labour costs, inefficient referral systems — “the pressures are many” and making things worse on the ground, Barber said.
Seven thousand people without a family doctor in Kingston. Another 10,000 about to be dropped from a Sault Ste. Marie health centre by May due to doctors retiring or leaving the community. The trend isn’t unique to Ontario: More than 60 per cent of Alberta’s family doctors are considering retiring early or leaving the province, according to a report commissioned by the Alberta Medical Association. More than 150,000 Nova Scotia residents have registered with a “need a family practice” registry, the Halifax Examiner reports. Quebec lost more family doctors in 2022 to retirement, private practice or other provinces than it produced, the Montreal Gazette reported.
According to a national survey, 6.5 million people in Canada, more than one in five, don’t have a family doctor or nurse practitioner they can see regularly. Sixty per cent of those who do can’t get a same-day or next-day appointment for a sprained ankle, urinary tract infection or other “minor” health problem. While the supply of doctors in Canada grew two per cent in 2022 compared with 2021, the increase was just 1.6 per cent for family medicine doctors, versus 2.5 per cent for specialists, according to the Canadian Institute for Health Information.
In Ontario, more than 2.2 million people are currently without a family doctor. Another 1.7 million are looked after by a doctor who is 65 or older. The Ontario College of Family Physicians predicts more than four million Ontarians will be without a family doctor by 2026, as more doctors narrow their scope or leave their practice entirely, and fewer young medical school graduates choose to opt in. The number of grads choosing family medicine is the lowest it has been in 15 years.
Without a family doctor, people fall off the radar, Barber said in an interview with National Post. Poorly controlled diabetes, poorly controlled hypertension, fewer cancer screenings, delays in cancer diagnoses, missed vaccinations. “There’s no doubt some people are dying because of this,” he said. The lack of access is driving people to retail walk-in clinics and emergency departments because there’s nowhere else to go, or they forgo care entirely. People who need care the most — Indigenous, racialized, and low-income communities — aren’t getting it, research shows. By some estimates, 10 million Canadians will be without any source of primary care within three to four years, a “disaster” for a country with universal health care, experts said at a national primary crisis meeting in November.
It’s opening opportunities for private and for-profit medicine for people who can afford it. Barber has had patients travel to Montreal to spend several thousand dollars on tests that had a yearlong wait in Ontario. “We are heading towards the American model,” he said on Thursday’s call with reporters.
Family doctors are spending up to 20 hours a week, the equivalent of more than two days of full-time work, on the paperwork burden — filling out lengthy disability and insurance forms, writing unnecessary sick notes for employers — time that eats away at the amount of time doctors can spend with patients who, because of an aging population, have more complex health problems. “It takes more time today to look after a patient than it did 10 years ago,” Barber said, including time spent managing patients as they linger on wait lists for specialist care.
“The reality is that family doctors are businesspeople and right now they’re in a failing, or failed business model,” he said. “Over the last 20 years there has been a 20 per cent cut in the funding that goes to a family doctor to run that business.
“That’s why they’re looking to get out.”
The OMA is in negotiations with the province for the next physician services agreement. “The government is pushing for zero per cent increase in pay this year ... that’s just going to demoralize every single family doctor on the ground,” Barber said. The doctors’ group has said it wants expanded access to team-based care — surrounding patients with different health care providers — and a centralized referral system and reduced paperwork (more streamlined forms, fewer sick notes, paid staff to take over the administrative load) to keep doctors considering retiring early from leaving.
“The resources need to go to the people who are already on the ground,” Barber said. “If every family doctor took on another 220 patients, then the issue goes away.”