List of Ontarians without a family doctor destined to get longer
Today, more than 2.3 million Ontarians are without a family doctor. Given the massive uptick in population, that number grows daily – as do a host of other problems related to an overstretched healthcare system.
The number of those without a family doctor is expected to increase to 4.4 million over the next two or three years, in part due to the retirement of family practitioners – currently, 2.7 million people in the province are looked after by a family doctor over the age of
65 – and the decreasing number of new doctors willing to follow that path.
There are also many doctors leaving or thinking of leaving family practice. The Ontario Medical Association (OMA) reports a majority of family doctors say they’re considering leaving the profession due to the unmanageable nature of running a practice in today’s environment.
“We are having an issue with family doctors leaving comprehensive family medicine – the cradle-tograve care – and that is a huge problem. Ten years ago, 80 per cent of doctors were doing that cradleto-grave family medicine. That’s down to about 65 per cent, which is crazy. That’s a loss of 2,200 family doctors,” says Dr. David Barber, chair of the OMA’s section on general and family practice.
Some 500,000 patients lose a family doctor every year, which is why the OMA wasn’t impressed by last week’s provincial government announcement of $110 million to support heath teams, calling it a pittance. Even if the province hits a target of providing primary care for another 300,000, it’s a drop in the bucket compared to attrition rates, let alone population growth.
That young doctors increasingly shun family practice is a major contributor to the problem, Barber notes.
“Ten years ago, 40 per cent of med students would have wanted to do family medicine. Now that’s down to 30 per cent. That’s got to change. We need to reverse that. Forget about getting more students into medical school, because they’re not going to choose family medicine.”
From overloaded rosters and low billing rates to hours of paperwork, family medicine just isn’t attractive to young doctors.
“The government brags about having more spots [in med schools] but it doesn’t matter because the spots aren’t going to be filled by people wanting to do family medicine,” says Barber, who has a practice in Kingston. “Med students in the last two years, they’re doing clinics, and they’re working in family medicine clinics – I have medical students in my clinic – and they see how tough it is, they see the workload, they see the doctors working into the evenings and on weekends, and the amount of paperwork. It is a huge turnoff.”
Clearly, there’s a need for more doctors practicing family medicine even as fewer new physicians go that route. Reversing that trend and bringing more family practices online isn’t going to happen overnight, if ever.
More money for such things would be helpful. But the province already spends more than $80 billion a year on the healthcare system, the largest single expense in its budget. There are, however, some tweaks that could provide relief at little cost, Barber suggests.
With family doctors having an average of
1,000 patients on their roster, dealing with the existing number of Ontarians without such primary care would require an additional 2,500 doctors. That’s beyond the pale.
“If we could do something to get that number from 1,000 to about 1,250, then our problem goes away. Seriously, it’s that easy,” he says, noting the province would have to make changes such as allowing family medicine practices to bill for nurses who see patients, freeing up time for the physicians.
“In terms of billing for diabetes, for example, right now we can’t. The family doctor has to see our diabetic patients in order to get paid. If a nurse sees that patient, we don’t get paid. If a nurse practitioner sees that patient, we don’t get paid. So, the government forces us to see those diabetic patients, and that’s about 10 per cent of our visits. It would be so easy for the government to take that off our plates with the idea that we would be rostering more patients, we would be taking on more patients because we have that capacity. So, there are some simple fixes, but the government doesn’t seem to be there.”
The OMA is calling on the province to give all family doctors and their patients access to government-funded primary care teams that include nurses, administrators and other health-care workers. Just 30 per cent of family doctors practise with government-funded, team-based support, meaning more than two-thirds do not.
A 2023 OMA report, Prescription for Ontario: Doctors’ Solutions for Immediate Action, says the two highest-priority solutions to make a dent in the crisis are: expanding access to team-based primary care for all Ontarians when and where they need it; and building a northern and rural physician workforce strategy and licensing more internationally educated physicians.
The OMA says such primary care teams should be tailored to meet the needs of patients in different communities. They should include at least a physician, nurse, administrator and at least two other inter-professional care providers, such as a social worker, registered dietitian, nurse practitioner, physiotherapist, pharmacist, specialists and mental health professional and/ or outreach worker.
As Barber notes, current government policies won’t allow for such improvements.
“One of the things that the government can do – and they can do this right away – is they can change the rules around billing,” he says, noting doctors are responsible for all costs of running their practices, billing only for listed services based on a provincial fee schedule.
“If we hired a nurse practitioner in our clinic to see patients, that’s actually a money loser,