A family medicine cure for health care

For a health care system struggling with backlogs and strained for resources and worried patients fretting about treatments, the family doctor offers a cure.

Family physicians have always been the backbone of health care, the caring, compassionate face of what can often seem like an impersonal medical system where demand outpaces capacity.

Family physicians help manage chronic conditions such as heart disease, diabetes and arthritis, can treat acute situations and injuries and perform minor surgical procedures. They provide the often vital early diagnosis of new health problems. They offer lifestyle counsel on such things as smoking, alcohol consumption, diet and obesity, knowing prevention of disease is preferable treating it. In a world of inequity, insecurity and instability, they are able to address the mental health issues that have become so pervasive — particularly among younger people — in the postCOVID-19 period.

Perhaps most importantly, they form a connection with their patients and become a trusted entry point into the complex and confusing health care world, co-ordinating care with other professionals and advocate for their patients’ needs in all parts of the system.

Yet, about one in five Canadians do not have a primary care provider and about 2.3 million people in Ontario do not have a family doctor — a figure the Ontario College of Family Physicians forecasts will reach 4.4 million in two years.

So, a recent report that medical school students in Ontario are choosing family medicine comes as good news.

As the Star’s Kenyon Wallace and Megan Ogilvie reported, all 546 of Ontario’s family medicine residency spots were filled this year. Last year, there were 100 unfilled positions in family medicine across Canada. This year, that number dropped to 75 out of a total of 1,702 available positions, meaning 96 per cent of family medicine residency spots across Canada were filled.

Medical leaders applauded the improving trend of graduates choosing to train in family medicine, but said other reforms such as higher billing rates and lower administrative burdens were crucial to keeping them in these roles long-term.

To that end, the Ontario government announced that intended to relax rules on when employers can request sick notes for short absences from work. This was a reversal of the Ford government’s earlier toughening of a sick note policy that had been scrapped by the former Liberal government in 2018 as a waste of doctors’ valuable time.

The Ontario College of Family Physicians estimates that move could free up some 261,000 physician hours annually, all time that could be spent seeing patients. But the college, noting that family doctors report spending 19 hours a week on administrative tasks, says further work is needed to reduce the burden and make more time for medicine. “We welcome any meaningful steps, including increasing the adoption of innovative digital heath solutions, to support family doctors in their practice so they can focus on patients, not paperwork,” it said in a statement.

Freeing up the time of family doctors would help reduce the onslaught of hospital emergency departments, which have become a primary source of care for those without primary care.

Expanding their availability might reverse the trend in urban centres of those without family doctors forced to rely on walk-in clinics, which do not provide consistency and continuity of care and often results in the expense of over testing and over treating.

Family medicine is no cure-all. But bolstering the ranks of family physicians and expanding their offices to become primary care hubs, with nurses and administrative support, undoubtedly saves the health care system in money and precious personnel resources elsewhere, even as it improves patient care and enhances lives.

The work of family doctors is hard and demanding. They are far from the highest paid of physicians. They treat all age groups with every imaginable complaint and symptom and must remain fluent in a wide spectrum of modern medical challenges.

Any measures, however modest, that make the field more attractive, that produces more practitioners, that makes their availability universal are to be applauded.