Almost 20 per cent of Toronto family physicians are considering closing their practices in the next five years, according to a new study warning that more residents of Canada’s largest city could soon have trouble finding a doctor.
The findings are based on a survey of family physicians conducted in January, 2021 – at the height of the second wave of the pandemic. Of 439 doctors in Toronto who answered a question about their plans for the future, 77, or 17.5 per cent, said they were thinking of winding down their practice.
“To me, that was a really surprising number,” said Tara Kiran, the lead author of the study, which was published Monday in the journal Canadian Family Physician.
In a related study published in September, Dr. Kiran and her fellow researchers at Unity Health Toronto and the non-profit research institute ICES mined Ontario Health Insurance Plan (OHIP) billing data to discover that almost three per cent of the province’s doctors had stopped practising during the first six months of the pandemic, about twice the normal rate.
Which is why Dr. Kiran, a family doctor at St. Michael’s Academic Family Health Team in Toronto, was startled to find significantly more doctors were thinking of giving up on office-based primary care.
“Here it was 17 per cent, almost one in five doctors, considering closing their practice,” she said. “If you’d asked me for an estimate before doing the survey, I would not have estimated something nearly that high.”
If more Toronto doctors than expected leave traditional cradle-to-grave family medicine in the next five years, it will exacerbate a human resources crisis that is already hobbling medical services from coast to coast. Doctors, nurses and other health-care professionals, ground down by the pandemic, have quit or cut back their hours, forcing some hospitals to temporarily close emergency rooms or reduce surgeries.
When patients are without a family doctor, they often turn to emergency departments for routine primary care, said Rose Zacharias, president of the Ontario Medical Association.
“Emergency departments are overwhelmed,” said Dr. Zacharias, a family doctor who worked in an Orillia, Ont., emergency department for years. “I never thought we’d see the day that emergency departments would close their doors. But if that’s what’s happening in conjunction with our current family doctor shortage, and that family doctor shortage is only getting worse, it’s not good.”
Doctors who responded to the survey had an average of 1,215 patients each, which means that if they went ahead and closed their practices, more than 93,550 patients in Toronto could lose access to their primary-care provider. That number would be much higher if the respondents were representative of their colleagues across Toronto.
Dr. Kiran pointed out that new doctors will open practices to replace some of those who leave, but it’s not known if there are enough of them in the pipeline. In the meantime, she said, provincial governments and health care leaders should try to identify physicians on the verge of closing their practices, offer them support to stay open or help their patients transition to a new doctor.
As a major city with world-renowned teaching hospitals, Toronto usually finds it easier to attract and retain doctors than smaller cities and rural communities. On the whole, Ontarians are more likely to say they have a family doctor than residents of most other provinces, according to the most recent Statistics Canada survey data.
In 2021, 89.7 per cent of Ontarians surveyed told Statscan they had access to a regular health care provider, more than any other province except New Brunswick. The Canadian average was 85.5 per cent.
Separate research published by the Ontario College of Family Physicians and based on OHIP data as of March, 2020, found that almost 1.8-million Ontarians did not have a regular family doctor.
For the study published Monday, Dr. Kiran and her colleagues first set out to discover how many Toronto family practices were open to patients during the pandemic. They surveyed more than 1,000 family doctors via e-mail and fax and by phone beginning in January, 2021. They found that 94.8 per cent of respondents were seeing at least some patients in person and 30.8 per cent were providing face-to-face care to patients with COVID-19 symptoms.
A little less than half of those surveyed answered the question about their future practice plans.