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As of March, 2020, 1.7 million Ontarians had a family doctor who was 65 or older, making their physicians likely candidates for retirement.Fred Lum/the Globe and Mail

More than three million Ontarians could be without a family doctor by 2025, according to new research that adds looming retirements to dwindling interest in family medicine and physician burnout as factors exacerbating the challenges faced by Canada’s COVID-19-battered health system.

Nearly 1.8 million patients in the country’s most populous province did not have a regular primary-care provider as of March, 2020, when the pandemic hit, according to figures released Tuesday by the Ontario College of Family Physicians. At the same time, another 1.7 million Ontarians had a family doctor who was 65 or older, making their physicians likely candidates for retirement.

The data were compiled by Ottawa family doctor Kamila Premji as part of her PhD research at Western University and drawn from Ontario Health Insurance Plan records for all of the province’s residents, which provide a more comprehensive picture of primary care access than polls or surveys.

“The research I’ve led shows that we’re about to have a large number of patients who are going to lose their family doctor to retirements in the next few years,” Dr. Premji said. “We’re concerned about the capacity in the system to absorb those retirements in addition to the patients who already don’t have a family doctor.”

Dr. Premji said her projection that one in five Ontarians will be unable to find a family doctor by 2025 doesn’t take into account new graduates who choose family medicine, or family doctors who move to Ontario from elsewhere. Many family doctors who retire will be replaced by younger colleagues, but it appears there won’t be enough of them to fill the breach, she added.

Fewer medical school graduates as a share of the total are picking family medicine as their top choice for residencies now than in the past, according to the Canadian Resident Matching Service, the national organization that arranges training opportunities for physicians. This year, 30 per cent of Canadian graduates chose it first, down from 37 per cent in 2015.

“I think it really is a perfect storm,” said Mekalai Kumanan, president-elect of the Ontario College of Family Physicians, which represents 15,000 primary-care doctors. “We’re seeing more family physicians choosing to retire. We’re seeing fewer medical students choosing family medicine and I think we’re seeing the overall strain on the system as our population is aging [and] patients have sometimes deferred care because of the pandemic.”

Taken together, the trends have a spillover effect on emergency rooms, and mean some sick patients don’t get the care they need as soon as they need it, said Dr. Kumanan, who practices family medicine in southwestern Ontario.

Ontario patients are far from alone in struggling to find primary care. In fact, Dr. Premji said several other Canadian jurisdictions likely have it worse.

Just under one in five Canadians do not have a family doctor, according to a survey Angus Reid released last week. It found that the problem is most acute in British Columbia and Quebec, where roughly one-quarter of adults in the two provinces are without a family doctor.

“We are in the midst of this crisis and it is actually accelerating,” said Alika Lafontaine, president of the Canadian Medical Association, on Tuesday.

He pointed to physician burnout as a major problem for family doctors, most of whom are small business owners. Their administrative burden isn’t limited to running their own office. They also help patients navigate the health care system, including getting referrals to specialists, Dr. Lafontaine said.

Doctors are spending up to two hours on administrative tasks for every hour spent on direct patient care, according to a 2021 report by the Ontario Medical Association. Doctors spend about six hours a day recording patient information electronically, both during and after clinic hours, the report says.

“It’s unreasonable to expect anyone to work in these conditions,” Dr. Lafontaine added.

Among those Canadians who have a doctor, only 14 per cent have easy access to that medical professional when needed, while others wait anywhere from a few days to more than a week to get an appointment, the Angus Reid survey found.

The survey of 2,279 adults was conducted online over two days in August. A sample of that size has a margin of error of +/- two percentage point, 19 times out of 20.

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