More Canadian seniors are finding themselves without a family doctor amid a shortage of primary-care physicians, compelling some older adults to seek private support as advocates highlight serious health consequences.
Statistics Canada data from 2020 shows that more than 14 per cent of Canadians are without a regular health provider – including some 900,000 in British Columbia alone, which is roughly 20 per cent of its population. While those aged 65 and older were the most likely age group to have one, data released last September showed that rate slowly decreasing between 2019 and 2020. Five out of 10 provinces saw a decline in the percentage of seniors with a regular health provider, with Alberta experiencing the worst drop – 1.9 percentage points.
For the minority of seniors who don’t have a doctor, finding one comes with extra challenges. The doctor shortage in rural areas, where the population is older, is most acute, said Laura Tamblyn Watts, founder and chief executive officer of CanAge, a national seniors’ advocacy organization. In the meantime, some doctors cherry pick their new patients and may not accept older patients, particularly ones with more complex health needs, she added.
“Right now, getting a family physician for an older person is harder than it’s ever been,” Ms. Watts said.
Bill VanGorder, chief operating officer for the Canadian Association of Retired Persons, or CARP, agrees, saying the lack of access to primary care for older adults was bad pre-pandemic and is “much worse” now.
The increasing difficulties of seeking longitudinal primary care has forced some seniors to pay out of their own pockets and one in B.C. to post a desperate newspaper ad to look for a physician.
In Quebec, the percentage of seniors who have a regular health provider ranked at the bottom among all provinces in 2020 – the only one where that rate is below 90 per cent. Among the province’s struggling seniors is Shelly Fender’s 83-year-old mother, who waited close to four years for a doctor in Montreal but was never moved up the waiting list, despite her being viewed as a priority.
Ms. Fender’s mother ended up paying for a private doctor when her pharmacist had exhausted the ability to renew medication. Last year, she moved to a seniors’ residence where a doctor is affiliated. But during the years without longitudinal primary care, Ms. Fender said her mom had several trips to the emergency department with different concerns and experienced memory issues, breathing problems, weight loss and anemia.
“There was absolutely no prevention, we were living on a prayer. Pretty much knowing one day there would be a huge medical crisis,” Ms. Fender said.
The health consequences for such seniors can be significant, according to Ms. Watts and Isobel Mackenzie, British Columbia’s seniors advocate. They said older adults are much more likely to have conditions that have to be monitored, such as diabetes, congestive heart failure and chronic obstructive pulmonary disease, and be on medicine needing proper prescription renewals.
“We know that it is directly correlated between whether a senior has a family doctor and whether they have good health,” Ms. Watts said.
A 2019 study of the North West Local Health Integration Network in Ontario found that among the 12,033 seniors admitted to hospital between Apr. 1, 2004, and Mar. 31, 2013, 41 per cent lacked a family physician. Among them, 8 per cent died during the initial admission and 16 per cent died in the subsequent year, the study showed.
“I think the real consequences of this will be felt in about two or three years,” Ms. Mackenzie said. “We’re going to turn around and go, ‘wait a minute, what happened to our good cancer outcomes? What happened to our reduction in alternative level of care days, what happened to our activity levels at the emergency department?’”
She added that crises in the health care system may prompt families to lean more heavily on wanting to put the elderly into long-term care.
But on Ms. Watts’s contention that some doctors may avoid taking on seniors, Ms. Mackenzie said she’s not aware of that happening in British Columbia. In fact, she said, there are incentives – provided through a partnership between Doctors of BC, which represents 14,000 physician members, and the Ministry of Health – for doctors who take on patients with complex care needs, which may encourage them to prefer those cases.
Josh Greggain, Doctors of BC’s president-elect, said family doctors in the province have the ability to decide who they will accept as patients.
“This may be based on a number of factors – such as how close they are to capacity, the nature of their existing panel (some may have very high number of complex care patients), and/or to protect their own health and well-being if they are carrying a large patient panel and are struggling to keep up with the workload,” he said in a statement.
But Dr. Greggain added that many family doctors choose to take on the patients with complex care needs specifically because they are most in need of continuous care.
According to B.C.’s Ministry of Health, the province’s College of Physicians and Surgeons’ Practice Standard on Access to Medical Care Without Discrimination outlines its expectations when physicians choose to limit their practices. For instance, it states: “While limiting a practice based on legitimate reasons is acceptable, decisions to accept or refuse new patients must be made in good faith. … A defined scope of practice must not be used as a means of unreasonably refusing patients with complex health needs.”
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