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opinion

Iris Gorfinkel, M.D., is a general practitioner and vaccine researcher in Toronto.

Canada is facing an unprecedented shortage of family doctors. An estimated 1.5 million Quebeckers and a quarter of residents in British Columbia currently lack a family physician.

As one of the most in-demand professionals in Canadian health care, a family doctor must always use their time optimally, which can be difficult given the number of services they are relied upon to administer.

There are at least two tasks that my colleagues and I, as general physicians, spend far too much time on that I believe could easily be done by other health care workers: administering vaccines and screening for common types of cancer. The time these services require results in longer waits for patients needing more immediate appointments.

Make no mistake – these interventions are critical, but they don’t need to be done by a family physician. A team-based approach would free up appointments and allow family doctors to focus on medical treatment.

Appointment gridlock could be partially eliminated by having centres dedicated to keeping adult and pediatric vaccines up to date. Alberta moved the administration of routine pediatric vaccines (like tetanus and polio) from doctors’ offices to public health units back in 1991, with strong support from the Alberta Medical Association. This resulted in more children getting vaccinated and higher numbers of kids getting their shots on time, and made booking appointments easier for working parents.

Cancer screening is necessary for discovering a disease before it causes symptoms. Yet, on average, family doctors will screen hundreds of patients before detecting a single case.

Vaccines and cancer screening save countless lives every year, but these services come at a steep cost to Canadians in need of faster service from their family doctor because of the time these preventions require. The risks, benefits and limitations of these interventions need to be explained before they are administered, and since family doctors are tasked with this, it has resulted in serious repercussions for millions of Canadians.

Ontario extends financial incentives to family doctors who ensure their patients’ cancer screenings are up-to-date. This is not without good reason: Pandemic-related delays are expected to cause a future spike in preventable cancers and deaths that could have been avoided by earlier detection. Delays in routine vaccinations are also expected to cause a surge in vaccine-preventable diseases. Family doctors are working diligently in their efforts to catch up on the backlog, but unfortunately these tasks come at the expense of having availability for patients with more acute needs and taking on more patients.

Waiting has become an unfortunate defining characteristic of Canadian health care, fueled by a lack of comprehensive primary care across the country. The overwhelming and unmet demand for family physicians has created a greater chance of patients winding up in an emergency room and a higher likelihood of hospitalization.

Shifting cancer screening and routine vaccinations away from family doctors to facilities dedicated to these tasks would be a step in the right direction. It could free up badly needed appointment slots while making better use of family doctors’ hard-earned skills and expertise.

Pushback against such clinics would undoubtedly follow; it won’t be easy to change the primary care system in Canada, and creating such centres has up-front costs. Yet the current costs paid by society and the growing lack of access to a family doctor are considerably higher.

For example, if I can’t see my patient with a urinary tract infection in a timely manner, she’s more likely to wind up in an emergency room to get treatment. She’s also more likely to develop a kidney infection because she couldn’t get her prescription for an antibiotic. A person suffering from a mood disorder who lacks access to primary care is more likely to become suicidal and require hospital admission. Unattended chronic health conditions, such as hypertension and diabetes, result in more heart attacks and strokes. Society’s most vulnerable are the hardest hit by these systemic problems because they’re the least able to advocate for a timely appointment – that is, if they even have a family doctor.

According to a 10-year Stanford University study, average life expectancy increases by more than 50 days for every 10 primary care doctors added to care for a population of 100,000 people. That advantage is simply unavailable to the 4.6 million Canadians who don’t have a family doctor.

Screening for cancer and giving vaccinations simply aren’t efficient uses of family doctors’ time. Dedicated facilities could deliver these services with more efficiency and better results. Provincial health care systems should consider this type of reform, as the urgency to optimize family doctors’ ability to deliver care to those who need it most has never been greater.

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