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Dr. Sloane J. Freeman is a pediatrician at St. Michael’s Hospital, Unity Health Toronto, and an assistant professor of pediatrics at the University of Toronto.

The OurCare national research survey estimates that 6.5 million Canadians over the age of 18 lack a primary-care physician, and a significant number of these people are parents with newborns.

Without a primary-care provider, newborns are especially vulnerable to falling through the cracks within our health care system. This is an even greater problem for newcomer families and those who are not familiar with navigating the Canadian health system.

Newborns require multiple doctor visits in the first days and weeks of life to monitor feeding, weight gain and possible jaundice. Babies born prematurely or with a low birth weight need even closer surveillance. Without close monitoring and follow-up babies are at risk of dehydration, jaundice, serious infections and unrecognized congenital health problems.

Many parents bring their newborns to emergency departments and urgent-care centres because they have nowhere else to turn. Some provinces have set up mobile clinics for newborns who don’t have a family doctor.

As hospital-based pediatricians in the downtown core, my colleagues and I ask every parent of a newborn if they have access to a primary-care doctor for their child. Most of the time the answer is a resounding “No.” Even for parents who do have primary-care providers for their newborns, long travel times and challenges in scheduling appointments make it difficult for them to access care within the first few days of life.

This crisis was heightened during the pandemic, when in-person health care access was restricted. Virtual care falls short for newborns who require physical examinations and weight checks to assess hydration status and growth. Another important consideration is that routine immunizations begin at two months of age, leaving little time for families to secure a primary-care provider for their infants to begin vaccinations.

In addition to family physician shortages, newborns face unique challenges in accessing primary care. First, many family physicians devote their practices entirely to the adult population. Second, since the first health care visit should happen within just days after birth, connection to primary care must occur in the prenatal period.

Proposed solutions to address the countrywide family-doctor shortage have included multidisciplinary team-based care, measures to attract more medical students into family medicine, and the removal of barriers for foreign-trained physicians to work in Canada as family doctors. Solutions that would increase the number of family physicians in the work force must also consider the provision of primary care to newborns and children.

For example, team-based models should include practitioners familiar with caring for infants, and new family-medicine graduates should be encouraged to take on young families and prospective parents. Ideally, a newborn would continue with their primary-care provider throughout their childhood and beyond.

As continuity of care and trusted relationships with primary-care providers are priorities for parents, it would be ideal for a newborn to continue with their primary-care doctor throughout their childhood and adolescence.

Any solutions to Canada’s family-doctor shortage must build in tools that enable expectant parents to find a primary-care provider for their newborn during the pregnancy.

In addition, methods to improve communication and referral processes between practitioners providing obstetrical care and primary care would help bridge this gap in access for newborns. Expectant parents with language barriers, or who have other challenges in accessing health care, may need more support in securing primary care in advance of their deliveries.

As we come together to address the family-medicine shortage across the country, we must prioritize access for an often-forgotten but vulnerable population – our newborns.

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