Dr. Mekalai Kumanan is president-elect of the Ontario College of Family Physicians. Dr. Kamila Premji is a family physician and assistant professor at the University of Ottawa. She is also a PhD candidate in family medicine at Western University
While there has been much news focusing on the urgent crisis in our hospital emergency rooms, the reality is that every part of Ontario’s health care system is under enormous strain – and that includes family doctors.
Based on the most recent available data, as of March, 2020, an estimated 1.8 million Ontarians do not have a regular family doctor. As is true for so much of the health care system, the demands on family medicine have been exacerbated by the pandemic and are projected to worsen in the coming years.
Our province is on track to see three million Ontarians without a regular family doctor within three years. That’s one-in-five Ontarians who could be affected.
We recognize that the issues driving this shortage are challenging and complex. It’s going to require an all-hands-on-deck approach between health care leaders, family doctors and the Ontario government. To break the current trend and set Ontario on the right track, we need to start addressing it now.
Family doctors are the foundation of the health system. The worsening family doctor shortage will have a devastating impact on the health and well-being of Ontarians.
When patients don’t have a family doctor, cancers may go undetected. Patients will turn to hospital emergency departments because they have nowhere else to go. Family doctors may not be able to provide the kind of care the growing population of elderly Ontarians needs in order to stay healthy and age at home, putting even more pressure on scarce long-term-care beds.
If patients can’t see their doctor in a timely manner, it not only impacts the individual, it adds more burden – and cost – to the entire health system.
So how did we get to this point? How did it get so bad?
It really is a perfect storm – a set of complex issues all emerging at once. New research from INSPIRE Primary Health Care points to four main factors driving the shortage of family doctors.
The first is that many family doctors are aging and set to retire: 4.9 million Ontarians currently have a family physician over the age of 55. Other research shows one-in-five Toronto-area family physicians surveyed in spring 2021 said they are thinking of closing their practice in the next five years. Additionally, more family physicians stopped working during the first six months of the pandemic than in the first six months of previous years.
At the same time, fewer medical students are choosing to focus on family medicine, and younger family doctors are leaving cradle-to-grave comprehensive family medicine for other specialized areas. This trend is concerning because it means that fewer family doctors will be in the system at precisely the time when we need them the most.
Another driving factor is that Ontario’s population is aging and older patients need more complex health supports. The medical complexities that come with living longer mean that patients will continue to need more time and longer appointments. It is time that family doctors don’t have.
Finally, many family doctors are exhausted from the pandemic. Family doctors continue to support vaccination efforts, work in COVID assessment centres, and, in many cases, are also working in emergency departments and hospitals to help keep them open. All the while, family doctors are seeing patients in their offices.
There are solutions. And while some issues will take time to change, there are things we can do immediately.
Easing the administrative burden family doctors face is one immediate fix. Family doctors spend more than 25 per cent of time – for many, it’s much more – on administrative tasks.
Streamlining the referral process for tests, specialists and services would help. Centralizing patient medical records so that family doctors can access patients’ results easily – without having to send follow-up requests that take time or cause delays – from other health care facilities is also key.
We also need to work toward ensuring family doctors have support from teams, which could include mental health professionals, administrative support staff, social workers and nurses – all of whom can take on tasks that do not necessarily require a family doctor but can ensure that patients get the care they need.
Currently, the most prominent form of team-based care serves 3.4 million Ontarians within 184 teams. But the provincial funding for this model has been frozen, preventing new teams from forming. The result is that only about 20 per cent of Ontarians currently have access to this model of care.
Our proposed solutions – reducing the administrative burden and creating teams – could free up more of family doctors’ time to focus on quality patient care. They will also help to ensure Ontarians receive the right care from the right person. They would go a long way to recruiting new family doctors and retaining those we have because it means they would be more able to do the type of work they aspire to.
The Ontario College of Family Physicians stands ready to work with the Ontario government to resolve these issues. Addressing the issues in hospital emergency rooms is urgent and necessary. But we must also prioritize the care that Ontarians receive from their family doctors. It’s the only way out of our current health care crisis.