Tara Kiran is a family physician and scientist at St. Michael’s Hospital, Unity Health Toronto, and the Fidani Chair of Improvement and Innovation at the University of Toronto.
Access to health care should be based on need and not on one’s ability to pay. Time and again, people in Canada have reaffirmed this as a fundamental value we share.
But, as it stands, too many people don’t have access to care when they need it – especially from a family doctor. This needs to be top of mind for our elected leaders when they meet this week to discuss the future of health care funding.
This past fall, a team of researchers heard from more than 9,000 adults in Canada who responded to the OurCare national research survey about their experiences with family doctor care and what they want to see in a better system. The survey was the first phase of OurCare, a 15-month initiative to engage the public about the future of family physician care in Canada.
More than one in five people reported not having a family doctor or nurse practitioner who they can talk to when they need care or advice about their health. Extrapolated to the population of Canada, that’s more than 6.5 million people aged 18 and over who don’t have access to a family physician.
Family doctors are the gateway to the health care system. We are the first point of contact when something is wrong, we provide care for ongoing illnesses, and prevent problems from developing in the first place. When people don’t have a family doctor, everything else falls apart: Emergency departments become crowded, there are more missed or delayed diagnoses, more illnesses and immense frustration.
The problem is worse for some than others. In our survey, greater numbers of men, people with a low income and people who are racialized reported not having a family doctor. Some of the biggest differences in access to care were by region, with more than 30 per cent of respondents in Quebec and the Atlantic provinces reporting not having a family doctor, compared to 13 per cent in Ontario.
One potential solution is expanding team-based care. Having family doctors work together with nurse practitioners, nurses, social workers, pharmacists and other health professionals can improve care for patients, improve joy at work for clinicians and grow the capacity of family doctors to care for more patients.
Our survey found that people in Canada were supportive of team-based family doctor care. Ninety per cent said they were comfortable with getting support from another member of the team if their family doctor recommended it. Yet few people said they had access to team-based care. Instead, the pandemic has seen a growth in Band-Aid solutions to the problem – there are more walk-in clinic options, including new virtual services where people can easily connect with a doctor by phone or video, but where there is often no opportunity for an in-person follow-up with the same doctor.
Respondents to our survey were also skeptical about these new virtual services; 70 per cent said they were not willing to use them if the company that ran the service received payments from or was owned by a pharmaceutical company, and 84 per cent were not willing to use these new services if the company that ran the service sold their anonymized health data to pharmaceutical or insurance companies.
So, what do people want from family doctor care? The most important elements for respondents were that their family doctor knows their patients as people and considers all the factors that affect their health, that they stand up for their patients, and that they co-ordinate their patients’ care across multiple places. Almost 90 per cent also said it was important to them that their care was close to home.
People in Canada are ready for change. Almost three-quarters of respondents agreed that family doctor care should be reorganized to operate similarly to the public education system – just as moving to a new neighbourhood guarantees your child a registration spot at the local school, families should have guaranteed access to local health care.
Over the next year, OurCare will be hosting regional dialogues with members of the public to better understand their needs, values and preferences and put forward recommendations for a better system. We have already begun a dialogue in Ontario and it’s clear there is appetite for bold reform.
Almost every respondent to our survey (97 per cent) said it was important that everyone in Canada has a relationship with a family doctor, nurse practitioner or team of health professionals they can see regularly. They are open to change that prioritizes relationship-based care. Now it’s time for governments to act.