The front door to health care in Ontario is broken and needs to be fixed

Opinion Piece
The Board of Directors, Peterborough Family Health Team

The front door to health care in Ontario is broken and needs to be fixed.

Family medicine plays a crucial central role in health care. The Ministry of Health has contributed to creating a critical shortage of family doctors that has brought the system to the precipice of collapsing, so that actions to reverse the trend are needed now.

The time has come when access to a hospital bed is no longer the main concern of Ontarians but rather it is the lack of care that will delay the need for a hospital bed. Ontarians number one health related concern is “I can’t find a family doctor”.

Walk-in clinics and phone Apps offering “primary care” are not remotely comparable to the care provided by a family physician. We use the term “family” because that captures the multi-decade commitment family doctors make to their patients, the patient’s family and the community they live in. They get to know you, have cared for your children, your aging parents. This cannot be replaced by access to a physician with little to no relationship with you or your community.

There are no established mechanisms in place to include family medicine in the health systems design that each new government touts will fix health care. There are few compensation options to support a family physician to sit at a local or provincial planning table. Family medicine has been identified as a priority in the provincial government’s new Ontario Health Team model, yet funding does not support participation from the sector. Hospital leaders and senior managers in other health and social services agencies are all paid to sit at these planning tables – very few family doctors are. When Family Doctors do participate in unpaid health system design work, they are not only doing it for free, but are also decreasing their own revenue through lost patient-care time.

Hospitals are rapidly becoming the first access point to health care for millions of Ontarians. This is expensive, episodic, and an escalated route to needing a hospital bed. Access to comprehensive care with a family physician is less expensive, more compassionate and keeps Ontarians out of hospital longer.

Family physician revenue models are outdated. Family doctors are compensated to see patients, not to run businesses, but their reality is that opening a practice makes them small business owners. Family Physicians must cover the rapidly increasing costs of paying the bills – staffing, rent and the purchase of equipment and supplies – before paying themselves. They work numerous unpaid hours doing tasks like completing insurance forms, writing work notes, reviewing consultation notes, and interpreting investigations (ie labs, imaging).

Family physician compensation has fallen behind other specialties. For many medical specialties the significant gains in medical technology have made it possible to double, triple, and even quadruple the number of patients seen. This has not been the case in family medicine. Patients are not getting younger, healthier or richer. Ontarians are older and many cannot afford what keeps us healthy, starting with food and secure housing.

The more complex the patient, the more time each patient needs with their doctor. The more time the doctor spends with each patient, the fewer patients can be seen. Fewer patients means less income. Simply put, as time per patient increases, family physician compensation decreases. This trend shows no signs of abating.

A province wide study led by Unity Health Toronto found that family doctors, over a 6 month period in 2020, left the profession at double the rate pre-pandemic.

In that short time period an estimated 170,000 patients lost access to a family physician. Estimates show that nearly 1.8 million Ontarians do not have a family doctor and another 1.7 million Ontarians have a family doctor older than 65 years.

In Peterborough alone in the 12 months between March 2021 and March 2022 3,630 residents lost their family doctor. This crisis is pitting community against community in the fight to recruit and retain family physicians.

There is a strong message to government when fewer and fewer medical school graduates are choosing to go into family medicine.

For those who’ve chosen to go into family medicine, some are hesitant about opening up a new practice or taking over for a retiring family physician. To do so comes with the additional responsibilities of running a small business.

New graduates want to care for their patients, not spend time dealing with the increasing administrative burdens such as handling rent, payroll and taxes. Since COVID has driven up inflation, the cost to run a practice is rapidly increasing while family physician compensation remains mostly static.

Queen’s University in Kingston, Ont., has committed 20 additional medical school seats in fall 2023 for those wanting to pursue family medicine. This is a positive step but is
nowhere close to keeping pace with family doctors retiring or leaving practice. These graduates can always choose other options such as being a locum, hospitalist, working in a hospital emergency department or pursuing a sub-specialty.

There is an important distinction between primary care and family medicine. You can get “primary care” on a phone App or at a walk-in clinic, but you can only get comprehensive primary care from your family physician.

A final thought. We applaud those who choose family medicine. Choose to build a long term relationship with their patients. Choose to lose sleep worrying about the issues they cannot solve for them – such as food on the table, a roof over their heads. Choose to feel the pain of having to turn down community members who need a physician but their patient roster is already over-flowing. Choose to put off retirement for years because they cannot find a replacement physician for the patients they have come to know on a very personal level.

Family doctors value their patients, now it’s time to tell our provincial government to value family medicine.

The Peterborough Family Health Team is a provincially funded agency of health professionals who work with the family practices of over 90 family physicians in Peterborough and Area. Board members are Dr. Robert Neville. Aaron Anderson, Dr. Alex Atfield, Dr. Luke Bowley, Dr. Michelle Fraser, Jane McDonald, Dr. William Shannon, Larry Stinson, and Dr. James Webster. The CEO is Duff Sprague