A family doctor shortage in Ontario is on track to significantly worsen, according to the Ontario Medical Association.
“Our system is on the precipice of a real disaster and we’re trying to sound the alarm,” says president Dr. Andrew Park.
The group, which represents doctors in Ontario, says 2.3 million Ontarians do not currently have a family doctor. By 2026, 4.4 million or a quarter of Ontarians are expected to be without a family doctor, according to the OMA and the Ontario College of Family Physicians (OCFP).
The warning from the OMA comes just days after the OCFP announced that, in Sault Ste. Marie and Algoma District, 10,000 patients would be losing their family doctors by the end of May and an additional 6,000 could lose access to their family doctor by the end of the year.
“The crisis we have seen unfold in Sault Ste. Marie, leaving thousands of people without a family doctor, will replicate itself across the province,” said Park.
“We can’t just sit back and watch this situation get worse. We need to act now so people in Ontario can get care when they need it.”
The OMA says underfunding in OHIP revenue, rising inflation and excessive administrative work are fueling the crisis. The OCFP says family doctors spend about 19 hours a week just on paperwork.
“There’s a crushing amount of administrative burden being put on family doctors driving that burnout,” said OCFP president-elect Jobin Varughese.
As an example, Varughese says just sending a referral can take a significant amount of time. Referrals aren’t automatically accepted and the current system doesn’t give doctors information as to whether a specialist is accepting patients currently or if they are even still covering what the referral is for.
“There’s many times in my own practice where I’ve sent a referral and the person will say, ‘you know what? I used to do that. I don’t do that anymore.’ And so that really affects the amount of time I have to run around doing that.”
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Additionally, the college says many family doctors are nearing retirement and fewer medical students are interested in taking their place.
Dr. Jodie Stewart, CEO of the Algoma District Medical Group, says the situation in Sault Ste. Marie is a direct result of retirement and burnout.
“Thirty-five per cent of our physicians are age 60 or older. And then we have, along with that, a lot of our younger physicians leaving office-based family medicine because of burnout, the administrative burden and just the hard work that it is practicing office-based family medicine today,” Stewart explained.
“What we’re noticing, which is the trend across Canada, is that fewer medical students are choosing family medicine as a career path, as a residency. And those that do complete family medicine residency are often tending not to do office-based primary care.”
The OMA also pointed to data from HealthForceOntario, which posts job openings for physicians, showing 2,500 openings in Ontario currently, including 305 in Toronto, 171 in Ottawa, 118 in Barrie and Muskoka region and 114 in Hamilton.
While the OMA does not know exactly how many of those positions are for family medicine, Park said “in typical systems, the majority of those by specialty will be family medicine.”
Dr. Allan Grill, chief of family medicine at Markham Stouffville Hospital, stressed that family medicine is the backbone of the health-care system.
“If you look at most robust primary care systems across the world, those that are successful, they’ve had high investments in primary care,” he explained.
“When people don’t have a family doctor, they really have no place to go for a lot of their vaccines, they can’t get their cancer screening on time, chronic illness isn’t managed properly so they end up sicker and then people go they go to the emergency room and it gets really awful.”
Earlier this month, the OMA outlined an 11-point plan to address issues across the health-care system in the province. Among the items specific to family medicine was expanding access to team-based care. The OCFP agrees, with Varughese stating that about 30 per cent of family doctors currently are part of a primary care team.
“What does that mean? It’s different per community. In some teams that might be increased mental health social workers, that might be system navigators, that might be nurses, dieticians.”
Grill says that teams allow physicians to delegate services, which “frees up space for the family physician to take on more complex patients, or just have more time to see other patients.” Grill is hoping that the 2024 budget will provide for more access to team-based care.
The province, which has been in negotiations with the OMA on the physician services agreement since October, says it has been taking action, adding “over 10,400 new physicians since 2018, including a nearly 10-per cent increase in family doctors.”
“While Ontario is leading the country with 90 per cent of Ontarians having a primary care provider, we understand that a key part of our Your Health plan is to ensure all Ontarians who want access to primary care are able to,” said Hannah Jense, spokesperson for the Minister of Health.
“That is why we are investing tens of millions of dollars to launch the largest expansion of new interdisciplinary primary care teams. Further details around other successful applicants will be shared very soon.”
The spokesperson added that a task force has been established the tackle the administrative burden and that the government is moving to replace fax machines with a digital communications alternative at all Ontario health care providers.
— with files from Global News’ Caryn Lieberman.