The Ford government’s recently released plan to ease pressure on Ontario emergency rooms makes no mention of the mass exodus of physicians from family practice. With that omission, the province’s Plan to Stay Open ignores the central role of family doctors in the health-care system, and sets itself up for failure.
A strong primary care system, identified as the cornerstone of health care, keeps patients away from emergency rooms and plays a huge role in encouraging self-management of illness and prevention of disease.
Critical role of primary care
Focusing mainly on hospitals to fix the problem is akin to closing the barn door after the horses have fled. We must look upstream to primary care where about 86 per cent of Canadians trust family doctors to assist them in staying healthy.
In my ongoing research on integrated health-care systems — including Ontario Health Teams and the capacity for family physicians to inform system change — I see a high degree of skepticism among family physicians about influencing system reform, since many have previously seen their input not heeded or not even sought. Time also limits their participation in health system research.
Until the government acknowledges the critical role family physicians have in population health and on easing the burden on acute hospital care, pressures will only be relieved temporarily. At the same time, family physicians are fed up. No wonder that some are walking away because they “can’t take it anymore.”
Increasing challenges in family medicine
Family physicians are dealing with significant burnout, ever-increasing workloads, unrealistic patient demands and lack of respect from other specialties. In addition to having a passion for providing continuous, comprehensive care, family physicians also need to acquire business acumen to manage overhead costs, performance management skills to hire, fire and coach office staff, and administrative prowess to deal with the mounds of paperwork that is done after the patient leaves (and is mostly non-billable).
Despite the value that most of us place on having a family doctor that we trust with our cradle-to-grave health issues, they are among the lowest paid and the least respected physicians, yet they have the most knowledge about the inefficiencies in a health-care system that is coming apart more each day.
To make matters worse, supply is decreasing. This year’s residency applications through the Canadian Resident Matching Service (CaRMS) indicates that the number of medical school graduates choosing family medicine as their top choice for training spots is declining steadily.
This should be worrying for all of us as patients. More exploration into why family medicine is no longer seen as a worthy profession is sorely needed as more and more patients will be unable to access the continuous, comprehensive care they require.
More Canadians without a family doctor
News headlines continue to highlight that more patients across the country are without a family doctor and fewer doctors want to enter, or stay, in family practice.
In addition to diminished supply of new family doctors, many are heading for the exits earlier than anticipated. Family physicians are choosing to retire early, and in some cases walking away from large and long-standing practices leaving more and more patients without a family physician and having no other option but to visit the emergency department for their health concerns.
Increasing the number of family physicians is important but retaining those that we already have should be viewed as absolutely critical. With the average age of a family doctor in Canada at 49, it’s not hard to predict that more retirements (planned or otherwise) will have a detrimental impact on the health of Canadians.
Primary care challenges
Primary care is not without its own challenges. For those that are lucky enough to have a family doctor, the time to see them varies, and access issues are a common theme in patient complaints. Different physician offices use different appointment booking practices and scheduling rules, which can impact patient access ratings.
There are inequities between family physicians with solo practices in comparison to those who are attached to a family health team — health-care organizations that provide primary health care to communities and include various health professionals such as nurses, dietitians, social workers and others who share aspects of patient care with doctors.
Ontario has done better than most areas of Canada with the introduction of family health teams in 2005, with team-based primary care reporting better outcomes for both patients and providers.
But no new family health teams have been funded since 2012, which is a problem. Ontario Health Teams were introduced in 2019, and offer potential to influence what is currently a cadre of services (including primary care, hospitals, long-term care, home care, health support services) to function better as an integrated health system covering a geographic region.
Ontario Health Teams do not provide direct care, but are tasked with building a better system of care, working to break down silos between health-care providers and organizations to function better for patients. Primary care must be a major player in these.
Political will is required to invest in the entire health-care system and not ignore the fact that primary care represents a very large part of this system. We have a capacity crisis for certain — but cannot fix only one flat tire when all the tires are flat!