Knock, knock. Is a doctor there?
Can you believe it? Over 2.2 million don’t have a regular family physician in Toronto the province of Ontario. The shortages are worse in Toronto, Canada’s most populous city and its financial capital.
One in five Ontarians, most of them Toronto dwellers, could be without a family doctor in the next three years, according to the Ontario College of Family Physicians (OCFP), which represents 15,000 family doctors in the region.
“We have a full-blown healthcare crisis on our hands,” said Dr Mekalai Kumanan, president of the OCFP, which is raising an alarm. Canada’s population saw record growth in 2022, spurred in large part by an immigration-friendly policy.
Older physicians are retiring but fewer medical students are choosing family medicine. And Toronto’s aging population faces ever-more medical issues.
Canada prides itself on universal health care, delivered through a publicly funded system dubbed medicare, at free or very low cost to residents. In contrast to the neighboring US, the Canadian system is intended to give all residents access to care regardless of their financial means.
But doctor shortages call that guarantee into question, particularly for immigrants and low-income people.
Primary care physicians are the “front door” of health care, the port of first call to evaluate a patient and determine if the person needs a diagnostic test or a specialist consultation.
The absence of preventive care results in missed flu shots, and more seriously, undetected conditions such as cancer, high blood pressure and diabetes, leading to expensive acute care situations, and compounding the burden on emergency rooms.
In 2021, a survey by the hospital network Unity Health Toronto found that one in five Toronto family physicians are considering closing their practice in the next five years.
“The pandemic caused healthcare professionals around the world to rethink work,” said Dr. Tara Kiran, the Fidani Chair of Improvement and Innovation at the University of Toronto. “It’s particularly challenging for those in family medicine where doctors aren’t as respected as specialists.”
Ontario’s Ministry of Health says more than 60,000 new nurses and 8,000 new doctors have registered to work in Ontario since the current government took office in 2018. But “we know more needs to be done,” says a spokesperson.
That’s why the province has announced more than 150 new medical school spots over the next five years, the largest capacity expansion in a decade, and is making it easier for internationally educated healthcare workers, including doctors, to practice in Ontario.
Are doctors overpaid, but overworked?
Experts and doctor groups are suggesting other urgent fixes. Physicians need a reduction in paperwork, which can add as many as 19 hours to their work week, according to the OCFP. They are asking the government for a centralized referral system and for more streamlined electronic medical records.
Dr. Adeyemo, Adebowale, a family physician in Toronto, Ontario noted:
“Increasing burnout among family doctors is taking a toll on their general well-being. The unending bureaucracies and the challenging pathway to registration also make it more difficult for doctors to integrate smoothly into the system.”
“Family doctors spend precious hours filling out multiple referral forms, doing lengthy insurance paperwork, writing up sick notes for minor illnesses or requesting diagnostic tests,” added Kumanan
Doctors say they also spend needless time on tasks that could be performed by other professionals like nurses and dietitians and are seeking financial aid to help expand their teams. Fewer than a quarter of family physicians work with a team currently.
The family doctor shortage vividly illustrates Toronto’s perilous situation, but the gaps are widespread across Canada.
Emergency rooms are also getting flooded as patients don’t know where else to go, causing ER backlogs that critics have cited as a factor in some poor health outcomes and deaths.
