Loading ...

The Ontario Medical Association (OMA) called attention to the increasing number of family physicians who are leaving practice during a February 15 panel discussion. OMA officials called for government intervention to address what they described as an urgent problem.

By the time Natalie Leahy, MD, left her 16-year family practice and her 1200 patients in Oshawa, Ontario, Canada, in September 2023, she had been spending about 3 hours per day on administrative tasks outside of patient charting. She often had to contact three or four specialists to find one to treat a patient.

She had seen billings cut and capped. The highest yearly reimbursement increase she observed was 1%.

"Right now, in Ontario, family medicine is a failed business model," said Leahy. "The amount we're able to bill has not kept up with inflation for the last 10 years." At one point, she took a part-time job doing on-call work overnight in a hospital to make ends meet.

After she experienced significant effects of burnout in 2014, Leahy took steps to protect herself from it. But 6 years later, the pandemic made the problems worse than ever. Additionally, two of her family members had health crises at the end of 2022. She needed to take some time off, but "we simply don't have replacements available when we need them."

She decided to leave family medicine. She now works as a general practitioner in oncology at Durham Regional Cancer Centre in Oshawa, Ontario, Canada.

Lack of Healthcare Access

Increasingly, physicians are choosing to leave family practice, said OMA President Andrew Park, MD. This choice directly affects patients.

Already, 2.3 million Ontarians lack a family doctor, said Park. "That number is expected to nearly double in only 2 years," meaning that 1 in 4 Ontarians would be without access to care.

A recent survey by the Ontario College of Family Physicians "found that two thirds of its members plan to change their practice model, reduce hours, or retire in the next 5 years," Park added. And the number of medical school graduates choosing family medicine is the lowest it's been in 15 years, according to the Canadian Residency Matching Service.

When Dannica Switzer, MD, started working in the rural north Ontario town of Wawa as a family physician, the community had seven doctors, which was the number that the government had assessed was needed. Now Wawa has three doctors. This change influenced Switzer's decision to work part time as a physician where and when she wants.

"We need immediate measures to retain these practicing rural physicians who have so much experience and play such an integral role," said Switzer. "We also need long-term plans. We cannot recruit our way out of a retention problem."

Federal Agreements Inadequate

Governmental officials have begun to act. On February 9, the federal government signed a $3.1 billion, 3-year agreement with Ontario with a focus on primary care.

Ontario was the fifth of the 10 provinces to sign a deal for a portion of the federal government's promised $100 billion commitment to healthcare, which the government made a year ago. But this amount falls short and won't stabilize the economic spiral, said Park.

David Barber, MD, chair of the OMA section on general and family practice and a family doctor in Kingston, calculated Ontario's needs. Though the government has proposed training 600 new family doctors, "that only covers 600,000 patients, so when we're looking at 4.4 million without family doctors — 5000 patients every year are going to lose their family doctor — that's just not enough," he said.

Funding for family doctors has been cut by 20% over the past 20 years, Barber added. "When doctors see this and look at the numbers, that's why they're looking to get out."

High-Impact Actions

During the discussion, the doctors listed several actions that would help immediately. Government stabilization payments to family physicians are needed now to help with overhead (such as payments for staff and rent) and keep practices from closing, said Barber.

Another need is a centralized referral system. Currently, family doctors use a "Yellow Pages" type system to research which specialists are right for each patient and what their wait times are like, said Park. "This is crazy," he added.

Streamlined information from hospitals and standard forms for imaging requests, rather than a different form for each hospital and diagnostic imaging center, would ease the administrative burden, said Leahy.

In addition, eliminating the requirement for sick notes for employees would help, said Barber. That requirement was ended after the beginning of the pandemic, he added, but has been reinstated and is adding to the paperwork burden.

In the small towns of northern Ontario, where family doctors are providing all the medicine, "we need immediate locum tenens support," said Switzer. Wawa needs 20 doctor days per month for each of the four doctors who no longer practicing there, she added.

All the physicians stressed the urgency of shoring up primary care. "All of our health is at stake," said Park. "Evidence shows that fewer family physicians in our communities is associated with poorer quality of life and shorter life expectancy. We need to act now to ensure there's a future for family medicine in Ontario."

Leahy, Park, Switzer, and Barber reported no relevant financial relationships.

Marcia Frellick, a graduate of Northwestern University's Medill School of Journalism, has been a Chicago-based healthcare journalist for more than 20 years. Her move to writing followed a progression of editing roles at the St. Cloud Times, the Iowa City Press-Citizen, the Cincinnati Enquirer, and the Chicago Sun-Times. Her writing has appeared in the Chicago Tribune, Science News, and Northwestern Magazine in addition to Medscape Medical News, MDEdge, and WebMD.