Patients in Canada may wait longer to see primary care clinicians if they have less education or are Black or Asian, according to an analysis of government survey data.

Income level was not found to be a predictor of wait times, and this finding makes sense in the Canadian context, Shehzad Ali, PhD, Canada research chair in public health economics at Western University in London, Ontario, told Medscape News Canada.

Universal health insurance coverage can blunt the effects of income on healthcare access, Ali explained. “In a system without point-of-care charges, income differences may matter less for getting an appointment, though they still affect many other outcomes. Other social factors, such as education for system navigation, can show a stronger signal,” he added. 

The data were published on October 14 in Canadian Family Physician. 

Potential Biases

Though Canada has a universal healthcare system, access to primary care remains a persistent challenge. Limited access to family physicians is a major part of the problem, as researchers, including Ali, have previously reported. 

In the current study, the researchers sought to determine how social and health factors affect access to healthcare. They examined data from the Canadian Community Health Survey “to capture a comprehensive picture of Canadians’ experiences waiting for primary care,” said Ali. The researchers analyzed data from the 2015, 2016, and 2019 cycles of the survey and created a weighted sample of 9.38 million participants.

Approximately 11% of participants reported waiting 1 month or longer for primary care appointments, 9.1% reported waiting between 2 weeks and 1 month, and 20% reported waiting 1-2 weeks. 

In contrast with previously published research, their study did not suggest that income, mental health status, and sexuality were significant predictors of wait times.

Factors associated with increased odds of waiting for at least 1 month for an appointment included having a high school diploma (adjusted odds ratio [aOR], 1.12) compared with higher education; identifying as Asian (aOR, 1.42) or Black (aOR, 1.57) compared with White; having “excellent” self-reported health (aOR, 1.10) compared with “good” self-reported health; lacking a regular primary care provider (aOR, 1.47) compared with having a regular clinician; and having multimorbidity (aOR, 1.11) compared with having no chronic conditions.

The findings reinforce the need to recognize how biases within the health system can contribute to longer waits for some patients, said Ali. He suggested that clinicians monitor practice-level wait times according to factors such as education, language, and ethnicity to identify where inequities may exist and to enable improvements. He also encouraged clinicians to reach out to patients with lower education or health literacy, who may be less likely to seek care early or advocate for appointments, to prevent inequities from widening. 

It is important to ensure timely access for patients with multiple chronic conditions, who often face the longest wait times despite having the greatest need for continuity and coordination, Ali added. Clinicians also should offer culturally safe and language-appropriate care, recognizing that communication barriers and unfamiliarity with the system can delay care for ethnic minority patients, he advised. 

Measure, Then Plan

Commenting on the findings for Medscape News Canada, Andrew Pinto, MD, associate professor of public health at the University of Toronto and family physician at St. Michael’s Hospital of Unity Health Toronto, Toronto, said that the study was well designed and addresses an important question. Pinto did not participate in the study but has collaborated with Ali on previous unrelated research.

Using the Canadian Community Health Survey, one of the largest national collections of health data, allowed the researchers to examine in a new way how social factors can affect medical care, said Pinto. Other research in this vein has focused on specialty care.

“It was quite novel that they were looking at wait times to receive primary care,” said Pinto. “It’s such an important area. Right now, in Canada, there’s a lot of focus on helping attach more people to primary care.” Gathering this kind of data is a crucial step toward addressing the causes of gaps in care, Pinto added.

“No primary care clinic sets out to provide unequal care, and yet this is what we see. To be able to address that, we need to measure, and then there needs to be a plan” to address the underlying causes of these disparities, Pinto concluded.

No funding for the study was reported. Ali and Pinto reported having no relevant financial relationships.

Kerry Dooley Young is a freelance journalist based in Washington, DC. She has reported on medical research and healthcare policy for more than 20 years.