An unhealthy shortage of family doctor

Posted on August 1, 2022 in Health Delivery System

Source: — Authors: – Opinion/Editorials
July 30, 2022.   By Star Editorial Board

Efforts to bolster the ranks of family doctors and encourage expansion of family medicine teams hold the promise of improving our collective health.

The crisis affecting hospital emergency rooms — backlogs, delayed treatments, temporary closures — is making headlines. The crisis around family doctors has been more gradual. But it is no less serious. It too imperils people’s health.

At the core of Canada’s health-care system is the promise of accessibility. For all those without a family doctor, that’s a broken promise. Statistics Canada found in 2019 that 4.6 million Canadians — about 14.5 per cent of those 12 and older at the time — did not have a regular health-care provider.

It’s not a new problem. But evidence suggests that solutions remain elusive. According to the Canadian Medical Association, 2,400 family physician positions were advertised on recruitment websites in 2021; the previous year, just over 1,400 family physicians entered practice. In 2021, 32 per cent of medical graduates chose family medicine, down from 39 per cent in 2015.

The shortfall affects not just our individual health, but the state of the health-care system.

Emergency room backlogs are the symptom of problems elsewhere in the system, usually bottlenecks in the hospital cause by a shortage of beds that prevents patients from being moved out of the ER.

But staffing shortages, nurses in particular, are certainly part of the problem. Away from emergency rooms, the lack of family physicians also has a bearing on the crisis. Without regular consultations with a family doctor, medical conditions go unrecognized. Opportunities to provide treatment are missed. Individuals then arrive at emergency rooms with ailments that are more progressed, more complex and therefore require more intensive treatments. The outcome may be less favourable than if the condition had been caught earlier.

It’s not good for the patients, and it’s certainly not a cost-effective way to provide health care.

Dr. Brady Bouchard, a Saskatchewan physician who serves as president of the College of Family Physicians of Canada, notes the number of unfilled family medicine residency positions has never been higher.

Bouchard said several factors combine to make family practice unattractive. Doctors have to manage all the obligations of a small-business owner, such as payroll and office administration — all tasks that take away from treating patients. Paperwork is an increasing burden. Working alone or in a small practice makes it impossible to take extended breaks such as parental leave, due to the obligation to patients and the financial penalty of shutting down a practice for any period of time.

The family physicians’ college, together with the Canadian Medical Association and the Canadian Nurses Association, have made a number of recommendationsto address the issues.

Some are short-term measures aimed at keeping health workers on staff. Others try to address the systemic issues, such as providing administrative and mental health supports.

Among their recommendations is one to expand collaborative teams, which Bouchard says would include doctors along with other health professionals such as nurse practitioners, physician assistants, dietitians and clinical pharmacists, in order to provide a range of care. The $3.2 billion promised for health care by the federal Liberals in last year’s election could be tapped to help make this happen.

Ontario and other jurisdictions have already made some changes along these lines — reforms that focus on building medical teams and changing how doctors are paid, replacing a fee-for-service approach with payment for each patient enrolled in a practice.

Other recommendations include increasing access to virtual care, something many Canadians experienced during the pandemic; measures to increase the supply of physicians, nurses and nurse practitioners; and support for those professionals trained abroad to get licensed to work in Canada.

Bouchard says that investments in primary care pay dividends. “If we’re talking about where to start on reform, make a robust primary care system as a base for the pyramid of your health system across the country.”

There is no single fix to the stresses Canada’s health-care system is facing. But efforts that bolster the ranks of family doctors — such as easing the administrative burdens that detract from patient care and encouraging the expansion of family medicine teams — hold the promise of improving our collective health.

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