B.C. showed how to fix the family doctor crisis — but Ontario’s not listening

Posted on October 23, 2025 in Health Delivery System

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TheStar.com – Opinion/Contributors
Oct. 23, 2025.   By Iris Gorfinkel, Contributor

In less than a year, nearly 1-in-4 Ontarians could lose access to the front door of the health system: their family doctor. This isn’t because medical schools failed to train them — their numbers have actually edged ahead of population growth — the problem is that fewer choose cradle‑to‑grave, comprehensive care.

Consequences can be dire: Treatable diseases go undetected, patients flood emergency rooms, and hospitals are overwhelmed by advanced cases. Today, 2.5 million Ontarians lack a family physician — and it’s on track to soar to 4.4 million by 2026.

The reason isn’t simply income. Family medicine has been Canada’s lowest-paid specialty for decades. The bigger problem is that 2-in-3 family doctors currently providing comprehensive care plan to cut back or retire soon. Ontario’s medical training programs saw this coming. Residency programs in family medicine have kept pace with population growth.

The real issue is that a growing number of family physicians — now 1-in-5 — opt out of comprehensive general practice and pursue focused roles, like ER shifts or walk-in clinics. The number of physicians rejecting cradle-to-grave care has nearly tripled since the 1990s.

British Columbia has shown a way out. When 1-in-4 B.C. residents lacked a family doctor in 2023, an alternative to traditional fee-for-service was launched. Family physicians agreeing to provide comprehensive care could opt for The Longitudinal Family Physician Model. It offered raises of nearly 40 per cent in gross pay, rewarding doctors based on patient complexity and time spent.

Its impact was immediate: Family medicine residency spots filled. Within two years, over 1,000 family doctors left focused roles to deliver comprehensive care, connecting nearly 250,000 residents to a family doctor.

But rather than follow suit, Ontario expanded medical school and family medicine residency spots, failing to address the root cause. Plenty of family doctors are being trained, but too few remain in comprehensive care.

Family doctors finish training in their early 30s with an average debt of $90,000. Those in comprehensive practice saw their earnings fall 15 to 20 per cent over the past decade while overhead costs like rent and salaries went up 30 per cent.

Compounding this, each week up to 20 hours is spent on unpaid administrative work — reviewing results, consult notes, prescription requests and forms. Meanwhile, Ontario’s aging population has increasingly complex health needs and rising clinical expectations make comprehensive care increasingly unattractive to providers.

The profession offers no sick leave, paid vacation or retirement plan. Then there’s the ongoing burden of ensuring coverage and paying overhead when away. All this makes opting for more focused care an enticing alternative. It costs less, pays more and offers better hours than traditional, cradle-to-grave family medicine.

Ontario’s $1.8‑billion investment in Family Health Teams — partnerships linking family doctors with services like nurses, social workers and mental health providers — addresses these issues and improves care. But teams cannot succeed without family physicians to anchor them. Without them, Ontario’s Primary Care Action Plan will remain a blueprint, not a solution. Even if they were available, attaching every Ontarian to a family doctor takes years, time many Ontarians can’t afford.

The fastest way to connect patients to a family doctor is to make comprehensive care more attractive. This is exactly what British Columbia did, teaching an unmistakable lesson: When the pay and working conditions outweigh those of alternative roles, doctors return to comprehensive family practice and patients get attached.

Replicating B.C.’s approach is estimated to cost $2 billion annually — about 2 per cent of Ontario’s total health budget. With the same success rate, it would attract 2,900 family doctors back into comprehensive care — enough to attach 3 million patients within two years.

Ontario stands at a critical crossroads: Invest in making comprehensive care viable, or leave millions without a family doctor. In the end, it’s not health systems but patients who pay the ultimate price — with delayed diagnoses, preventable hospitalizations and lives cut short.

Iris Gorfinkel is a family physician and clinical researcher in Toronto.

https://www.thestar.com/opinion/contributors/b-c-showed-how-to-fix-the-family-doctor-crisis-but-ontario-s-not-listening/article_106a008a-d481-423a-a8e4-c09ceafbe0bb.html?source=newsletter&utm_content=a02&utm_source=ts_nl&utm_medium=email&utm_email=0C810E7AE4E7C3CEB3816076F6F9881B&utm_campaign=top_23794

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