Family doctors are suffering and so are their patients

Posted on November 13, 2023 in Health Delivery System

Source: — Authors: – Opinion/Contributors
November 13, 2023.   By David Barber, Contributor

Family doctors are the backbone of the health-care system that Ontarians rely on and they are exhausted, frustrated and in some cases giving up.

I read with interest the recent column in the Toronto Star by Dr. Michael Rachlis on the topic of access to family doctors in Ontario.

In his piece, Rachlis advocates for more collaboration and teamwork in the delivery of primary care and lays the blame for poor access to family doctors in Ontario to inefficiencies in the way that family doctors practice.

While I disagree with many of the assertions in Dr. Rachlis’ work, we are in agreement on one thing: the practice of family medicine in Ontario is in great disarray, and both doctors and patients are suffering as a result. The section on general and family practice within the Ontario Medical Association, of which I am chair, has 15,000 members. I speak with many of them in my role, and I can tell you with absolute certainty that the profession is in crisis. Family doctors, the backbone of the health-care system that Ontarians rely on, are exhausted, frustrated and in some cases, giving up.

The money that family doctors make is at the very bottom of the range of all physicians’ pay, according to the Canadian Institute for Health Information. We all knew this when we got into this work — if family doctors were motivated by money, we would have chosen different career routes in the medical field. But when we are responsible for all the overhead costs of operating a clinic, which are rising every year, and our fees don’t increase to keep up, the difference has to be made up somewhere and it comes out of the doctor’s pocket. When we are paid on what’s called a capitation basis, where we receive a set fee to provide primary care to a defined patient group, our fees are clawed back any time one of those patients visits a walk-in clinic, which is now very prevalent in Ontario.

These two issues and others mean that it is getting harder and harder to operate a financially sustainable family medicine practice. We’re not trying to get rich doing this, but we do need to make a living, just like everyone else.

Family doctors struggle with overwork. The cost pressures on our practices mean that we need to see more and more patients to make the math add up. This causes burnout in doctors and can have negative impacts on our patients who struggle to get into our clinics in a timely manner. I cannot tell you how many of my colleagues in family medicine are truly at their wits end. They want to provide the high-quality, innovative general patient care they trained for and love, but the stresses of the job, personal, professional, and financial, have them at their breaking point.

As a result, we are seeing new doctors choose other things to specialize in, and many older family doctors retiring earlier than they otherwise would have. And when this happens, Ontarians suffer.

The causes of the crisis in family medicine are complex and multi-faceted. There’s no single magic bullet solution that can restore our system to balance. However, it is important for Ontario to take a clear-eyed look at the situation and acknowledge where we’re at. Family doctors are barely hanging on, and policymakers need to understand the urgency of the issue, or the situation will deteriorate further due to attrition. While most of Dr. Rachlis’s critiques of our work are poorly informed and unhelpful, his closing sentence is absolutely right: we need to change the way physicians do their work.

I couldn’t agree more. In fact, family doctors long for change, and we invite this conversation wholeheartedly. We really have no other choice.

Dr. David Barber is chair of the section of General and Family Practice of the Ontario Medical Association and an assistant Professor at Queen’s University.

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