Dr. Tara Kiran (Credit Katie Cooper Unity Health Toronto)
By: Jennifer Stranges, Senior Communications Advisor, Unity Health Toronto
The number of Ontario's family physicians who stopped working doubled during the first six months of the COVID-19 pandemic compared to previous years – accounting for more than 170,000 patients losing access to a primary care provider – according to a new study.
The research, led by Unity Health Toronto and ICES and published in Annals of Family Medicine, showed nearly three per cent of Ontario's practicing family physicians stopped working during the first six months of the pandemic.
The study comes as the healthcare system in Ontario grapples with unprecedented pressures, including staffing shortages and a surge of patients seeking emergency care.
“Nearly 1.8 million Ontarians don't have a regular family physician. Our findings suggest things are only going to get worse, which is really concerning because family medicine is the front door to our health system," said Dr. Tara Kiran, lead author of the study and a family physician at St. Michael's Hospital of Unity Health Toronto.
“The family doctor shortage is difficult for people personally, but also impacts other parts of the system. For example, when people don't have a family doctor, they are more likely to head to the emergency room," said Dr. Kiran, who is also a scientist at the MAP Centre for Urban Health Solutions at St. Michael's Hospital and an adjunct scientist at ICES.
Researchers used data from ICES, a non-profit research institute, to calculate the ratio of total visits between March 11, 2020 and September 29, 2020 to total visits in the same period in 2019. The analysis included each family physician who had at least 50 billing days in 2019 and counted virtual appointments as well.
In a separate analysis of each year from 2010 to 2020, researchers examined the cohort of physicians practicing in the first quarter of the year and noted the number and percent who stopped practice – indicated by having no billings – between April 1 and September 30 of the same year.
Researchers found each year between 2010 and 2019, an average of 1.6 per cent of family physicians who worked in the first quarter of the year stopped work between April and September. In contrast, three per cent stopped work in 2020.
Though 385 family physicians out of 12,000 stopping practice is not a large figure, the researchers note that over half of the physicians who stopped working had patients formally enrolled on their roster, and estimated the physicians cared for more than 170,000 patients.
The family physicians who stopped working were more likely to be aged 75 or older, practice in a fee-for-service model, care for under 500 patients, and work less than other physicians in the previous year, the research showed. The findings suggest that many of the family doctors who stopped work early in the pandemic were approaching retirement and accelerated their plans at the start of the pandemic.
“The shortage of family physicians and other primary care providers is a complex Canada-wide problem related to aging of physicians and patients, increasing patient and system complexity, declining interest in family medicine among medical school graduates, and misdistribution of the workforce, especially affecting rural areas. These pre-existing factors have been exacerbated by the pandemic and call for fundamental changes in how we are organized, paid, supported, and deliver care," said Dr. Rick Glazier, co-author of the study, family physician at St. Michael's Hospital, and a scientist at the MAP Centre for Urban Health Solutions at St. Michael's Hospital and a senior scientist at ICES.
The researchers are calling for a reevaluation of the payment model for family doctors, and taking steps towards a model that creates a more predictable income and provides doctors with flexibility to take more time to manage increasingly complex patients. Second, they suggest expanding team-based primary care to embed health professionals like social workers, pharmacists, and nurses into the practice. Researchers say the addition of these other health professionals can improve the quality of care, improve work satisfaction for physicians, and enable physicians to take care of a larger number of patients. The researchers also recommend developing a system for physician coverage during vacation, parental or personal leaves, and developing formal partnerships between hospitals and small family practices to support infection prevention and equipment procurement.
Research about primary care is also important to improving patient access. Dr. Kiran is leading an important project on the future of primary care. As part of the project, she is conducting a research survey to hear from people across Canada about their experiences and priorities. Study findings will be shared with policy-makers and used to shape a blueprint for the future of primary care in Canada. For more information and to take the survey, visit www.ourcare.ca.