Millions of Ontarians without family doctors as experts call for 'radical overhaul' of specialty

A doctor checks a patient with a stethoscope. THE CANADIAN PRESS/AP/Thomas Kienzle

New data has revealed more than 2.2 million Ontarians are without a family physician – a trend experts project will only worsen until the specialty of family medicine undergoes a "radical overhaul."

The data, collected by INSPIRE Primary Health Care, found the number of people without a family doctor has ballooned from the previously reported 1.8 million.

In Toronto, 415,000 people – or just over 14 per cent of the population – are lacking continued care from a family physician, hitting the lowest income earners – more than 120,000 people – hard.

“We're currently facing a crisis in family medicine,” Dr. Mekalai Kumanan, president of Ontario College of Family Physicians (OCFP), told CTV News Toronto.

The data indicates income disparities are most pronounced in the west end, north of the city core, and in Scarborough, according to OCFP. Other vulnerable Torontonians impacted include at least 203,000 who live in racialized neighbourhoods, 54,000 who suffer from mental illness, and 30,000 who live with diabetes.

The data forecasts a worsening trend with a projection of more than three million Ontarians expected to be without a family doctor by 2025.

The statistic doesn’t account for the number of new graduates entering the field, but research shows that less medical school students are choosing family medicine as a portion of the workforce nears retirement.

The first residency match of 2023, which took place last month and places medical school students into specialty positions, resulted in 100 unfilled family medicine spots in Ontario. In contrast, British Columbia had only two empty spots.

“We have seen a declining interest or trend of declining interest in family medicine, over the past many, many years,” Kumanan, who has practiced family medicine for 15 years, said.

“I believe that challenges that we face in practice are a contributing factor to that declining interest.”

She pointed to the heavy administrative burden, including up to 19 hours of paper work per week, as one of the factors family physicians have the highest burnout rates among their peers.

“I think some of the challenges that we're facing now have been years in the making and have just become more and more of an issue over time,” Kumanan said.

Now is the time for real change in Ontario. Supporting family doctors in practice will allow them to focus on the high-quality care they provide to their patients. We must expand team-based care and minimize the administrative tasks that family doctors currently face. https://t.co/wBdi93gmmc

— Dr. Mekalai Kumanan (@OCFP_President) April 5, 2023

One of those issues, according to former federal health minister Jane Philpott, is the “hidden curriculum” that teaches medical school students that family medicine is less desirable.

To combat the crisis, Philpott, now the dean of Queen’s University’s faculty of health sciences, said family doctors need to be placed in teams where they work alongside other health-care professionals, like nurses, occupational therapists and physical therapists.

“This is the fundamental fix that we need to recreate functional systems of health care in Canada,” Philpott said in a tweet on March 23 reacting to the release of match-day data.

“But more importantly, it's about the primary care system which needs a radical overhaul.”

268 unfilled residency positions in family medicine in the CaRMS match yesterday. Highest number ever.

We have a serious problem to manage together. Why are med students not choosing a career as a family doc (best specialty ever😀)?

Many reasons - some of it is on us...🧵

— Jane Philpott (@janephilpott) March 24, 2023

Research conducted in 2019 by The College of Family Physicians of Canada shows that patients who have continued access to a family physician show consistently better health outcomes — a sentiment echoed by Kumanan as she underlined the need to tackle the ongoing crisis.

"When a patient is connected to a family doctor and they are likely to live longer, they're less likely to go to the emergency room, they're less likely to be admitted to the hospital."