Ontario is facing a family-doctor crisis. That won’t come as news to the 2.3 million residents of the province who don’t have and likely can’t find one. If that seems bad, the future is likely going to be worse. The Ontario Medical Association predicts that, by 2026, that number will rise to 4.4 million — a full quarter of the population of Canada’s largest province. That, indeed, may be something worse than a crisis.
At a time when family physicians are nearing retirement and younger doctors are burning out or choosing not to enter family medicine, something has to give. And fast.
Unfortunately, as things stand, nothing good is set to give. Who would want to launch or join a family practice right now? Being overworked, underpaid, and underappreciated in a stressful job isn’t exactly going to inspire people to rush into the gig. And the province isn’t stepping up to address the problem.
In January, ahead of the Ford government’s upcoming budget, the OMA released a “Solutions” report outlining what could be done to improve Ontario’s dilapidated health-care system. It recommended a handful of measures designed to raise family-care coverage, including developing a northern and rural strategy, reducing the administrative burdens family physicians face, and expanding team-based care.
The paperwork doctors face is absurdly burdensome, particularly in an age when that sort of thing is meant to be streamlined and under a government obsessed with cutting red tape. The Ontario College of Family Physicians estimates that family physicians spend 19 hours a week on paperwork — time that would be better spent caring for patients. Reducing the paperwork burden would be good for doctors and patients alike; the former would rather not spend their days doing paperwork, and the latter would prefer doctors spent more time with them and less time filling in forms.
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And, yet, while these are important recommendations, there’s one weird trick that might go even further to solve the province’s growing crisis: paying family physicians more. Earlier this week, Mike Crawley reported for the CBC that low pay and rising inflation are driving doctors out of family practice. The story is familiar, since it mirrors what millions of people are facing across the country as work gets harder and life gets more expensive, but pay doesn’t keep up.
As Crawley notes, the OMA says that while inflation has risen 25 per cent in the past decade, OHIP billing for family doctors has failed to keep pace, rising just 6.1 per cent. Meanwhile, those doctors make less than $40 for seeing a patient: that’s right, $40 under the province’s fee-for-service model.
The essentially stagnant rate of billing and low fee-for-service rates make running a clinic and practising as a family physician extremely difficult to manage, which leaves patients — and the health-care system — paying the cost with long searches to find a doctor, long waits in shabby walk-in clinics, more trips to the emergency room, medical issues left untreated, and worse health outcomes in the long run.
Conservatives often defend the free market — for instance, absurdly high CEO pay — by arguing that you get what you pay for, that the market demands higher salaries for such highly skilled folks. What if we applied their logic to health-care workers? To family physicians? If you pay, they will come, right? So why not pay them?
Agenda segment, September 14, 2022: Is there a doctor in the province?
Both the Liberals and the Progressive Conservatives are to blame for the health-care crisis. The draconian, slash-and-burn years of Mike Harris’s PC government in the 1990s set the province up for disaster. The Liberals, who governed from 2003 until Doug Ford’s win in 2018, share plenty of the blame. They didn’t fix the problem. But Ford, who has now been in power for coming on six years, hasn’t made much progress on the matter either, pandemic notwithstanding.
There is no one simple way to solve Ontario’s health-care crisis. Would that there were. However, any plan to address solving the many problems the system faces must include reforms to family practice, which means listening to the OMA and expanding team-based care, paying special attention to northern and rural areas, relieving administrative burdens, and, above all, paying family physicians better.
Family doctors improve and save lives. As the first line of defence in the health-care system, they are a non-negotiable part of our well-being. And yet the province is treating them as a pesky budget-line matter. That approach leaves everyone worse off and will lead to even greater long-term crisis. It’s time to pony up the cash for better care.
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