It is undeniably true that we do not have enough family doctors. You’ve all heard the stat. Roughly 2 million Ontarians do not have access to a family doctor. Family doctors are intended to be the primary gatekeepers for the entire health-care system, outside of emergency contexts. Minor illnesses? Age-related problems and necessary lifestyle and living-arrangement changes? Mental-health issues? Your primary-care practitioner, typically a family doctor but sometimes a nurse working with a family health practice, is supposed to be your first point of contact, moving you through to the rest of the system.
When millions of people do not have access to this kind of care, we find ourselves dealing with all kinds of problems. Some people simply go without getting care, which can result in deaths and clearly creates suffering. Others endure a gradual worsening in their condition, which eventually becomes a crisis, at which point they are forced to turn to an already overcrowded hospital emergency room, arriving much sicker than they might have been had they been seen to faster. That, obviously, puts pressure on our hospitals.
So, yes. Absolutely. Sign me up for an aggressive campaign to recruit family doctors. And by all means, put me down as well for listening to the mounting complaints of family doctors, particularly about how they are compensated, so that we can do a better job of keeping existing physicians in the system longer. And I’m already on record supporting the diversion of minor ailments toward pharmacists as a way of relieving that pressure, as well. We’ve got all kinds of problems here, and we should be doing everything in our power to tackle them.
But I’ve been thinking a little bit lately about the other side of this equation. We all know it’s a bad thing when millions of people don’t have access to a family health team. No one really argues the opposite point. It’s a problem, and it’s universally recognized as such. But what about those of us, myself happily included, who do have a family doctor? What is our experience with the system like?
No one should think I’m about to unload about my own personal experience with my family doctor. I like him! I’m lucky to have him, especially because he’s very conveniently located within limping distance of my house, something that matters for a guy who sprains and breaks his ankles as regularly as I do. Sigh. So if you happen to see this, Doc, note that I’m sending you nothing but love and affection and gratitude.
But, overall, I have noticed a deterioration in the system in recent years. And I’ve heard much the same from other people. I think we may be in a bit of a situation where we’ve viewed the issue with family doctors as a binary: if you don’t have one, it’s bad, but if you have one, it’s good.
It’s obviously better to have one than not, but are we beginning to see the impacts of an overburdened system filtering down to affect even those who have a family physician?
This is something I’m going to have to spend a bit of time working on. This column, in a way, represents more of my putting a marker down than it does my having reached any particular conclusion. But it has been interesting to me in recent months to have repeated examples come up, including one I was personally involved in, where even people with access to a family doctor or family health provider of some kind are having one hell of a struggle navigating the rest of the system.
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I’m going to be vague here to protect the privacy of the person involved, but, just as an example, I know of a recent case where someone was able to access the health-care system via their family health-care provider, who agreed that they required further attention. But everything after that got more complicated. Tests could be ordered and sometimes completed in a timely way (sometimes not), but then the results just sort of vanished into the bureaucratic ether. That took a while to sort out. After that, referrals into the rest of the system sometimes worked, but sometimes didn’t. And some of these failures were pretty basic. Files weren’t being transferred. Phone calls were going unreturned. Someone taking a day off could disrupt a process that had been unfolding over weeks, and it would then take weeks to get back on track.
That’s just one example. We all have our stories of these day-to-day health-care-system frustrations. In general, my experience with the system has been pretty good. But if the overall health-care system is wobbling, even those fortunate people with a doctor may find the utility of that family doctor diminishing as the doctors try to hand off patients with further care needs to a system that is simply breaking down. And this isn’t a secret: the Ontario Medical Association published a report last year that warned that the family health system is moving toward a disaster. I can’t imagine it’s gotten better since.
Indeed, I have reason to suspect it hasn’t. I spend a lot of time speaking with medical professionals. For professional reasons, not personal ones, thank God — I’m still relatively healthy, except for those damned ankles. But the level of frustration and concern I’m hearing is mounting rapidly. Even compared to where we were during the pandemic, in the midst of the emergency.
Some of that frustration is probably a kind of emotional catharsis. Or simply people reaching their breaking point. Our doctors have been working flat out for years, as have all their affiliated health-care professionals, and I can only imagine the emotional strain that not seeing things get better puts on them.
But I did have a very interesting conversation recently during which a medical professional I trust and consider a voice of moderation and reason privately told me that I should be considering arranging some kind of global health-insurance plan for myself and my family. This person is no longer convinced we can avoid a functional collapse in our health-care system, meaning that anyone who can afford it may end up seeking treatment abroad because they won’t be able to access it at home.
It’s a big problem, and it’s a hard one to take on, because there are about a thousand different ways into it. But over the next few weeks, my readers should expect to hear more about family doctors. Even for the people who have them, are they able to do the job we are counting on them to do? What challenges are they running into in the broader system? Why are so many considering leaving medicine or at least leaving Ontario and even Canada?
I don’t have all those answers yet. But I do have concerns. I suspect many of you have them as well. And this is something we should be talking about.
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