It’s not every day you get to see a headline lay out the problems of the future.
In fairness, it’s not exactly rare, anymore, sadly. These days, it does seem to happen with depressing frequency! But we still shouldn’t become totally numb to it. There are plenty of things that are going wrong right now that we have every reason to jump on and fix. But I doubt we will.
The headline in question? This one: “Physicians sound alarm over unfilled Ontario residency spots.” Of the 560 family medicine positions offered up by the province’s resident-matching service — the system that links newly graduated doctors with the residencies that will complete their training and begin their careers — 108 went unfilled. No qualified human beings signed up to take on those roles. Demand is outstripping supply.
Just over 100 people may not sound like a lot on the scale of a province of 15 million. But that’s deceiving. When I saw the headline this morning, I immediately pinged a family doctor I know well. I asked what the typical practice size is for a family doctor, in terms of patients.
There isn’t exactly a typical one; these things will obviously depend a lot on the individual circumstances of the practitioner, as well as on their location and the needs of the local population. As a ballpark figure, I was told that a new resident operating in a family practice clinic could have a few hundred patients under their care. A hundred times a few hundred is tens of thousands of patients.
The real problem, my doctor friend told me, is what happens next. Residency for family medicine lasts two years in Ontario. After those two years, they become family doctors who can open their own practice or join an existing one. A typical patient enrolment for one of those newly minted family doctors will vary based on a lot of factors, but as a working figure, I was told, assume a thousand patients for a family doctor who is early in their career.
That’s a ballpark figure, I stress again, but it’s a useful one. Take it and do the math. A shortage of 100 doctors doesn’t sound like a big deal until you consider that each of them, just to use that round number, may have been the family doctor for 1,000 patients. We’re not talking small numbers anymore. That’s 100,000 people — 108,000 thousand, to be precise — who will not have family doctors, because these positions went unfilled and never resulted in new family doctors beginning their career in Ontario.
We have been warned. It was just a few weeks ago right here that I published an interview with Dr. Ramsey Hajizi, who mentioned this exact issue. “We have something called CaRMS — the Canadian Residency Matching Service,” he told me. “It matches up medical residents with their specialties. And over the last 10 years, 20 per cent fewer residents are choosing family medicine. Anecdotally — and I don’t have stats to back this up, but it’s what I’m seeing as someone who teaches and supervises residents — there aren’t many choosing to specialize in family medicine.”
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This year’s shortfall is just more proof of what he was warning us about. Qualified professionals are having a look at careers in family medicine in Ontario and taking a pass. These people are not going to end up unemployed. They’re just going to take their skills and experience and find other ways to contribute and support themselves and their families.
And God bless them. That’s fair. It’s not my place to tell any individual what they should do with their talents and training. But the issue, scaled up to the size of the province, is obvious and clear. Unless Ontario finds a way to bridge this gap, we have baked in another 100,000-plus Ontarians who will not have a family doctor. There are already more than 2 million of us in that category, and that’s tracking up — fast. It’s going to double to 4.4 million in just a few years. And this is exactly how that happens: a growing population combined with unfilled residency spots makes it more than an inevitability. It becomes a mathematical certainty.
And as has been repeatedly explained (but must be explained again and again because we seem to not learn the lesson), a family doctor is a patient’s primary access point to the entire health-care system. People who lack family physicians typically try to make do with walk-in clinics or show up at emergency rooms when they become truly sick. This a very expensive way to treat what may prove to be a routine, relatively minor illness, and it often means that more serious issues can be missed until they have progressed into full-blown medical emergencies. That, too, adds costs to the system.
I confess to a feeling of pretty immense frustration on this issue. I have a family doctor, a young one. I hope that I continue to benefit from his services for many years to come! Don’t retire or move, Doctor, please! But we know what the math is. We know what the numbers are and will become. This is a problem that’s already bad and is continuing to get worse before our very eyes. The shortfalls of today are the full-blown crises — with life-and-death implications — of tomorrow. We know this. We know we need to do something about it. We even have a decent sense of what we can and should do.
But we don’t do it. We aren’t doing it. And I don’t know how to explain that.
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