According to Statistics Canada data from 2019, more than 1.3 million Ontarians do not have access to a family doctor.
“Primary care and family medicine really are the foundation of the health-care system,” says Sarah Newbery, a rural generalist family physician who has practised in the northwestern town of Marathon for more than 20 years. “When people have a family physician who knows them well — understands their history and understands their context — people actually receive better care, there are better health outcomes, and the cost to the system is less.”
The issue
Family doctors help keep their patients healthy, prevent disease by identifying potential risk factors, manage chronic illness, and connect patients to specialists and other health-care services as needed, according to the Ontario Medical Association, which represents the province’s doctors.
But family doctors are unevenly distributed throughout the province. A 2017 report from the Institute for Clinical Evaluative Sciences found that family physicians are concentrated in densely populated urban areas, such as the GTA. According to ICES, other urban areas, including Thunder Bay, Sault Ste. Marie, and Hamilton, had less access to family doctors, while the Muskoka region, considered rural, had higher access.
Sarah Newbery is a family doctor in Marathon. (Courtesy of NOSM University)
Doctor shortages are especially acute in northern and rural communities — places where people tend to be older and sicker, Newbery says. According to estimates from the Northern Ontario School of Medicine, at least 325 doctors are needed to address the shortage in northern Ontario, including 135 family doctors and 166 specialists such as psychiatrists and pediatricians. (The OMA estimates that 100 family doctors and 130 specialists are needed in northern Ontario.)
Researchers for a 2021 report published in the Canadian Journal of Rural Medicine interviewed 19 family doctors who’d left rural communities and found “a range of factors influencing physician’s decisions to leave,” including limited career prospects for their partners, burnout, and a lack of opportunities and amenities in these communities.
Ontario’s doctor shortage — and government policy aimed at resolving the issue — can be traced back decades, but the pandemic has compounded the problem. Nearly three-quarters of doctors surveyed by the OMA said they experienced some level of burnout in 2021, and 40 per cent say they’re considering early retirement because of the pandemic.
What the experts say
When Newbery (who is originally from a small town in northern British Columbia) first moved to Marathon in the 1990s, there were more births than deaths, but today that trend has reversed, she says: “People are living longer with an increasingly complex burden of illness.” As a result, it has become more complicated for doctors to provide care and perform administrative duties.
Stephen Viherjoki’s schedule reflects the many roles a family doctor plays in a smaller community. In addition to practising as a family doctor at Dingwall Medical Group, Viherjoki is the interim chief of emergency services at Dryden Regional Health Centre, where he spends about half his time in the emergency department. “Then I do one week in five working as a hospitalist, where we’re keeping care of in-patients in our always-full hospital,” says Viherjoki.
Besides wanting to see the vacancies in northern Ontario filled, both Viherjoki and Newbery are concerned about replacing doctors who leave or retire. “We struggle to replace ourselves when it’s time for people to move on,” says Newbery.
Newbery wants the next government to focus on appropriate supports and resources that recognize the complexity of care family doctors provide. “Those supports don’t need to be complicated,” she says. “It’s a bit of additional team-based resourcing, mentorship resources, to support new grads to enter into practice.”
When people have a family physician who knows them well...people actually receive better care, there are better health outcomes, and the cost to the system is less.
Ontario’s family-health-team model — a sort-of one-stop shop for primary health-care services — is an example of team-based resources, “but the challenge is that, historically, only about 30 per cent of family physicians in Ontario have been able to access those team-based resources,” says Newbery. She hopes a new physician’s-services agreement recently reached between the Ontario Medical Association and the province will help more family doctors access these team-based resources: “That’s going to be really helpful.”
Newbery and Viherjoki also highlight the expansion of medical-school and residency spots at Ontario’s six medical schools over the next five years. “I think if many of those positions are targeted to create family physicians … that will be helpful,” says Newbery, who would like to see more medical students exposed to practice in rural and northern communities “in ways that make them feel attracted to that future career.”
Viherjoki, like many physicians he knows in Dryden, grew up in northwestern Ontario. “Homegrown people definitely have a higher likelihood of staying after medical school,” says Viherjoki, who is also a district chair with the OMA. “We need more medical students in residency positions and support so those students from rural, remote, and racialized communities go to med school and then stay in their own communities.”
“We need to help doctors that are trained in other jurisdictions to become qualified here and get settled here,” he adds.
To facilitate these initiatives, Viherjoki and Newbery want solutions that ease the administrative burden for doctors so they can spend less time doing paperwork and more itme providing care. “We need less red tape and paperwork so that the doctors we do have can be better utilized and spend more time with their patients,” says Viherjoki.
Agenda segment, October 14, 2021: Public health care, personal care
What the parties say
TVO.org asked the four major parties to answer written questions about how, if elected, they would ensure all Ontarians have access to a family doctor, what they would do to attract medical students and retain family doctors in northern and rural communities, how they would support doctors experiencing burnout, and what they would do to help doctors from other jurisdictions qualify to practice in Ontario. Here’s how their spokespeople responded:
Progressive Conservative Party of Ontario
“Doug Ford and the Ontario PCs have made record investments in hospital capacity, long-term-care beds, and in the workers on the frontlines.
“We are saying yes to the new [Toronto Metropolitan University] medical school in Brampton, and getting it done by championing the largest expansion of undergraduate and postgraduate medical school education positions in over 10 years. After years of neglect from the Liberals, we have also expanded medical education spaces at the Northern Ontario School of Medicine to build a better, more resilient health care system for Northern, Indigenous, Francophone, rural and remote communities.
“Doug Ford and our Ontario PC team are also making it easier and quicker for foreign-credentialed health workers to begin practicing in Ontario by reducing barriers to registering with and being recognized by health regulatory colleges.
“We are also investing $142 million to support nurses’ tuition reimbursements in exchange for service in underserved communities across Ontario, as well as $194 million in emergency funding that includes support for front line health care workers experiencing burnout and stress.”
Ontario New Democratic Party
“Ontario’s northern, rural, and remote communities face barriers to accessing timely health care due to shortages of health care workers, including primary health care, mental health and addiction treatments. New Democrats will take immediate action to begin hiring 300 doctors in Northern Ontario including 100 specialists and 40 mental health practitioners.
“We will develop an incentive package to recruit doctors, and their families, to live and work in Northern Ontario, expand the number of seats and training opportunities at the Northern Ontario School of Medicine and introduce a scholarship program for students from rural and remote communities in Northern Ontario who want to practice medicine.
“The Ontario NDP will provide more funding for nurse practitioner-led clinics, which play an important role in the delivery of primary care. New Democrats will also expand Community Health Centres. We will immediately begin work on a long overdue expansion of Ontario’s Community Health Centres, adding 20 new or satellite centres in communities where they are needed most. We will work with existing Centre leadership and health experts to identify communities with the highest needs. The priorities will include new centres to meet the unique needs of Indigenous, Francophone and underserviced Northern communities.
“We will work collaboratively work with Northern communities to enhance incentives and supports for more physicians and health care workers to practice in Northern Ontario and other communities that are chronically underserviced. We will also work with the College of Physicians and Surgeons of Ontario to expedite the process for international medical graduates to obtain their license to work in Northern Ontario.
“An NDP government will also train more doctors and health professionals to work in the North by expanding the number of seats and training opportunities at NOSM University, funding travelling doctors to bring a resident with them when they go to a Northern Ontario community to practice, increasing student aid and introducing a special scholarship program for students from Northern Ontario who want to become health care practitioners.
“We will fund travel accommodations for medical residents to take elective rotations in rural and Northern communities, so that residents no longer have to pay out of pocket to work in rural and Northern communities.”
Agenda segment, May 5, 2022: Which party will get health care right?
Ontario Liberal Party
“There is a critical shortage of health care workers in Ontario. To create the staffing we’ll need as we expand our health care capacity and replace retiring workers, Ontario Liberals will train and hire 100,000 new health care professionals to meet demand over the next six years — prioritizing full-time roles across the health system, including a target of 70% jobs in long-term care homes being full-time.
“We’ll help reach this goal by getting more internationally-trained nurses, physicians and other health professionals working in Ontario and replacing unnecessary requirements for Canadian experience – focusing instead on competency-based assessments and bridge training. We’ll also increase admission in nursing programs by a minimum of 10% each year – which will add 2,000 additional nurses – and create over 450 new medical school and residency spaces across the province, using new learning avenues to do so including in Brampton and Scarborough. We’ll also cover tuition costs for any medical and nursing students in Ontario who commit to working long-term in a rural or remote community.
“A major driver of our plan to hire 100,000 new nurses, doctors and other health care workers is our commitment to ensuring access to primary care within 24 hours of when you need it – no matter where you live in Ontario. When you need help, you shouldn’t have to wait days, weeks or even months to get it.
“Our plan will increase the number of family doctors and nurse practitioners across Ontario and we’ll fund more team-based primary care clinics, including Family Health Teams and Nurse Practitioner-Led Clinics. We’ll also create 15 new community health centres across the province, which help tackle social, economic and environmental challenges impacting people’s health in underserved communities.”
Green Party of Ontario
“Ontario Greens are committed to making healthcare more accessible, in particular in traditionally underserved communities. We will: expand access to family health teams in communities across the province and increase opportunities for physicians to join team-based models of care; include a diverse array of healthcare providers in the teams to ensure a holistic, connected, comprehensive approach to health; increase options for primary care, such as community health centres, and support expanded virtual care options for primary care providers through adequate funding by the province to decrease long travel time for patients and increase service availability in remote locations.”
To attract and retain family doctors in northern and rural communities and encourage medical students to practice in underserved communities, a spokesperson for the Green Party of Ontario says the party will: “double the Northern and Rural Recruitment and Retention Initiative and the Northern Physicians retention initiative to recruit 230 doctors and specialists to Northern communities; we will rebalance the healthcare funding formula to ensure better access in rural and remote areas; increase core funding for community-based, grassroots mental and physical health supports in communities that have traditionally been underserved, and provide cultural responsiveness training for all healthcare professionals across our system that is trauma-informed and rooted in equity and anti-racism.”
To support doctors experiencing burnout, the Green party “will increase the hospital budget by 5% on top of base funding so doctors are not stretched so thin. We will also make mental health care more affordable and accessible so all doctors can access the mental health care they need.”
“Students from remote, rural and racialized communities often face many barriers to accessing medical learning, including a lack of financial support. Ontario Greens will make medical education more affordable and accessible and immediately reverse the Ford government’s cuts to OSAP by converting loans to grants for low and middle income students and eliminating interest charges on student debt. We will also address the systemic issues in the medical system by providing support for Black and Indigenous healthcare workers through greater mentorship opportunities, partnerships with allies, and equitable human resources processes.”
To help doctors from other jurisdictions become qualified to practice in Ontario, the Green Party spokesperson says, if elected, the party “will fast-track credential approvals for 15,000 international healthcare workers.”
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