Opinion: Don’t blame family doctors for the current health care crisis

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Liana Hwang is a family physician working in refugee health and midwifery in Calgary and Canmore, Alberta. Adam Pyle practices emergency medicine in Oshawa, Ontario. Both are journalism fellows at the University of Toronto’s Dalla Lana School of Public Health.

The Ontario government has pledged its continued support for hospitals and last month reaffirmed its commitment to increase funding by providing an additional $827 million this year.

For family physicians, there have been only severe reprimands.

We need family doctors to see patients in person, Health Minister Sylvia Jones said, channeling Elon Musk as she insisted that all parts of the system must be 100% working.

Then, in late November, his department sent a memo to provincial family health teams asking them to offer services seven days a week, including evenings, seemingly oblivious to those already offering extended hours.

There is a tendency to blame family physicians based on anecdotes, according to family physician Tara Kiran, whose research team surveyed nearly 1,200 Toronto-area family physicians and found that even in January 2021, before most family physicians were vaccinated, 99.7% of practices were open and 95% were seeing patients in person as needed.

If you’re lucky enough to have a family doctor now, chances are you’ll soon join the five million Canadians who don’t. More than half of family physicians report that they are exhausted but cope, or that they are exhausted and thinking of taking time off work or have taken a break. Last year’s survey by Dr. Kirans found that nearly one in five family physicians in Toronto were considering closing their practice in the next five years.

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As two family physicians with 26 years of combined experience, who both made the difficult decision to close our family practices this year, it is clear to us that family medicine is in a desperate state of attrition. Burnout existed long before the pandemic, but now we are seeing an unprecedented exodus of physicians from community practices. For example, 10 family physicians have closed their practices in Canmore, Alberta in the past 30 months.

We have a lot of family doctors over the past decade the number of family doctors has increased by almost a quarter. But working conditions steadily deteriorated and, like us, many turned to other areas of practice.

What has kept us in family medicine for so long is our relationships with our patients. Yet far too often we were forced to choose between spending time with them or filling out forms and other administrative tasks. Each week of family medicine requires 11 hours of paperwork, more than any other specialty. Research suggests that more than a third of this burden is unnecessary.

We have both suffered the moral distress of caring deeply for our patients and trying to help them navigate a broken system. We have tried to fill the gap in home care, long-term care and mental health support. We have done our best to help suffering patients trapped in the purgatory of Canada’s waiting lists for diagnostic procedures, surgeries and appointments with overworked specialist colleagues.

We’ve heard that family medicine is the foundation of the health care system, but we prefer to think of it as the roots of a giant tree. It is the source of the strength of the tree, which sustains and nourishes it.

Our roots are in shallow soil. No individual effort can compensate for the lack of systemic support for family medicine over the past decades. In Canada, only 4.7% of current health care expenditures are spent on primary care, defined as general ambulatory care. By comparison, Australia spends 11.5%.

Primary care spending pays for itself many times over. Access to a family physician has been shown to decrease hospitalizations, emergency department use, and readmissions. Patients with continuity of care have better health outcomes and report better quality of life.

And we’ve known for a long time that we need a transformation of primary care systems, not just more money. Team models like Alberta’s Primary Care Networks and Ontario’s Family Health Teams need to be supported and expanded. Our aging population needs access to long-term care. A national electronic medical record would improve patient care and reduce administrative burden. Simplified pathways for foreign-trained healthcare professionals and national licensing for physicians would partially alleviate our workforce crisis.

Politicians need to stop overwhelming remaining family doctors with unrealistic demands and start focusing on solutions. It’s time to tend to the roots before the tree falls in the storm.

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