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

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

The Ontario government has proclaimed its steadfast support of hospitals, and last month it reaffirmed its commitment to boost their funding by providing an additional $827-million this year.

For family physicians, there have been only stern reprimands.

“We need family physicians to be seeing patients in person,” said Health Minister Sylvia Jones, channelling Elon Musk as she insisted that all parts of the system need to “operate at 100 per cent.”

Then, in late November, her ministry sent the province’s Family Health Teams a memo requesting them to offer services seven days a week, including evenings, seemingly oblivious to the many that already offer extended hours.

There is a pattern of “blaming family physicians based on anecdotes,” according to Tara Kiran, a family physician, whose research team surveyed almost 1,200 Toronto area family physicians and found that even in January, 2021, before most family physicians were vaccinated, 99.7 per cent of practices were open and 95 per cent were seeing patients in person when needed.

If you are fortunate enough to have a family physician now, there is a very real chance that you will soon be joining the five million Canadians who do not. More than half of family physicians report that they are either “exhausted but coping,” or “burned out and thinking of, or have taken, a break from work.” Dr. Kiran’s survey last year revealed almost one in five Toronto family physicians was thinking of closing their practice in the next five years.

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

We have plenty of family physicians – over the past decade, the number of family physicians has increased by almost a quarter. But working conditions have steadily deteriorated, and like us, many have moved into other areas of practice.

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

Both of us suffered from the moral distress of caring deeply for our patients and trying to help them navigate a broken system. We tried to make up for the lack of home care, long-term care and mental-health supports. We did our best to help suffering patients trapped in Canada’s waiting-list purgatory for diagnostic procedures, surgeries and appointments with overloaded specialist colleagues.

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

Our roots lie in shallow ground. No amount of individual effort can make up for the lack of systemic support for family medicine over the past decades. In Canada, just 4.7 per cent of current health care expenditure goes toward primary care, defined as general outpatient care. By comparison, Australia spends 11.5 per cent.

Spending on primary care pays for itself many times over. Access to a family physician has been shown to decrease hospitalizations, emergency department use and re-admissions. Patients with continuity of care have better health outcomes, and report better quality of life.

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

Politicians need to stop crushing the remaining family physicians with unrealistic demands, and start focusing on solutions. It’s time to tend to the roots before the tree topples in the storm.