Can the family doctor shortage in Canada be fixed?

Whether you have a family doctor or you’re looking for one, chances are you've faced long wait times.

Last year, the Angus Reid Institute reported there were six million Canadians without a family doctor, and a third said they had been searching for more than a year.

And even for those who have found a doctor, the wait to get an appointment often ranges from days to weeks.

Danielle Martin, a family physician and chair of the department of family and community medicine at the University of Toronto, discussed the systemic issues behind the family doctor shortage in Canada on CTV’s Your Morning Friday.

“Family medicine is an incredible career based on relationships over time with our patients and really, really rewarding,” said Martin; however, there are not enough family doctors in the country.

The lack of access to family doctors is not only causing issues for patients, but also for the Canadian health-care system as a whole.

In response to lack of family doctor access, people are relying on walk-in clinics to see a professional, which increases the burden on the health-care sector, as walk-ins are not meant for in-depth or long-term care.

This creates a “self-fulfilling” systemic issue, said Martin, of one of the problems that both led to and sustains the lack of access.

“The more people seek their care in walk-in clinics, the more walk-in clinics there are, the more that attracts family doctors and other professionals to work in a walk-in clinic setting, the fewer family doctors are available to take on patients for the long-term,” said Martin.

Although walk-in clinics are a “completely understandable choice” for people who don’t have access to a family doctor, “what we want in family medicine is a relationship over time,” she said, adding family doctors are able to recognize early signs of changes in diseases and work on health goals with patients they’ve known over time.

“You can’t do that in a walk-in clinic.”

WHAT SYSTEMIC ISSUES ARE CAUSING THE SHORTAGE?

Martin said the doctor shortage starts in schools, where medical students are not choosing to open their own family practices. Instead, many would rather have a medical focus, like sports health or physiology.

“For many of our younger generation, (family medicine) is not an attractive career option,” she said.

A study by the Canadian Medical Association showed the percentage of medical graduate students choosing family medicine fell from 38.5 per cent to 31.8 per cent between 2015 and 2021.

“We really need to think about how to support our students to select this amazing career so we can serve the population of the country,” said Martin.

Martin said another systemic issue causing the shortage and deterring students from this type of medicine is lack of resources for family doctors who have their own practice. In hospitals or major health-care centres, family doctors have access to better technology and more staff - nurses, assistants, office administrators and others– who can help with patients.

“But in the community, most family doctors are really entrepreneurs,” she said. “They have to rent their own office space, hire their own secretary, choose their own electronic record, buy their computers, et cetera.”

The last issue Martin mentioned is how there are not enough family doctors in rural communities in Canada.

In some areas, there may be a single family doctor for an entire town. One doctor in Wheatley, Ont., the Angus Reid report stated, was responsible for 1,400 patients.

This forces people to travel outside of their local regions and into major cities to receive care, leading to longer wait times at clinics, and longer waitlists for family doctors.

WHAT CAN BE DONE TO FIX IT?

Martin said the key to address the lack of interest in family medicine is to change the current individual structure and add some funding to make it more appealing to students.

She recommended government funding be used to build interprofessional teams, so that family doctors can work with other physicians and related experts. This way, a family doctor can go on vacation or take a break, knowing their patients will be taken care of by another professional.

This will also help patients access other professionals working within the health-care sector, such as nurses and pharmacists, in a more efficient way.

“Team-based models will allow doctors to do the work of being doctors and function in a more supportive environment,” she said. “If we invest in that, then we will make it into a more attractive career.”

Martin said this investment will help ensure proper care for people in the community and reduce spending long-term as it will reduce measures patients have to take due to gaps in access, such as emergency visits to the hospital.