Opinion

Take the survey: What are your priorities for primary care?

Do you have a family doctor or nurse practitioner that you can talk to when you need care or advice about your health?

Even before the pandemic, 15 per cent of people living in Canada said the answer was no. And unfortunately, all indications are that things have gotten worse.

New research from our team published this week shows that the proportion of family doctors who stopped work nearly doubled in the first six months of the pandemic compared to the previous decade. Other research we’ve done found that in 2021, almost 20 per cent of family doctors in the Toronto-area are thinking of closing their practice within the next five years.

Now, two and a half years into the pandemic, there are many anecdotal reports of doctors leaving practice. The reasons are varied and relate to burnout, administrative overload and general “moral distress” at not being supported to deliver the kind of care they want to.

At the same time, fewer medical students are choosing family medicine and even those that do are less likely to work in a practice where they commit to providing comprehensive care for a panel of patients that they see for the long term.

These problems don’t affect everyone in the same way. We found that the proportion of family doctors who stopped work was much higher in some communities, including rural communities in Northern Ontario and near Georgian Bay. Our research has shown that new immigrants and people living in low-income neighbourhoods are less likely to be meaningfully connected to a family doctor. So are people with Opioid Use Disorder and those recently incarcerated – two groups of people who have higher health needs.

Family doctors, nurse practitioners and primary care teams are the front door to our health-care system. Without good primary care, people are left without someone to help them when they are ill – or someone to keep them from getting ill in the first place.

Sound depressing? It is.

But better is possible.

There are health systems around the world that have figured out how to ensure that all their residents have access to high-quality primary care. We can, too.

We need to make improving primary care a priority. Then we need to redesign our system to make it work.

We need to make improving primary care a priority. Then we need to redesign our system to make it work. That’s hard and will no doubt require trade-offs. Let’s work through an example.

When you move to a new neighbourhood in Canada, your children can automatically enroll in the local school. You don’t need to work your connections or get on a wait list to get them in. But, if you move neighbourhoods again, you need to find a new school. In some countries, primary care works similarly. Neighbourhood residents can automatically sign up with a handful of practices near them. The practices have a duty to take them on and hire doctors and staff accordingly.

But there are trade-offs. When you leave the neighbourhood, you are asked to sign up with a practice in your new neighbourhood. In this system, there can be less of a relationship between the patient and individual practitioner. Instead, patients may see any of the family doctors or nurse practitioners in the practice, all of whom have access to the patient’s health record.

What trade-offs are acceptable to you?

Do you currently have a family doctor or nurse practitioner that you can talk to when you need care or advice about your health? How important is it that every person living in Canada has a relationship with a family doctor, nurse practitioner or team of health-care professionals they can see regularly if they need to?

These are questions we ask in the OurCare/NosSoins National Research Survey.

The survey is the first phase of OurCare/NosSoins, a year-long initiative we’ve launched to hear from people all across Canada about their needs, preferences and priorities for primary care.

Join the conversation and help shape what better looks like when it comes to primary care.

OurCare.ca wants to hear from you! Take the research survey, part of the OurCare project based at MAP Centre for Urban Health Solutions, Unity Health Toronto. Participation is completely voluntary and anonymous. The survey is open until Oct. 18.

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2 Comments
  • Lori Davidson says:

    I am a 52 yr.old without a Dr. In 2020 I had to have Emergency Triple Bypass Surgery without any support. It was extremely scary because I had no idea what was going on or what to expect. Since then I have been having more health issues than I ever have before and no one to help me. I had to leave my job and have no income now for two years and I struggle with depression everyday. I have definitely fell through the cracks. I need help.

  • Dr. John Calvert (PhD) says:

    Why no discussion about Community Health Centres? Why is all the discussion on providing access to physicians and ignoring the social determinants of health. The framing of this is very biomedical and very narrow. The problem is lack of access to comprehensive primary health care. Physicians play a role in this but many other health professionals and health providers also contribute. In addition, many of the health issues people face are attributable to other factors that are beyond what individual physicians can deal with but which are within the scope of a properly funded Community Health Centre with its focus on improving population health and not just treating people who are already ill.

Authors

Tara Kiran

Contributor

Tara Kiran is a family physician, St. Michael’s Hospital Academic Family Health Team, and Fidani Chair in Improvement and Innovation, University of Toronto.

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