Primary care and family medicine are intended to be the foundation of Ontario’s health-care system. It should serve as the first point of contact for patients, offering continuity and comprehensive care. Unfortunately, this vision is far from reality.
A glaring disconnect has existed between the government’s stated commitment to primary care and its inaction to support it. The result is a system strained to its limits and increasingly relying on the dedication family physicians and primary care clinicians have to their patients.
The good news – the highly respected Jane Philpott will serve as chair and lead a new primary care action team with a mandate to connect every person in Ontario to primary health care within the next four years. Philpott’s focus is the expansion of team-based primary health care across the province. The plan will also support more access to existing primary care teams, reducing the significant administrative burden on family doctors and improving connections to specialists and digital tools. Primary care teams may include family physicians, nurse practitioners, nurses, mental health clinicians, pharmacists, dietitians and other disciplines.
The not-so-good news – the crisis is now and deepens with each passing day. Across the province, primary care is grappling with high staff turnover and chronic staffing shortages. Recruitment challenges are exacerbated by a more than five-year wage freeze for inter-professional health-care providers and a decade-long freeze on Family Health Team base budgets.
The promise of new models of primary care is exciting but there is no model or family physician growth plan that will solve the problem without a long-term commitment to adequate funding. In Ontario, we have four options for compensating family physicians: Fee-for-Service, Blended Capitation, Salary and Alternative Payment Plans – each originally designed to ensure family physician compensation was fair, appropriate and tailored to the population served. Ontario also has team options – again designed to best meet the needs of specific populations – Family Health Teams, Nurse Practitioner Led Clinics, Community Health Centres and Aboriginal Health Care Centres.
What all family physician compensation models and primary care teams have in common is more than a decade of government disinterest and neglect. The government much prefers to announce new solutions rather than fix what’s broken. Before the Ontario government funds new models of care, significant funding needs to be invested in those we have. I think it does a great disservice to patients to blame today’s crisis on current models when they’ve been neglected for more than 10 years.
The decimation of primary care teams and the reduced appeal of opening a family practice have together created a perfect storm.
The consequences of this lack of investment are increasingly visible. Established family physicians are retiring, and replacements are difficult to find. Family medicine graduates are increasingly opting out of comprehensive care practices. Fewer nurse practitioners, mental health professionals, pharmacists, dietitians and nurses are joining primary care teams. This undermines the health of communities across the province. At the same time, privatization of primary care services is spreading.
The crisis in family medicine and primary care has resulted in the offloading of costs onto municipalities as they compete against one another for these limited resources. Health care in Ontario is not intended to rest on ability to pay whether that is an individual or a municipality.
Primary care is the cornerstone of a cost-effective, compassionate and sustainable health-care system. It reduces hospital admissions, improves health outcomes and provides continuity of care. However, this vital sector is on the brink of collapse. Without immediate intervention, the very foundation of Ontario’s health-care system will crumble, leaving countless Ontarians without the care they need and deserve.
By aligning compensation for primary care professionals with the value they provide and ensuring fair recognition of their contributions, the health-care system can build a stronger, more equitable foundation moving forward. This would not only improve retention and job satisfaction but also enhance the quality of care provided to communities.
