Beyond funding: Why money alone won’t save primary care

The recent analysis of Ontario’s primary care crisis featured in Healthy Debate (March 24) correctly identifies chronic underfunding as a central problem. His argument that “there is no model or family physician growth plan that will solve the problem without a long-term commitment to adequate funding” resonates with anyone who has worked in family medicine over the past decade.

However, as a physician who has witnessed this crisis unfold over 40 years of practice, I believe we need to examine why increased funding alone may not be sufficient to address the depth of our current crisis.

While the article accurately describes the devastating impact of wage freezes and budget cuts, the relationship between funding and primary care sustainability is more complex. Consider this: even well-funded primary care models are experiencing physician shortages and burnout at alarming rates.

Recent data from a Medscape physician wellness survey reveals that 40 per cent of physicians under 45 report burnout compared to 23 per cent of older physicians. This generational shift in burnout rates suggests that younger physicians are encountering systemic problems that adequate compensation alone cannot resolve. When 61 per cent of younger physicians say they would take a salary reduction for better work-life balance, they’re signalling that money isn’t their primary concern – sustainable practice conditions are.

The March 24 article’s point about the “more than a decade of government disinterest and neglect” is crucial, but the neglect extends beyond funding to fundamental system design. Throwing money at broken workflows, inefficient administrative processes and unsustainable practice models may temporarily mask problems without solving them.

Consider the administrative burden crisis. Research shows that family physicians spend approximately 19 hours per week on administrative tasks – nearly half their working time on activities that add no clinical value. Increasing physician compensation without addressing this inefficiency is like paying someone more to do a job that’s inherently broken. The result is expensive inefficiency rather than improved patient care.

Or take a look at rural communities, where recruitment and retention remain challenging even when physicians receive premium compensation. The issue isn’t just money – it’s isolation, lack of support systems, overwhelming call schedules and administrative burdens that make rural practice unsustainable regardless of compensation levels.

When a rural community loses its family physician, the economic impact often exceeds what would be required to implement comprehensive system improvements. Yet, we continue to treat physician recruitment as a compensation problem rather than a system design problem.

The article correctly advocates for team-based care models, noting that teams “may include family physicians, nurse practitioners, nurses, mental health clinicians, pharmacists, dietitians and other disciplines.” However, successful team-based care requires more than funding – it requires fundamental changes to workflow design, communication systems and care coordination processes.

Many well-funded team-based initiatives have struggled because they added team members without redesigning the underlying practice model. The result is often increased overhead costs without proportional improvements in efficiency or patient outcomes. Effective team-based care requires sophisticated coordination systems, clear role definitions and technology infrastructure that many current funding models don’t address.

While “improving connections to specialists and digital tools” is part of the solution, this highlights another area where funding alone proves insufficient. Many primary care practices have received technology funding only to implement systems that actually increase administrative burden rather than reducing it. Electronic health records that require more documentation time than paper charts, communication systems that generate more interruptions than they prevent, and scheduling systems that complicate rather than streamline operations all represent well-funded failures.

The problem isn’t lack of technology investment – it’s lack of thoughtful technology implementation that prioritizes workflow efficiency.

The challenge of accessing specialist care illustrates why system design matters as much as funding. Even when specialist consultations are well-funded, patients often wait months or years for appointments. This creates a cascade of problems: family physicians spend increasing amounts of time managing complex cases without specialist input, patients’ conditions worsen during delays all while family physicians experience frustration and burnout from being unable to provide optimal care.

Traditional approaches to this problem focus on funding more specialist positions, but innovative approaches might include virtual specialist consultations, case review systems and technology-enabled specialist guidance that could dramatically improve access without requiring proportional increases in specialist numbers.

A particularly troubling trend is municipalities competing against each other for limited health-care resources. This phenomenon reveals how funding shortages create perverse incentives that undermine system efficiency.

When municipalities bid against each other for family physicians, they drive up costs without increasing the total supply of physicians. This approach may solve individual community problems but exacerbates system-wide shortages. A more sustainable approach would involve regional coordination and system-wide planning that optimizes physician distribution rather than encouraging wasteful competition.

While increased government funding is undoubtedly necessary, sustainable primary care may require innovative approaches that complement traditional government investment. This might include:

Outcome-based funding: Compensation models that reward improved patient outcomes and system efficiency rather than simply volume of services provided.

Technology-enabled efficiency: Investment in systems that demonstrably reduce administrative burden and improve workflow efficiency, with funding tied to measurable improvements in physician productivity and satisfaction.

Community partnership models: Approaches that engage local communities in supporting primary care sustainability through partnerships that don’t compromise universal access principles.

Regional coordination systems: Funding models that incentivize regional cooperation rather than municipal competition for healthcare resources.

While it is true that “established family physicians are retiring, and replacements are difficult to find,” the statistics reveal an even more concerning trend. Family physicians are retiring earlier, often citing burnout and system frustration rather than financial concerns.

When experienced physicians with established practices choose early retirement despite financial incentives to continue working, this suggests money alone cannot address the fundamental sustainability challenges they face. Several practical approaches could amplify the impact of an increase in funding:

Administrative burden reduction: Implement automated billing systems, eliminate duplicate documentation requirements and create shared administrative services across multiple practices. Goal: reduce administrative time from 19 hours to less than five hours per week.

Virtual specialist integration: Develop systems in which family physicians can access specialist consultation within days rather than months through virtual case reviews and remote guidance systems.

Regional coordination models: Create regional health-care planning bodies that coordinate physician recruitment and resource allocation, eliminating wasteful municipal competition while ensuring equitable distribution.

Technology-enabled team care: Invest in communication platforms that allow seamless coordination between team members – nurses, pharmacists, mental health professionals – without increasing administrative burden on physicians.

Outcome-based pilot programs: Test innovative funding models that reward practices for improved patient outcomes and administrative efficiency, providing data to guide broader system reform.

The appointment of Jane Philpott to lead Ontario’s primary care action team represents an important opportunity. Success will require combining adequate funding with equally urgent system reforms that address workflow efficiency, administrative burden and care coordination.

The crisis in primary care is real and urgent. With 6.5 million Canadians currently without a family doctor, we cannot afford partial solutions. The goal should be building a primary care system that is more sustainable, efficient and effective than what existed before the crisis began.

This means increased funding that supports not just current models, but transformation toward more sustainable practice conditions that can retain the next generation of family physicians while serving patients better.