Do we have a GP shortage in Ontario?

WATCH ABOVE: A new website launched in Alberta allows patients to find family doctors near them who are accepting patients. Dr. Samir Gupta has the story in this week’s On Call.

More On Call with Dr. Samir Gupta stories on Globalnews.ca

TORONTO — Alberta has taken an interesting new step to enable more people to have a family doctor.

A new website launched by Alberta Health Services called “Find a Doctor” allows patients to enter their address or postal code and provides them with the details of the family doctor closest to them who is accepting patients.

In fact, there is a similar program in Ontario called Health Care Connect, but people have to register for it online.

But is access to a general physician still a major problem in Canada? According to the Canadian Community Health Survey in 2010, about 15 per cent of Canadians did not have a regular doctor. However, about half of these people were not looking for a doctor anyways.

The number was also lower in Ontario, at about nine percent (suggesting that about four to five per cent of people in this province actually don’t have access to a GP).

Although recent figures are hard to come by, it does appear as though this number has been slowly dropping. It’s also important to mention that this is not so much about the number of doctors, as it is about the distribution of doctors.

READ MORE: Can’t find a family doctor? Well-off more likely to secure appointments, Canadian research suggests

The number of new doctors practicing in Canada has grown faster than the population for several years now, while the number of medical graduates has increased every year since 2001.

However, the problem is that 18 per cent of Canadians live in rural communities, but just 8.5 per cent of our doctors work there.

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And although rural recruitment has been much better in the last five years, we still have rural areas where patients can’t find doctors and urban areas where doctors are competing for patients.

Ontario in particular has made some remarkable changes to address this issue.

The focus in Ontario has not only been on the number of doctors and the number of people covered, but also on access.

It’s nice to be able to say you that have a GP, but it’s not of much use if you can’t access your doctor when you need them most.

The Commonwealth Fund Survey in 2010 showed that only 45 percent of Canadians could get a same-day or next-day appointment with a doctor, while 33 percent reported waiting six days or more.

This was the worst performance among the 11 high-income countries included.

READ MORE: How Ontario’s new health care changes affect patients

And what do patients do when they can’t access their doctor?

They end up in busy emergency rooms (which is why we also had the longest average ER waiting time), and they end up being seen by someone who doesn’t know their history, whereby we sacrifice continuity (and therefore quality) of care.

Ontario has made two major changes in the last 15 years to try to address this.

The first is to increase team-based care, which means that nurse practitioners and other allied health team members are sharing more and more in care and doctors who are organized in teams can now share call duties and offer after hours and weekend services to their patients.

The other change is a migration from what’s called a “fee-for-service” model, where GPs got paid for each patient visit, to a “capitation model,” where GPs are paid a flat fee for taking care of someone for the year.

There are huge practical advantages for both patients and doctors under this new model.

Instead of having the pressure to churn through a large number of patients each day to cover their overhead costs and to make a good living, doctors now have a security blanket of a certain annual income, and can take more time with each patient and offer holistic care.

In 2000, roughly 95 percent of GPs in Ontario were paid fee-for-service, whereas in 2013, this had decreased to only 28 percent.

In fact, Ontario Ministry of Health cutbacks which are now limiting access to this model of care are a point of contention between doctors and our government in recent negotiations.

Although I often hear from patients who can’t find a GP, I also occasionally hear from patients who tell me that they don’t need a GP.

Here is what I tell them…

TOP 5:  Reasons You Need to Have A Family Doctor

1. Counselling – The so-called annual physical doesn’t seem to have much value, but the idea of visiting a doctor regularly is to get health counselling and access to prevention.
2. Screening – Although many screening tests are falling by the wayside, blood pressure checks, pap smears and colon cancer screening are still recommended, as well as osteoporosis and diabetes screening in high risk groups.
3. Coordination of Care – I often hear from my patients that they don’t need a GP because they have me and their other specialists. But I always remind them that the family doctor is the “quarterback” who keeps track of what all the different specialists are saying, coordinates things and understands the whole picture.
4. Care Transitions – People often tell me that they don’t need a GP because they’re in good health. But when something unexpected happens and someone ends up in hospital, the GP plays a crucial role in following up after discharge, and making sure that people recover smoothly. I can tell you that not having a GP wreaks havoc on the discharge process.
5. Access to Care – Even if you’re well, you never know when something might happen that will require you to see a doctor. And more and more, having a family doctor gives you access to urgent care without needing to wait for hours in a walk-in clinic or emergency room.