For many Ontarians, securing regular access to a family physician or primary care provider is a struggle. The inability to make an appointment with a family doctor also has big consequences for the province’s health-care system as a whole – particularly in emergency rooms where patients who should be seen by a family doctor end up taking space and using resources meant for those who are critically ill or sick.
As Ontarians gear up for next month’s provincial election, Global News is taking a hard look at this and other key issues voters are considering before casting their ballots on June 7.
According to Statistics Canada, 92.5 per cent of Ontarians had access to a primary care provider in 2014. This includes access to a family doctor, general practitioner, or even a nurse practitioner in some smaller communities. But Statistics Canada’s most recent survey from 2016 shows this figure had declined to 90.3 per cent.
With the province’s total population close to 14 million people, this means roughly 1.3 million Ontarians reported not having regular access to primary care in 2016.
Where you live in the province also has a big impact on your ability to access primary care.
According to Statistics Canada, just 83.4 per cent of residents in the Greater Sudbury area had regular access to primary care in 2016. In Toronto, this figure was 89.2 per cent, while in Hamilton the number was 94.5 per cent.
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Rural and northern residents also struggle when it comes to finding comprehensive primary care, especially within close distance to their homes or at the time they need it.
A 2017 study from the Institute for Clinical Evaluative Sciences (ICES) found the supply of primary care experts in Ontario was unevenly distributed, with most family physicians concentrated in the GTA and other large urban centres. Residents living in rural communities – even suburbs of some larger cities – have limited access to family medicine, the report says.
“Access to primary care is an important factor affecting overall population health,” said Rick Glazier, a family doctor and senior scientist at ICES, at the time the report was released.
The report considered the distances people needed to travel to access primary medicine. While every community in the province was served by some kind of primary care, the distances northern and rural Ontarians had to travel to access these services were significantly higher.
To fill the gaps in the availability of family medicine, some communities in Ontario have created incentives to attract new family doctors, like offering signing bonuses and covering travel and other expenses if a doctor decides to move to their community.
Cornwall, Ont. – roughly 30 minutes west of the border with Quebec – is an example of this. The city has long struggled to meet the need for family doctors. It set up a “recruitment fund” in the late 1990s offering new family doctors a one-time payment of up to $25,000 to start a local clinic and take shifts at the community hospital.
The city also launched a $150,000 university scholarship encouraging local students to enter family medicine. City officials say this is an easier way to expand primary care services because the students already have a connection to the community and are more likely to stick around after they graduate.
“Ideally, we’d like to succeed in having one new contract per year,” said Mark Boileau, director of economic development for the city of Cornwall.
“The medical field is just like every other field where you have people in the baby boom age – so not only are you having difficulty attracting doctors, but doctors are retiring.”
Since launching the program eight years ago, the city has had one student come home to set up shop and two more are currently in school.
One of the biggest consequences of limited access to family medicine is the burden it places on emergency rooms.
With some hospitals reaching as high as 140 per cent occupancy in recent years – and more than half of the province’s hospitals having exceeded their maximum capacity last summer according to the Ontario Hospital Association – any unnecessary visit to the hospital can lead to longer wait times and patients spilling into the hallways on stretchers – something often called “hallway medicine.”
In a 2016 report, Ontario Auditor General Bonnie Lysyk said roughly 243,000 visits were made to the province’s emergency rooms in the previous year that could have been treated by a family doctor. Lysyk estimated the cost to taxpayers for these visits was $62 million. More than half of this cost – $33 million – was racked-up by patients already enrolled in one of the province’s Family Health Organizations, which Lysyk says resulted in excess waste.
Part of the problem with unnecessary visits to hospitals is that while many Ontarians report having a family doctor, they’re not always able to access these services when needed, especially during overnight hours and on weekends.
In a 2016 survey by the Commonwealth Fund looking at health policy in 11 of the world’s most developed countries, Canada ranked lowest in terms of its ability to provide primary care to patients in a timely manner. Ontario scored only slightly better than the Canadian average, with just 41.4 per cent of respondents saying they could get an appointment with their primary care provider on the same day they called or the next.
The same survey showed that 44.2 per cent of Ontarians believed their last visit to the hospital emergency room was for something that could have been treated by a family doctor. What’s more, 60 per cent of Ontarians said accessing primary care at night or over the weekend is either “somewhat” or “very” difficult, which experts point to as a key reason why people misuse emergency services and clog up resources meant for those in urgent need.
“So this is a well-known problem, not just in Ontario, but across Canada,” said Brett Belchetz, an ER doctor in Toronto.
“The numbers are not good,” he said. “[People] admit they don’t have an emergency problem, but they’re going to an emergency room because they have nowhere else to go … What this leads to is tremendous pressure on our emergency rooms.”
When it comes to who’s most trusted to fix Ontario’s health-care woes, the most recent polling from Ipsos conducted exclusively for Global News shows NDP Leader Andrea Horwath has a clear advantage.
In total, 36 per cent of the 1,000 people surveyed between May 11 and May 14 said Horwath was most committed to improving the province’s health-care system. Roughly 20 per cent of respondents said PC Leader Doug Ford was most committed, while just 14 per cent of those surveyed said Premier Kathleen Wynne is most committed to improving health care.
When it comes to working with doctors, nurses and other health professionals, Horwath earns top marks, with one-third of respondents seeing her as the most capable leader.
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Ford, meanwhile, is largely viewed as a problem for the future of health care in Ontario. Forty per cent of respondents said Ford is the biggest threat to the province’s health-care system. This figure was 30 per cent for Wynne and just eight per cent for Horwath.
In total, 68 per cent of Ontarians said they are satisfied with the state of health care in the province.
Two-thirds of people surveyed said they believe improvements to health care in Ontario should come from more efficient use of money that’s already being spent – not by adding new tax dollars to the pot.
While Wynne and the Ontario Liberals have been accused by groups like Concerned Ontario Doctors of driving the province’s health-care system into a “crisis”– increased wait times in emergency rooms and a lack of beds being cited by doctors as examples of the problems – the Liberals most-recent budget included $882 million in new spending for hospitals and many promises for improved care for seniors.
It’s unclear how much – if any – of this new funding will go toward family medicine, but experts say primary care should be a key focus of any new health-care spending.
The Liberals have also promised $2.1 billion over four years to revamp the province’s faltering treatment of mental health issues, while pledging massive expansion to the province’s newly created pharmacare program.
NDP Leader Andrea Horwath, meanwhile, has made ending “hallway medicine” a top priority for the party, saying a New Democrat government would cut wait times by investing in hospitals.
The party’s platform also promises to increase access to family medicine, specifically targeting the time it takes for those with a primary care provider to get in to see someone. The plan lacks details of exactly how this will be accomplished, but Horwath has been adamant in her commitments to increasing access to primary care in Ontario.
Doug Ford and the Progressive Conservatives have yet to release their platform outlining specific reforms to the province’s health-care system. But like the Liberals and NDP, the PCs are promising to increase funding for long-term care in the province. Ford has said a PC government would create 30,000 new long-term care beds within the next 10 years.
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As for family medicine, Ford says 15 years of Liberal waste and mismanagement have created a health-care system that no longer works for Ontarians. He says he will cut bureaucratic spending and increase funding to front-line service providers like family doctors and nurses.
Ford has also promised to cut overall spending in the province by four per cent. Again, the PCs have not released any details as to exactly where these cuts would be made.
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