Iris Gorfinkel: Despite spending billions, Ontario is failing to solve family doctor shortage - Toronto Star

Health teams make sense, but cannot be built when the pipeline of family doctors is running dry.

“Just over half (52 per cent) of Ontario’s family doctors plan to cut back or retire over the next five years,” writes Dr. Iris Gorfinkel. “This is expected to bleed the system of 500 family doctors annually. Worse, far fewer doctors are entering the system.”

Iris Gorfinkel is a family physician and clinical researcher in Toronto.

On Oct. 26, the Ministry of Health proudly announced that its $3.4 billion Primary Care Plan had connected 511,000 Ontarians to primary care teams, clearing 470,000 names from the Health Care Connect wait-list. Led by Dr. Jane Philpott, the ambitious, multi-year plan aims to attach every Ontarian by 2029. 

Is it a policy triumph or a bureaucratic trick? 

Untold numbers of these “newly connected” patients already had family doctors. When established clinics transitioned into primary care teams, their existing patient rosters were reregistered and simply repackaged as “newly attached primary care team patients.”

As the Ontario Medical Association warns, these funded team models frequently fail to create net-new capacity, meaning thousands of existing patients are recounted without creating new doctor-patient relationships.

The government also shrunk the Health Care Connect wait-list through sweeping database validation reviews. While removing unreachable names, or those who moved away, is standard, claiming they were ”cleared and connected” overstates the number of newly attached patients.

Just how many truly unattached Ontarians have been attached remains hidden.

Being attached isn’t enough when you are sick. When a fever strikes, more than one-third of attached Ontarians cannot secure a same-day or next-day appointment. Such lack of access forces desperate patients into overcrowded emergency rooms.

There’s no denying that health teams make sense. Giving vaccines and doing well-baby checkups do not optimize the use of a family doctor’s advanced training. Physicians should be reserved for complex medical conditions, supported by nurse practitioners, nurses and pharmacists in order to maximize the capacity of health teams.   

But teams cannot be built when the pipeline of family doctors is running dry. After all, family physicians are responsible for 98.5 per cent of total patient attachment in Ontario.

Ontario’s plan to add 340 undergraduate seats and 551 postgraduate residencies will take at least 12 years to yield results. The problem? Forcing fresh graduates into restrictive, multi-year comprehensive care mandates sets a legally precarious trap that turns away talent.

The Ontario Medical Association reports that 2.5 million Ontarians lack a regular family doctor. To meet that gap, Ontario would need 3,500 more family doctors. The province is fighting a losing battle against impending retirements and alternate career paths chosen by new family doctors.

Just over half (52 per cent) of Ontario’s family doctors plan to cut back or retire over the next five years. This is expected to bleed the system of 500 family doctors annually.

Worse, far fewer doctors are entering the system: half of new graduates are actively abandoning comprehensive family medicine for alternative roles like emergency medicine, hospitalist medicine, or palliative care. These roles offer fixed hours, lower overhead and higher compensation than traditional family practice. Opening a community clinic means running a small business, paying rent, hiring staff and potentially drowning in a burnout-inducing administrative load.

“No thanks,” newly minted family doctors say as they bolt from offering cradle-to-grave care, often for good.

The math is brutal: Ontario outputs 775 family medicine graduates annually, but given that half opt out of comprehensive care, it leaves 387 new family doctors. Given that 500 family doctors retire each year, the province is left with a net loss of 113 family physicians annually.

Ontario’s population growth cannot be ignored. Even if the government’s $3.4 billion plan succeeded in attaching every Ontarian to a health team by 2029, the influx of nearly one million new residents over the last few years means we’re chasing a moving goalpost.

Solving the primary care crisis is impossible without accurate data. As impressive as the ministry’s attachment figures are, critical questions remain: How many had a family doctor to begin with? How many did not? How many of the cleared names from Health Care Connect actually received a doctor?

Transparency is also lacking on the type of patients who were attached — whether they were young, old, sick or well — critical, given that seniors require the most care.    

The lack of disclosure on these fundamental points is concerning. Taxpayers paid $3.4 billion for Ontario’s Primary Care Action Plan. It’s time the Ministry of Health released the data. All of it.

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Opinion articles are based on the author’s interpretations and judgments of facts, data and events. More details

Iris Gorfinkel is a family physician and clinical researcher in Toronto.