A Toronto-based research team met with nearly 10,000 Canadians to survey the current state of the health care system and found deep dissatisfaction and frustration with primary care in Canada, which faces an acute shortage of family physicians. found.
The OurCare initiative, led by Dr. Tara Kiran, a family physician and scientist at the MAP Center for Urban Health Solutions at St. Michael’s Hospital in Toronto, conducted a national survey, assembled five “Provincial Priorities Panels,” and established a series of A regional roundtable was held. Over the past 16 months. The company just released a 72-page report explaining its findings.
This is the most comprehensive survey ever conducted on Canadians’ views on their health care system and provides important data on the poor state of access to primary care in a growing and aging country. It provides:
While Canadians are generally proud of a health-care system that provides care based on need rather than ability to pay, OurCare researchers found that many believe the system provides universal, high-quality health care on time. I discovered that I don’t think I’ve been able to fulfill my promise to provide for Lee.
“Despite the diversity of voices we heard, it was clear that many Canadians agree: They want everyone to have access to primary care.” Kiran told CBC News.
“We don’t have enough primary care. Too many people don’t have access to what is the gateway to the health care system. We are a nation of haves and have-nots.
“So many people have absolutely nothing and no access. In fact, I think it’s shameful.”
The report found evidence of a so-called “attachment crisis.” An estimated 22 per cent of Canadian adults (about 6.5 million people) do not have a regular doctor or nurse to see.
The problem seems to be getting worse.in 2019 Statistics Canada survey14.5 per cent of Canadians aged 12 and older report not regularly accessing primary care.
According to OurCare research, access is particularly limited in Quebec, with 30.8 per cent of people reporting not having a primary care provider.
Meanwhile, in Atlantic Canada, 30.9 per cent of those surveyed said they did not have a family doctor or nurse.
The data also reveal significant age disparities, with fewer young people reporting seeing a doctor regularly.
According to OurCare, approximately 35% of Canadians aged 18 to 29 do not have a primary care physician.
Canada lags far behind other wealthy countries in access to primary care. In the United Kingdom, Norway, the Netherlands, and Finland, more than 95% of the population has a primary care clinician or clinic. data Published in Canadian Medical Association Journal.
These countries guarantee access by automatically registering people with doctors and clinics.
Meanwhile, in Canada, many people spend years on waiting lists just to see a general practitioner. Many family physicians have closed their doors to new patients.
OurCare also found that many people who have a provider of some kind still struggle to access primary care in a way that best fits their needs.
According to the OurCare report, only 35% of people surveyed said they were able to get a same-day or next-day appointment if they needed urgent care.
Physician hours are limited, with relatively few people (36%) reporting being able to see a doctor on weekends or after 5:00 pm on weekdays.
Lack of access has consequences. According to the Canadian Institute for Health Information (CIHI), the number of unscheduled emergency department visits jumped from about 14 million in 2021-22 to 15.1 million in 2022-23. data.
OurCare’s report concludes that the best way to solve Canadians’ crisis of trust in primary care is the elusive but relatively simple solution of hiring more doctors and nurses. There is.
“When people don’t have access to primary care, it basically means they don’t get the care they need,” Kiran said. “They’re not getting preventative care. Their chronic diseases aren’t being managed.”
Kiran said everyone should have some type of relationship with their primary care physician in a system where the primary care physician plays an important gatekeeper or “quarterback” role, treating patients, coordinating care, and referring patients to specialists. Stated.
“If we don’t make meaningful changes to primary care, people’s health will deteriorate. That means their mental health, their physical health, their social well-being. It’s going to make my condition worse.’ My quality of life has deteriorated,” she said.
The report concludes that increasing the number of doctors would improve the health of the population, improve mortality rates, and reduce healthcare costs.
The number of physician training slots in Canada has remained largely stagnant for the past decade, despite population growth and millions of people living without a family doctor, according to a CBC News analysis.
It’s this last point that could motivate some politicians to address the primary care gap with more urgency, Kiran said.
Although adding a physician increases initial costs, focusing on preventive medicine may save money in the long run. This means treating symptoms before more expensive interventions such as surgery are needed.
Kiran said the latest health agreement between the federal government and states, as well as a series of bilateral agreements, have brought about meaningful improvements, but do not meet all of the country’s needs.
The federal government agreed last year to spend $46.2 billion more on health care over the next 10 years than originally planned.
Citing his own research, Kiran said the government would need to spend tens of billions of dollars more to meaningfully improve primary care.
“Incremental improvement is not enough. Even if we go from 77 percent to 80 percent coverage, or 85 percent, that’s not enough,” she says.
“In fact, we need to design to cover the whole population, and that really means looking at the health system from a different perspective. A vision of providing quality primary care for everyone. To achieve this, we will need to invest 10 times more than we have in the past.”
The federal government has signed agreements with provinces and pledged billions of dollars to help solve Canada’s primary care physician shortage, but experts say millions of patients are left without a primary care physician. He points out that this alone is not enough.
The report calls on governments to accelerate the licensure of foreign-trained health professionals and to train and recruit more people to work in primary care.
Removing some of the barriers faced by foreign-trained doctors would be an “immediate potential solution to the medical workforce crisis,” Kiran said.
The report says the system is in decline as fewer graduating medical students choose family practice, a significant number of physicians approach retirement, and more physicians choose to leave family practice following the trauma of the pandemic. He said there was an urgent need to strengthen it.
These findings are consistent with what CBC News recently reported.
The number of physician training slots has stagnated over the past decade, and family medicine enrollment has fallen dramatically, according to a CBC News analysis of medical school data.
It is difficult to determine exactly how many Canadian doctors work abroad, but there are thousands of doctors in countries such as Australia, the United Kingdom, and the United States.
Many aspiring doctors in Canada find that with limited medical school and residency slots in the country, their only option is to work abroad.
Many of them would like to return to work in Canada, but the cumbersome bureaucratic process for certification prevents them from doing so, doctors told CBC News.
“Should we be more open to primary care and different types of health professionals providing different types of training? I think the answer is yes, because to some degree better than no care. It’s better to take care of people, and there are people who aren’t being cared for right now,” Kiran said.
Canada is losing hundreds of qualified Canadian doctors who were trained overseas because a combination of red tape and prejudice makes it difficult to obtain training in Canada.
Kiran and researchers also suggest expanding team-based primary care and more robust virtual care arrangements to increase access and reduce physician burnout.
These and other recommendations, including a call for patients to easily access their medical records online, are part of the organization’s efforts to support a primary care system in crisis. is part of the OurCare Standard that the province and Ottawa are seeking to adopt. .