Pandemic has caused an exodus of family doctors in Ontario, study finds

TORONTO — The number of family doctors in Ontario who left the profession at the start of the pandemic is twice as high as the years before COVID-19 hit, new research shows.

About 3 per cent of family physicians in the province — 385 physicians — stopped practicing between March and September 2020, according to a study conducted by Unity Health Toronto and published Monday in the medical journal Annals of Family Medicine.

This represented approximately 170,000 patients who lost access to primary care. This is higher than the 1.6% of family physicians who stopped working for a comparable period each year between 2010 and 2019.

« The pandemic has made the bad situation in primary care even worse, » said lead author Dr. Tara Kiran, a family physician and researcher at St. Michael’s Hospital, part of the Unity Health Toronto network.

“We really need to solve this problem by helping more people turn to family medicine and primary care.”

The research builds on figures released last week which showed that in March 2020, almost 1.8 million Ontarians did not have a family doctor and an additional 1.7 million Ontarians had a doctor. family over 65 years old.

« It’s a big problem for patients in Ontario, » said Dr. Kiran.

When Ontario locked down the province in March 2020, it also ordered family doctors not to see patients unless absolutely necessary. Visits, in-person or virtual, have dropped by more than 30%, Ms. Kiran pointed out.

This has disproportionately affected family physicians who bill the province for every patient they see, known as the fee-for-service model. Family doctors in walk-in clinics are an example of this model, said Tara Kiran.

The study found that these physicians represented a higher proportion of family physicians who left the profession compared to physicians who had their own patient list and were paid more like a salaried employee.

« For fee-for-service doctors, it meant a huge drop in income all of a sudden, » the doctor said.

“At the same time, they had to pay their staff, pay their rent like every other small business, but also get personal protective equipment, enhanced infection prevention control, which was almost impossible to find at the time. .”

Accelerate retirement

The researchers also found that doctors aged 65 and over left their jobs at a higher rate than those of the same age in the pre-pandemic era.

“We hypothesize that what likely happened is that the pandemic and those stresses, challenges and worries likely accelerated their retirement plan,” Ms. Kiran explained.

And those with smaller practices – less than 500 patients – were also more likely to quit their jobs.

The findings came after researchers looked at the total number of doctor visits in the province from March 11 to September 29, 2020 and compared them to the same period the year before.

They also analyzed the years 2010 to 2019 to determine the baseline of those leaving each year, to ensure that what they saw between the start of the pandemic and the previous year was not a mistake.

They found that there were 12,247 active family doctors in 2019 and 11,862 active from March to September 2020.

Dr. Kiran said researchers are currently interviewing physicians to better understand why they left the profession.

The researchers also observed that certain regions had a higher proportion of family doctors who stopped working, including northwestern Ontario, the Niagara region and the Bruce Peninsula on Lake Huron.

There has also been a higher proportion in parts of the Toronto area and Ottawa, Kiran added, although the problem is hitting harder in rural Ontario.

“Rural areas have a lower number of doctors to start with, so leaving a few of them had a bigger effect on those communities,” she explained.

Researchers are calling for a reassessment of the family physician compensation model to stabilize incomes, Kiran said.

They also launched a website, ourcare.ca, for patients across Canada to let them know what they would like to see in primary care.

« I think when people read this kind of research, it’s easy to feel depressed and to feel like you’re living in a broken system and things are going to get worse, » said Dr. Kiran. But I think the public can be part of the solution.”

The Ontario College of Family Physicians said Dr. Kiran’s research confirms the observed trend of early retirements compared to the years before the pandemic.

« Our health care system is facing a crisis and this crisis includes family medicine, » said Dr. Mekalai Kumanan, president of the nonprofit organization that represents family doctors.

Fewer family doctors in the province means there will be higher hospitalization rates and shorter life expectancies when patients are not in contact with a family doctor, Dr. Kumanan said. These patients will also put more strain on ER systems, she said.

“Ultimately, this increases the overall cost of our healthcare system, because we know that it is much more cost effective to provide care to patients preventively in the community than to access care at a later stage when ‘they are sicker.’