Pandemic has spurred exodus of family doctors from Ontario, study finds

Ontario’s family physicians left the profession early in the pandemic at double the rate of years before COVID-19 hit, new research shows.

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

This represented approximately 170,000 patients losing access to primary care, and was higher than the 1.6% of family doctors who went out of work during a comparable period each year between 2010 and 2019.

« The pandemic has made a bad situation worse in primary care, » 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 work builds on figures released last week which showed that in March 2020, nearly 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, » Kiran said.

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, fell more than 30%, Kiran said.

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, Kiran said.

The study found that these physicians made up 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 salary.

« For fee-for-service physicians, that meant a huge drop in income all of a sudden, » Kiran 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. . »

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 period.

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

And those with smaller practices — fewer than 500 patients — also left work at a higher rate.

Researchers looked at visits from March to September 2020

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 year before 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.

Kiran said researchers are currently interviewing doctors to better understand why they left the field.

They also found that certain regions had a higher proportion of family physicians who quit 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 said, 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 said.

The researchers are calling for a reassessment of the compensation model for family physicians to stabilize incomes, Kiran said.

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

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

Study confirms trend, says professional group

The Ontario College of Family Physicians said 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 that 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 connected to a family doctor, Kumanan said. These patients will also put more strain on the acute care system, she said.

« When patients don’t have a family doctor, they’re more likely to go to the emergency room, » Kumanan 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’ I’m sicker. »