More than six million Canadians say they do not have regular access to primary care physicians. It’s a crisis the experts say has caused untold harm and cases of preventable death and disease — and it’s expected to get worse before it gets better.
In Canada’s system of publicly funded health care, family doctors play a crucial gatekeeper role by coordinating care and ensuring access to preventative medicine, drugs, diagnostics and specialists.
Unlike in the U.S. — where some insured people can go directly to specialists and clinics — Canadians must go through family doctors or general practitioners at walk-in clinics if they need a particular kind of care.
In Canada, having a family doctor isn’t a perk. It’s a necessity.
As long as so many people lack easy access to primary care, population health can be expected to get worse, said Dr. David Barber, a family doctor and chair of the general and family practice section of the Ontario Medical Association (OMA).
“I really worry about this. I get really scared thinking about the patients that don’t have access to the health-care system,” Barber told CBC News.
He said the multi-billion-dollar health accord signed between Ottawa and the provinces — which offers money for more medical residency positions and recognition of foreign medical credentials — is a good start, but the numbers suggest governments need to do much more.
A CBC News analysis shows the number of medical residency spots in Canada has remained largely stagnant over the past decade despite population growth and millions of people going without a family doctor.
The population is growing and family doctors are retiring en masse. More than 1.7 million people in Ontario have a family doctor who is over the age of 65, Barber said.
As a result, the OMA predicts one in four people in the province will be without a “cradle to grave” family doctor by 2026.
“This is the way I frame it — would it be acceptable for 25 per cent of all kids to not go to school because there aren’t enough teachers?” Barber said.
“There’s a lot of harm, there’s a lot of morbidity and mortality happening because of this,” he added. “We’re going to see so much more sickness.”
As CBC News has reported, the number of medical residency positions — a crucial pipeline that brings more doctors into the system — has been stagnant for the past decade. The number of medical students choosing family medicine has plunged.
The precious few residency spots available are sometimes given to foreign students from wealthy countries like Saudi Arabia, who are contractually obligated to go home after finishing their residency.
A tangle of red tape makes it exceedingly difficult for Canadian-born doctors who were trained abroad to come home and practise.
New Canadians are also subjected to an onerous process in order to get the credentials they need to practise in their new country — a process that can take years to complete.
And a large number of family physicians are not practising in traditional clinics but are instead choosing to work in hospitals or sports medicine clinics where they can find more regular hours and a better work-life balance.
CBC News spoke to some Canadians who don’t have a family doctor. They all say they’re afraid of getting sick without a doctor to rely on, or to help them navigate a labyrinthian health-care system.
Canada is losing out on hundreds of qualified Canadian doctors trained abroad who can’t practice because they find it difficult to get residencies here due to a combination of red tape and bias.
They worry about letting ailments go untreated, about spending hours on end in emergency rooms. They worry about sick family members falling through the cracks.
Three years on a waiting list
Jane Williams lives in Victoria, B.C.
Her doctor announced his retirement with plenty of advance notice, to give his patients time to find someone else to care for their health.
But Williams hasn’t found anybody in the three years she’s been looking. She said she’s been shuffled from one wait list to another since the provincial government consolidated a regional list into a province-wide directory.
All she wants, she said, is to know where she is on the waiting list — information that provincial officials have told her can’t be disclosed.
Her husband Steve is going in for surgery later this year. She said she fears that, without a family doctor, he won’t get the post-operative drugs and advice he needs to fully recover.
“What are you supposed to do if you’re in the middle of a medical crisis?” she said. “It’s just going to have a push-on effect on the hospitals, which nobody wants.”
Williams said it’s unconscionable that a wealthy country like Canada leaves millions of people twisting in the wind without access to a primary care provider.
“It’s challenging. We’re not exactly sure what’s going to happen,” she told CBC News. “We’ve been on a list for like three years and it just doesn’t seem like anything’s happening.
“It speaks to poor advance planning on behalf of the governments. They see the population increasing with immigration. They see we’re losing family doctors. And they see there’s an older generation like myself that tends to have more health care needs.
“It seems like the issue just keeps getting kicked down the road, right?”
Getting older
Bill Wishart, 65, works a physical job “cruising woodlots” as a forestry technician near Sydney in Cape Breton.
He considers himself healthy — his only ongoing concern is high blood pressure — but he’s had his fair share of injuries, including wrecked shoulders and a bad hip that needed replacing.
Wishart has had sporadic access to a family doctor over the past 10 years in particular, with four or five different providers. He’s had about 15 different family doctors over his lifetime, he said.
He said he hasn’t always been happy with the care he’s received — a previous family doctor misdiagnosed his hip pain, depriving him of the replacement he really needed for years — but at least he had somebody to turn to when something popped up.
Canadian medical students trained abroad are struggling to get a residency in Canada, while the number of foreign nationals, or ‘visa trainees,’ getting a spot has increased by 70 per cent, a trend that advocates say needs to end.
He lost his family physician last November when she moved to Ontario to be closer to family.
He’s on the provincial waiting list. He’s also hoping his wife’s doctor takes him on as a patient — before he develops something that needs more regular care and attention.
“When you get a little older, you’d like to be able to access a check-up on a regular basis if nothing else, you know?” Wishart said.
“I know things are going to start to break down. If you don’t have a family doctor, someone who’s been following your health, it’s hard. You just don’t have anyone who you have some consistency with. I’m afraid I’m going to miss something myself.”
Wishart places the blame in part on the federal and provincial governments.
He said Ottawa in particular hasn’t done enough to help provinces recruit and retain family doctors.
Pointing to the millions of dollars allegedly wasted on the pandemic-era ArriveCan app, Wishart said that money could have been a game-changer for a smaller region like his, which is perpetually starved for health resources.
“The ArriveCan money is just frigging gone. If you put $56 million in — if you fired that into a place like Truro or Amherst, it would go a long way to helping out a little bit,” he said, referring to the price tag of the bungled app development.
“The amount of money we spend on health care, I’m just blown away that we don’t have a better system, a better way to do it. I don’t have the answer, I don’t work in health care but it’s mind-boggling that we don’t put more emphasis on family doctors.”
The advocate
Marilyn Gifford lives in Sarnia, Ont. She has a family doctor but seeing so many other community members go without, she said, makes her “ill.”
She said her corner of Ontario is in dire need of more family doctors because provincial data suggests one in three people living there could be without one in five years’ time — a much higher rate than the provincial average.
She has launched a grassroots campaign to secure more medical residency spots for local students who train abroad in countries like Australia and the U.K. A doctor must go through a residency before they can be licensed to practice.
Armed with a petition clipboard — and an apron that says, “This old lady needs 1,000 [signatures]” — she’s met personally with some 2,900 people in her area so far. She said the petition uptake has far exceeded her expectations.
“The stories are horrible,” Gifford said of her interactions with local residents.
“There is no primary care available for the average person. My apron here has heard so many stories and so many are so heartbreaking.”
Each year, the country’s medical schools — the bodies that control residency programs — turn away hundreds of potential residents who studied abroad, denying them positions while privileging their own medical school graduates.
She said she won’t rest until more spots are freed up to graduate more doctors to serve in communities like hers.
“We’re in crisis mode here. There’s no way we’re going to catch up by continuing to do what we’ve been doing because we’re falling behind,” she said.
“There’s a simple, viable solution to this and that’s simply to increase the number of residency spots. Cut the red tape.”