By Peter Chow
The Ontario government has consistently chosen worsened access to primary medical care over the increased cost of improved access – not only access to a family doctor or other primary care provider, but also access through hospital ER and walk-in departments.
Canada is tied for last place (out of 10 OECD countries) for the percentage of patients able to make a same-day appointment with their primary healthcare provider when sick.
Compared to other high-income OECD countries, Canada has the highest rate of use of hospital ER’s for accessing primary care “and often they tell us it’s for a problem that could have been treated by their regular doctor.”
Compared to other industrialized countries, Canada has the highest rate of patients reporting excessively long waits in an emergency department, according to a report by the Canadian Institute for Health Information (CIHI).
The report shows 29% of Canadians had to wait four hours or longer before being seen during their most recent emergency department visit.
Although obtaining access may be arduous, 76 percent of Canadian adults rate the quality of care they receive from family physicians as excellent or very good (Canadian Institute for Health Information 2009).
1992 — The NDP government of Bob Rae calculated what each new medical graduate would cost the province, not merely what that physician would bill for medical services rendered, but also in the costs generated by that physician’s hospital utilization, by investigations and tests ordered and the cost of treatments and drugs prescribed. The NDP attempted to cut health-care costs by reducing the number of doctors graduating from medical schools by 12%.
Rae has since said his decision to cap medical school enrollments contributed to the doctor shortage plaguing the province.
1999 — Report of fact-finding commissioner Dr. Robert McKendry says Ontario has a “growing pervasive problem” with its general supply of doctors.
2001 — An expert panel led by McMaster president Peter George says Ontario needs a comprehensive plan to manage a looming shortage.
2002 — The shortage is described as a crisis. The Ontario Medical Association (OMA) warns of the public’s growing “widespread discontent” and predicts that: “Barring aggressive and immediate government intervention, the province of Ontario will have a grossly inadequate number of physicians” in future.
2005 — The doctor shortage deepens. About 1.5 million adults are without a family doctor. The government says new ways of delivering family care are to be studied, and family health teams come into vogue.
• A million adults and 130,000 children still don’t have a family doctor.
• The OMA estimates Ontario needs at least 1,000 family doctors now.
• Ontario has fewer family doctors per 100,000 residents than in 2002.
• Ontario is 10th in Canada for number of family doctors per 100,000 at 84.
• It ranks eighth among the provinces for its general doctor-patient ratio.
• The number of communities designated as under-serviced due to lack of doctors is 141, up from 122 in 2003.
Enrollment in Canada’s 17 medical schools has remained relatively flat for the past decade, versus a steady rise for more than a decade in the United States, which is nearing a targeted increase of 30% set by the Association of American Medical Colleges in 2006 to address a projected physician shortage.
So, it would seem that a simple solution to Canada’s doctor shortage would be to increase enrollment in medical schools. Provincial governments control enrollment numbers, but most medical schools would welcome the ability to take on more students, according to Dr. Genevieve Moineau, president of the Association of Faculties of Medicine of Canada. “If a school feels it has the capacity, it would be happy to expand,” she says.
The demand is certainly there from prospective students. Dalhousie University, for example, receives between 900 and 1100 applications annually for its 108 first-year positions.
Enrollment in medical schools remains flat despite the impending medical apocalypse of the aging population.
Furthermore,a shortage of residency positions means any rise in the number of medical students would be counterproductive, as there would be no way to provide the extra graduates with the postgraduate training they need to become practising physicians. “It’s very important that provinces ensure that the number of medical school spots is right, but they also have to support them with the appropriate number of residency spots,” says Moineau.
In recent years, the number of residency positions available across Canada has fallen. In 2015, Ontario cut the number of medical residency positions by 50.
“Cutting the number of residency spaces … can cause patients to rely on walk-in clinics and emergency departments instead, unnecessarily raising the cost of health care services,” said PC Leader Patrick Brown.
The OMA called the elimination of 50 first-year residency spaces “irresponsible and unacceptable,” and said the government was being short-sighted.
The Liberal government made the cuts to save costs and help reduce its $10.9-billion budget deficit, but not to help patients, added Toth.
“Ontario’s doctors do not believe this decision was made with patients as the top priority,” he said.
In 2018, the Globe and Mail reported that “More graduates of Canadian medical schools were shut out of residency placements this year than ever before, meaning the skills of dozens of doctors-in-training could be going to waste while many patients in Canada struggle to find family physicians.
The organization that matches medical students with residency spots revealed on Tuesday that 115 of this year’s Canadian medical-school graduates failed to secure a crucial training placement, up from 99 last year and 77 the year before.
Residency is the last leg of the long journey to become a doctor. If medical-school graduates do not complete between two and seven years of hands-on training as resident physicians, they cannot practice medicine.”
The Ontario government has consistently chosen worsened access to primary medical care over the increased cost of improved access – not only access to a family doctor or other primary care provider, but even access through hospital ER and walk-in departments.
In Ontario, medically necessary hospital and physician costs are entirely covered by the public health care system. However patients pay privately for many drugs, dental care, eye care, physiotherapy and other services.
Canadians can purchase supplemental private coverage for services that are not covered by the public plan, but cannot purchase private insurance for basic medically necessary services.
Private insurance for basic services would enable those with private insurance to “jump the queue”. It would be better to shorten the queue for everyone, by improving access to primary medical care.
The only way to do this is to elect government that will fund health care appropriately, that will fund medical education so that there are enough doctors, instead of eroding health care under the guise of fiscal restraint.