Pandemic spurred exodus of Ontario family doctors, study indicates

Ontario family doctors left the profession at the start of the pandemic at double the rate of the years before COVID-19 hit, new research indicates.

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

That accounted for an estimated 170,000 patients losing access to primary care, and was higher than the 1.6 per cent of family doctors who stopped working during a comparable period each year between 2010 and 2019.

"The pandemic has made a bad situation even worse in primary care," said lead author Dr. Tara Kiran, a family doctor and researcher at St. Michael's Hospital, which is part of the Unity Health Toronto network.

"We really need to address this issue by supporting more people to go into family medicine and primary care."

The work builds on figures released last week that showed as of March 2020, nearly 1.8 million Ontarians did not have a family doctor and another 1.7 million Ontarians have a family doctor older than 65 years old.

"This is a big problem for patients in Ontario," Kiran said.

When Ontario locked down the province in March 2020, it also directed family doctors to not see patients unless it was absolutely necessary. Visits, either in person or virtual, plummeted by more than 30 per cent, Kiran said.

That disproportionately affected the family doctors who bill the province for each patient they see, known as the fee-for-service model. Family doctors in walk-in clinics are an example of that model, Kiran said.

The study found those doctors were a higher portion of the family physicians who left the profession compared to doctors who had their own roster of patients and were paid more akin to a salary.

"For fee-for-service doctors, it meant a huge drop in their income all of a sudden," Kiran said.

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

Researchers also found that doctors 65 and older had left the job at a higher rate compared to those the same age in pre-pandemic times.

"We hypothesize that what probably happened is the pandemic and those stresses and challenges and worries probably accelerated their retirement plan," Kiran said.

And those who had smaller practices — fewer than 500 patients — also left the job at a higher rate.

Reseachers looked at March to September 2020 visits

The findings came after researchers pored through the total visits to doctors across the province from March 11 to Sept. 29, 2020, and compared them to the same period the year before.

They also analyzed the years 2010 to 2019 to figure out the baseline for those who left every year to ensure what they saw between the start of the pandemic and the year before wasn't a blip.

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

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

They also found some regions had a higher proportion of family doctors who stopped working, including northwestern Ontario, the Niagara Region and Bruce Peninsula on Lake Huron.

There's also been a higher proportion in parts of the Toronto area and in Ottawa, Kiran said, although the issue hits harder in rural Ontario.

"Rural areas have lower numbers of doctors to begin with, so a few of them leaving had a greater effect on those communities," she said.

The researchers are calling for a re-evaluation of the payment model for family doctors in order to stabilize incomes, Kiran said.

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

"I think when people read this kind of research, it's easy to feel depressed and feel like we are living in a broken system and things are going to get worse," Kiran said. "But I do think the public can be part of the solution."

Study confirms trend, professional group says

The Ontario College of Family Physicians said Kiran's research confirms the trend they've been seeing 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 non-profit organization that represents family doctors.

Fewer family physicians across the province means there will be higher rates of hospitalization and lower life expectancy when patients are not connected to a family doctor, Kumanan said. Those patients will also put more strain on the acute-care system, she said.

"When patients don't have a family physician, they're more likely to go to the emergency room," Kumanan said.

"Ultimately this increases the cost overall to our health-care system because we know it's much more cost-effective to provide care to patients in a preventative way in the community than it is for patients to be accessing care at a later stage when they're more sick."