More family doctors needed: report

Two medical groups say Canada should aim to ensure 95 per cent of people in every community have family doctors by 2012.

The College of Family Physicians of Canada and the Canadian Medical Association set that target Wednesday in releasing their final report on primary-care wait times.

To reach the goal, the groups suggested:

• Find ways to encourage more medical students to choose family medicine.
• Increase training opportunities for qualified international medical graduates to work as family physicians.
• Help family doctors streamline their offices and manage workload so they can see more patients.
• Develop and maintain patient registries of people actively looking for a family doctor.

The 32-page report, titled The Wait Starts Here, included a poll by Ipsos Reid that suggests 17 per cent of Canadians, or 4.1 million people age 12 or older, don't have a family doctor. These people resort to going to emergency rooms or walk-in clinics for care, which the groups say is not efficient and offers poor continuity of care.

Of those surveyed, 98 per cent said they believe training more doctors is key to improving access to family doctors and specialists.

'If we are to address Canada's serious challenges in providing timely access to care, we simply need more hands on deck.' —Dr. Lydia Hatcher

Most Canadians surveyed, 84 per cent, said they were concerned about the number of people lacking a family doctor.

Among the 82 per cent who do have a family doctor, 51 per cent said they were concerned about the three to four weeks it can take to get an appointment with their family doctor. They also expressed fears that their family doctor would retire or move away.

Ticking wait-time clock

"If we are to address Canada's serious challenges in providing timely access to care, we simply need more hands on deck," Dr. Lydia Hatcher, co-chair of the Primary Care Wait Time Partnership, told reporters.

"To that end, the partnership is calling for collaborative and concerted action so that 95 per cent of Canadians in every Canadian community can have a family doctor by 2012."

To reach the target, three million more Canadians would need to get a family doctor in about two years.

Of those polled, 83 per cent were concerned about the time it takes to see a specialist. The critical finding is that the system needs to start the wait-time clock when a patient visits a family doctor for a referral to a specialist, Hatcher said. The measurement and tracking of a patient's wait time needs to be improved, she said.

Increased enrolment in medical schools as well as the number of family doctors being trained are all steps toward reaching that target, said Dr. Cathy MacLean of the College of Family Physicians of Canada.

MacLean added there are still concerns about the overall health human resource planning for Canada and the distribution of physicians.

Reducing the referral time to see specialists is complicated and needs more study, such as finding a way for medical offices to communicate over wide geographic areas, according to the report.

'Just in time' techniques pushed  

The report is "moderately good," said Dr. Michael Rachlis, a health policy analyst in Toronto.

The groups touched on the idea of "advanced access" — applying the principles of "just in time delivery" to family doctors' offices — but don't include it in the recommendations, Rachlis said.

Often family doctors who clear their two- to four-week backlog of patients seeking appointments are then able to offer just in time service.

But to reach the goal, doctors may need to change their schedules, Rachlis suggested, such as:

• Avoiding clinic staff meetings on Mondays, which tend to be the busiest day in family practices.
• Matching capacity to supply, the way beer stores increase staffing during the holiday season.

The report was not written by the governing councils in medicine, which are at the provincial level, he noted. If the provincial medical associations decided to implement the suggestions, they could make many of the changes themselves, such as improving collaboration between family doctors and specialists.

Rachlis criticized a lack of leadership from provincial governments and physicians themselves.

The two medical groups established the primary-care wait time partnership in 2007. The partnership issued its interim report in April 2008, focusing on timely access to specialists in areas such as cancer care, cardiology and hip replacements.

Since then, the groups have turned their attention to waits for family doctors, based on surveys, focus groups and discussions between doctors.

More doctors

There has been progress in increasing the number of doctors working in Canada in the past five years, according to a report released by the Canadian Institute for Health Information last week.

Between 2004 and 2008, the number of active physicians in Canada grew from 60,612 to 65,440, representing an eight per cent increase across the country. Over the same time, the country's population grew by 4.3 per cent.

In 2004, 23 per cent of medical students across Canada chose family medicine as a career. This year, it increased to nearly 33 per cent, Dr. Cal Gutkin, executive director and CEO of the College of Family Physicians of Canada, said when CIHI's report was released. 

The poll was conducted Nov. 17-19, based on online interviews with 1,021 adults. The unweighted results are considered accurate within 3.1 percentage points 19 times out of 20.