A new study by the Ontario College of Family Physicians has found that 2.2 million of the 14 million residents of Canada’s largest and wealthiest province do not have a family doctor. The finding is a major indictment of the for-profit or paid model that is now being promoted as Ontario’s go-to model for surgeries by the province’s Conservative government.
“The number of unassigned patients is growing across the province and region,” says Steve Gray, managing director of Medical Associates of Port Perry. “The Medical Associates wait list has never been higher and will grow further as our family doctors retire.
According to the Ontario College study, over 40,000 Torontonians, 5,000 Mississauga residents and many others across the province lack access to a regular physician. Those without a GP typically delay necessary follow-ups on serious health problems, with the result that these problems get significantly worse. This, in turn, places additional pressure on other areas of the provincial health care system, especially Ontario’s emergency departments.
It’s a problem of a variety of snake that eats its tail. The lack of family doctors leads to delays in following up on health problems, which makes health problems worse, putting a strain on the already overwhelmed emergency departments. The whole scenario jeopardizes the province’s healthcare system, providing the perfect opportunity for for-profit merchants to double down on their solutions.
Part of the cause for the decline in coverage likely stems from an overall decline in the total number of general practitioners during the pandemic. Ontario had 12,247 active general practitioners in 2019, but only 11,862 between March and September 2020. As reported by CBC News, Ontario’s lockdown policies ordering general practitioners to refrain from seeing patients unless they was absolutely necessary led to a drop in visits of almost 30%. Since most GPs and walk-in clinics are private practitioners, billing to the province under the fee-based model has driven many out of business.
“For paid doctors, this has meant a huge drop in their income all of a sudden,” Dr Tara Kiran, a GP and researcher at St Michael’s Hospital, told CBC News. At the same time, they needed to pay their staff, pay rent like any other small business.
To make matters worse, like the Toronto sun observed, Ontarians are increasingly being denied tax-paid medical services [because] provincial governments of all stripes have reduced the number of services and drugs covered by OHIP [the Ontario Health Insurance Plan] save.
This was especially true for general practitioners in more remote areas and with fewer than 500 patients. “Rural areas have fewer doctors to begin with, so some of them leaving have had a bigger effect on those communities,” Kiran told CBC News.
But the trend precedes the pandemic. As the same CBC News article notes, in March 2020, 1.8 million Ontarians already did not have access to a family doctor. More than a decade earlier, in 2008, a Health policy The study estimated that 7.8 percent of Ontarians (about 0.9 million of 12.88 million) were not connected to or did not have a GP.
This deficit, the Health policy study notes, has hampered the system’s ability to provide early treatment for potentially difficult conditions, provide preventative care (such as blood pressure checks, mammograms and Pap smears), and manage chronic disease. Largely, those without access are younger, poorer and typically members of immigrant communities. Overall, this population has worse health outcomes than middle-class Canadians.
As the Health policy study noted:
Those without a family doctor were more likely to be male, young or recent immigrants. Their employment status was more likely to be employed or unemployed, and they were less likely to report chronic conditions. Ontarians with a family doctor were more likely to retire, have two or more children, or be established immigrants. They were more likely to report trusting the healthcare system and also more likely to have multiple chronic conditions.
Part of this can be explained by the fact that the rich are in better health than the poor, often live longer and experience fewer disabilities. Wealthier people often have the option of taking time off to see a GP, while the poor have to rely on paid sick leave policies.
Given that successive right-wing Ontario governments have historically relied on family doctors and preventive care as a tool to offset cuts to hospitals and nurses, the general practitioner shortfall is clearly concerning.
Last September, Ontario hospitals were overwhelmed by the influx of patients with RSV and COVID-19. Instead of undoing the government’s cut to health care wages, Ontario Health Minister Sylvia Jones worked to divert attention away from the government’s cuts by insisting that family doctors would step up.
We need to make sure primary care physicians see their patients before they have to go to the emergency room or hospital, Jones said. We have a robust system when all players work together. And we need all those parts to basically work 100%.
Elsewhere, others in health care have promoted this same fee-for-service system, in which doctors actually operate private but publicly insured facilities, as a model of how privatizing other services supposedly should improve access.
The most visible moment of the crisis so far occurred earlier this year when the government responded to rising backlogs and waiting times by pushing to shift surgical procedures mainly cataract surgeries, MRI scans, CT scans and hip and knee prostheses from hospitals to mainly for-profit structures Independent Healthcare Structures (IHF).
We take cataract surgeries, pick up the backlog there. Let’s change people’s lives and take care of hip and knee replacement surgeries, said Ontario Premier Doug Ford. You add them all up, what I understand is that it’s 50 percent of surgeries. The privatization program has been punctuated by a massive increase in hospital emergency room closures for a total of more than 184 days of lost service, across the province, from March 2022 to 2023.
Despite these catastrophic developments, free market advocates remain undaunted. Andrew Pak of the Ontario Medical Association told al Globe and mail, Your family doctor practice is a for-profit business. . . . It is a private company within a publicly administered healthcare system. Indeed, the call may come from inside the house. As the Domestic mail He noted, The outpatient plan is supported by the Ontario Hospital Association, the Ontario Medical Association, and a number of hospital CEOs. Don’t be surprised if hospitals themselves lead the way by establishing satellite surgery centers.
The battle with private care champions dates back to the early days of Canada’s Medicare program.
In the early 1960s, Saskatchewan’s Cooperative Commonwealth Federation (CCF) government expanded its provincial health insurance plan with the Saskatchewan Medical Care Insurance Bill. In the immediate aftermath, lobbying, threats, and strikes by for-profit doctors worked to prevent the government from hiring doctors at public clinics like Swift Current’s.
Supporting the CCF’s initial position, spokesman Dr Hugh MacLean said in a 1937 radio address:
In our current system of practice, preventive medicine is largely overlooked because members of the [medical] The profession is almost entirely committed to the curative end of the practice, so that preventable deaths are not prevented and correctable conditions are not corrected because people are not in the financial position to have their condition discovered.
Instead, the right-wing Keep Our Doctors campaign has famously led the fight to prevent a wage system and defend their private facilities and payments. Sensing the dangers of socialized medicine, they strongly opposed calls for wage-only service and instead pushed for state-subsidized health insurance on a fee-based basis.
Eventually, the CCF government capitulated. As a result, family doctors and hospitals in Canada are not public institutions. They are private structures that offer publicly insured services and often take the lion’s share. Both the Ontario Hospital Association (OHA) and the Ontario Medical Association (OMA) have supported privatization efforts in the past. In the 1980s, OMA’s federal counterpart, the Canadian Medical Association, was adamant, in the account of former health minister Monique Bgins, that all sources of private health insurance funding should be permitted. Since then, a number of professional medical associations have rushed to support privatization.
In the 1990s, then-OHA CEO David MacKinnon stated that the drive to partner with the private sector was already driving our hospital system. That was made easier, he noted at the time, by the fact that many hospital board members and a disproportionate number of board chairmen are businessmen.
The principle of universal health care dictates that those who are sicker have the greatest need of care. This requires affordable, free healthcare at the point of use. Leaving this to small businesses, which operate on notoriously tight margins, and a network of private fiefdoms may be one of the worst ways to achieve this.
Private healthcare providers are first and foremost related to the pursuit of profit. Their unequal supply often reflects social inequalities. Such inequalities are precisely what a universal healthcare system, especially one that purports to provide preventive care, aims to prevent. A truly universal program is a public program. Public health, with full ownership and provision of services, can autonomously execute its directives. He is free from the capricious needs and irregularities of the market. It is the only sane and efficient response to Ontario’s GP deficit crisis.
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