Massive new survey finds widespread frustration with access to primary health care

A Toronto-based research team met with and surveyed some 10,000 Canadians about the state of the health-care system and what they found is deep dissatisfaction and frustration with primary care as the country grapples with a severeshortage of family doctors.

The OurCare Initiative led by Dr. Tara Kiran, a family doctor and scientist with the MAP Centre for Urban Health Solutions at Toronto's St. Michael's Hospital conducted a national survey, assembled five "provincial priorities panels" and convened a series of community roundtables over the past 16 months. It just released a 72-page report describing itsfindings.

It's one of the most comprehensive surveys ever conductedon Canadians' views of the healthsystem and it provides crucial data on the poorstate of primary care accessin a growing and aging country.

While Canadians are generally proud of a health systemthat delivers care based on need rather than the ability to pay, the OurCareresearchers found many people believe the system has failed on itspromise to deliver universal and high-quality health care in a timely manner.

"Despite the diversityof the voices that we heard from, it was clear there is so much people in Canada agreed on. They want everyone to have access to primary care,"Kiran toldCBC News.

"Primary care is falling short. Far too many people don't have access to what is the front door to the health-care system. We're a country of have and have-nots.

"So many people have absolutely nothing no access and I think that's shameful, actually."

The report found evidence of what it callsan "attachment crisis" an estimated 22 per cent of Canadian adults (about 6.5 million people) do not have a family doctor or nurse practitioner they can see regularly.

The problem appears to be gettingworse. In a 2019Statistics Canada survey,14.5 per cent of Canadians aged 12 and overreported not having regular access to primary care.

The OurCare survey found access is particularly limited in Quebec, where 30.8 per cent of people report they don't have a primary care provider.

In Atlantic Canada, meanwhile, 30.9 per cent of people surveyed said they have no family doctor or nurse practitioner.

The data also revealsa significant age disparity, with fewer young adults reporting regular access to a doctor.

About 35 per cent of Canadians aged 18 to 29 are without aprimary care provider, according toOurCare.

Canada lagswell behind other wealthy countries on access to primary care. In theUnited Kingdom, Norway, the Netherlands and Finland,more than 95 per cent of the population has a primary care clinician or place of care, according to data published in the Canadian Medical Association Journal.

Those countries guarantee access by automatically registering people to a physician or practice.

In Canada, meanwhile, many people spend years on waiting lists just to getaccess to ageneral practitioner. Many family medicine practices have simply closed their doors to new patients.

OurCare also found that many people who do have some sort of provider still struggle to access primary care in a way that best serves their needs.

Only 35 per cent of thosesurveyed said they could get a same-day or next-day appointment when they needcare urgently, saidthe OurCare report.

Doctors' office hours are limited, and relatively few people (36 per cent) reportedaccess to a clinician on weekends or after 5 p.m. on weekdays.

That lack of access has consequences. The number of unscheduled emergency room visits jumped from about 14 million in 2021-22 to 15.1 million in 2022-23, according to Canadian Institute for Health Information (CIHI) data.

The OurCare report concludes that the best way to solve Canadians' crisis of confidence in primary care is with a relatively straightforward, if elusive, fix: bring in more doctors and nurse practitioners.

"When people don't have access to primary care, itfundamentally means people aren't getting the care that they need," Kiran said. "They're not getting the preventativecare. Chronic conditions aren't being managed."

Kiran said that in a system wherefamily doctors playa crucial gatekeeping or "quarterback" role treating patients, coordinating care and providing referralsto specialists everyoneshould have some sort of relationship with a primary care clinician.

"If we don't make meaningful change to primary care, we're going to see people's health deteriorate. That means their mental health, their physical health, their social well-being. And, ultimately, it's going to mean people having a worse quality of life," shesaid.

More doctors will lead to a healthier population, improved death rates and lower health care costs, the report concludes.

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It's that last point that may motivate some politicians to address primary care gaps with a greater sense of urgency, Kiran said.

Adding doctors costs more upfront but could savemoneyin the long run througha greater focus on preventative medicine treating conditions before they require more costly interventions like surgery.

The federal government's latest health accord with the provinces and a series of bilateral side deals amount to a meaningful improvement but they don'tdeliver allthe country needs,Kiransaid.

The federal government agreed last year to spend $46.2 billion more on health care than originally planned over the next ten years.

The government needs to spend tens of billions of dollars more than thatto meaningful improve primary care, Kiran said, citing her research.

"Incremental improvement isn't enough. Going from 77 per cent covered to 80 per cent or 85 that won't cut it," shesaid.

"We actually have to design around full population coverage and that means actually looking at our health-care system differently. We need 10 times the investment that has been committedto realize that vision of high-quality primary care for everyone."

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The federal government is striking deals with provinces and pledging billions of dollars to help solve Canadas family doctor shortage, but experts say its not enough to address the situation for millions of patients without a primary physician.

The report calls on governments to acceleratelicensing of foreign-trained health-care professionals and train and recruit more people to work in primary care.

Dismantling some of the barriers foreign-trained physicians face would be an "immediate potential solution to the health human resource crisis," Kiran said.

The system needs reinforcements urgently, the report said, because fewergraduating medical students are picking family medicine, a significantnumber of doctors are approaching retirement andmore doctors are choosing to leave family practice after the trauma of the pandemic.

Those findings align with what CBC News has reported recently.

The number of medical residency spots has been stagnant for the last 10 years and family medicine enrolment has dropped dramatically, according to a CBC News analysis of medical school data.

While it's hard to pinpoint just how many Canadian doctors are working abroad, there are thousands of them in countries like Australia, the U.K. and the U.S.

Many would-be Canadian doctorsfound that their only choice was to work abroaddue to limited medical school and residency spots here at home.

Many of them would like to come back to Canadato work but can't because of a tangle of red tape for credential recognition, doctors have told CBC News.

"Should we be more open to different kinds of health professionals providing primary care, different kinds of training? I think the answer is yesbecause some care is better than no care and some people are getting no care right now," Kiran said.

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Canada is losing out on hundreds of qualified Canadian doctors trained abroad who cant practice because they find it difficult to get residencies here due to a combination of red tape and bias.

Kiran and her researchers are also suggesting an expansion of team-based primary care to increase access and reduce physician burnout, and a more robust virtual care regime.

Those recommendations and others including a callto make medical records easily accessible to patients online are part of the "OurCare Standard" the group wants provinces and Ottawa to adopt as part of a push to prop up a primary care system that's on the ropes.