A new study from researchers at ICES and Western found 1.74 million patients in Ontario are now attached to family physicians aged 65 or older, and that many of those patients are elderly and have complex medical needs.
The study, published in Canadian Family Physician, explored key trends in the characteristics of comprehensive family physicians – those providing care for a broad range of ages and health needs – and the patients attached to them.
The researchers found that for the first time, there was no growth of the comprehensive family physician workforce, and an overall decline in the number of early career physicians (under 35 years old.)
“One of the reasons that over two million Ontario residents don’t have a primary care provider is because many physicians are retiring, a trend that’s likely to worsen with fewer early career physicians stepping in to fill the gap,” said Dr. Kamila Premji, a family physician, ICES (Institute for Clinical Evaluative Sciences) fellow and PhD candidate in family medicine at Western’s Schulich School of Medicine & Dentistry.
A primary care system in flux
The study included over 11 million Ontario patients as of March 2022, and 9,375 comprehensive family physicians. This was an updated analysis of similar cohorts from 2008, 2013 and 2019.
Along with a decline in the overall growth of the family physician workforce and greater proportion at retirement age, the findings also showed that females made up the majority of the comprehensive workforce. Overall, a declining proportion of family physicians are practicing comprehensiveness, from 77 per cent in 2008 to 65 per cent in 2022.
A recent study by the same team showed that many family physicians are choosing to work in hospitals instead of practicing comprehensive family medicine.
“The data helps us to better understand the shortages we are facing, and informs strategies like team-based care, which can better support family physicians who provide comprehensive care and can reduce burnout,” Premji said.
Compared to the overall family physician workforce, the authors found that near-retirement family physicians were caring for a higher proportion of patients aged 65 or older, and many with chronic obstructive pulmonary disease, congestive heart failure, diabetes and frailty.
“Looking to the future, we are concerned that the primary care system may not be able to absorb these medically complex patients who are attached to retiring family physicians, which will only exacerbate the current crisis,” said senior author Bridget Ryan, adjunct scientist at ICES and professor at Schulich Medicine & Dentistry.
One limitation of the study was that patients of Community Health Centres could not be linked to family physicians, and the data did not capture non-physician practitioners, although these populations only make up around 2 per cent of patients.
