Family physician and scientist Dr. Tara Kiran in Toronto on June 20.Tijana Martin/The Globe and Mail
In Norway, every resident is automatically assigned a family doctor. Patients in the Netherlands have access to primary care 24 hours a day through a network of after-hours care. And in Britain, newborns must be registered with a local medical practice within six weeks of birth.
As the number of Canadians without a family doctor rises, policy makers can learn lessons from these other wealthy developed countries where more than 95 per cent of people have regular access to a primary-care provider, according to a new report.
The report, published Monday in the Canadian Medical Association Journal (CMAJ), reveals how the country falls short in several key areas in comparison with nine other Organization for Co-operation and Development (OECD) countries. Canada has fewer physicians overall per capita, spends less of its total health budget on primary care, and has relatively high maternal- and infant-mortality rates.
Statistics Canada’s most recent data from 2021 suggest that 14.4 per cent of Canadians don’t have a health care provider they can see regularly for care. The number of orphaned patients is expected to increase as older doctors retire and younger ones turn away from traditional family practice.
“We have to have a goal of guaranteed access to primary care and funded appropriately,” Tara Kiran, an author of the report and a family doctor at St. Michael’s Hospital and primary-care researcher at the University of Toronto, said in an interview. “Until we do that, unfortunately, we have a situation where we have haves and have-nots.”
Family doctors are the cornerstone of a high-functioning health care system. They help patients navigate the system, referring them to specialists for early screening and treatment of medical conditions. They also get to know the people they serve over time, allowing them to deliver higher-quality care than a walk-in clinic or emergency department.
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The CMAJ report examines four countries – Norway, the Netherlands, Britain and Finland – where family doctors, known there as general practitioners, play a strong gate-keeping role.
Most of the doctors work in primary care – an office-based clinical setting that allows them to provide continuity of care for patients from infancy to old age. Registration with a doctor is either automatic, mandatory or strongly supported in all four countries, the report says. Doctors also provide after-hours care to their patients.
Walk-in medical clinics – a staple of Canada’s health system – are almost non-existent.
“These countries have really figured out how to hold their clinicians accountable for timely access to care,” Dr. Kiran said in the interview.
In Canada, by contrast, family doctors have more freedom over where they practice, how many hours they work and the patients they accept, the report says. A Globe and Mail story last year on Canada’s crisis in primary care found that many doctors divide their time between office-based care and practising in hospitals, nursing homes, walk-in clinics or sports-medicine clinics.
Working in primary care is becoming less attractive for many family doctors, causing them to reduce their hours or close their practices altogether. At the same time, many doctors are nearing retirement age – 14.6 per cent in Canada were 65 and older in 2022, figures from the Canadian Institute for Health Information show.
Overall, Canada has 24.4 physicians for every 10,000 residents, leaving it lagging well behind the other nine OECD countries, the report says. Norway has the most, with 50.5 physicians for every 10,000 residents.
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With fewer physicians in Canada, family doctors must step in to support other parts of the health system, including working in hospitals, which leaves less of the work force providing primary care.
Canada also earmarks 5.3 per cent of its total health budget for primary care, well below an average of 8.1 per cent among other OECD countries, the report says.
In addition, the report notes that Canada’s infant-mortality rate was 4.5 deaths for every 1,000 live births in 2020, the highest among the ten countries.
International variations in how the data are collected can affect the rankings. Canada, for example, registers a higher proportion of babies weighing less than 500 grams, with low odds of survival, resulting in higher reported infant mortality, says a separate OECD report. In 2022, Canada ranked 31st out of 38 OECD countries, that report says.
More research needs to be done on this issue, Dr. Kiran said. “I think we actually just don’t know what all the determinants are for why or infant-mortality rate is so much higher than in other OECD countries.”
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