When Linda Thomas wants to see her family doctor in person, she makes a six-hour, 540-kilometre drive from the Northern Ontario town of Elliot Lake to Brampton, the suburb of Toronto where her physician practices.
Ms. Thomas, a 78-year-old retiree, knows this is not ideal. But she can’t find a doctor willing to accept new patients in Elliot Lake, just like she couldn’t find one in Woodstock, the Southwestern Ontario town she moved to in 2013 before departing for Elliot Lake. Ms. Thomas has been getting by with phone appointments and occasional long commutes to her Brampton doctor for more than a decade.
“If I could find one up here in Elliott Lake, I would definitely change doctors. But at my age who knows how long you’ve got? By the time you find a doctor,” she said, laughing, “you’re dead.”
Ms. Thomas is one of approximately 670,000 Ontarians who live more than 50 kilometres from their family doctor, according to new data to be released Thursday by the Ontario College of Family Physicians. She is also among the nearly 133,000 people in the province who live more than 200 kilometres from their doctor, a figure that underscores the severity of the primary-care shortage in some parts of the country.
“It’s very, very worrisome,” said Mekalai Kumanan, president of the OCFP and a Cambridge family doctor who herself cares remotely for patients all over the province.
Dr. Kumanan said plenty of public attention has appropriately been paid to the 2.52 million people in Ontario who didn’t have a family doctor as of last year. That figure is up from 1.83 million in 2020, according to data based on Ontario Health Insurance Plan records, also released Thursday by the OCFP.
“We haven’t heard as much about the patients who do have a family physician on paper, but in reality, you have to ask, ‘How likely are they to be able to access that family physician given how far away they are?’” she said.
Archna Gupta, the physician and researcher who compiled the new figures, found that patients were typically better off being near their doctors. The further away they lived, the less likely they were to be screened for cancer and the more likely they were to visit the emergency department for non-urgent health concerns.
“The most stark finding was that the further individuals lived from their family doctor, the more likely they were to have no primary-care visits – not to their own doctor and not to any other doctor, either,” said Dr. Gupta, a Toronto family doctor and researcher with Upstream Lab, part of the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.
Dr. Gupta embarked on the new research after noticing that some of her own patients asked to stay on her roster after moving to places as far away as Windsor and Ottawa. Unable to find any other Canadian studies exploring the issue, she analyzed de-identified OHIP billing records and postal-code data for doctors and patients to see how many were located more than 50 kilometres apart.
Dr. Gupta’s study, which has yet to be published in a peer-reviewed journal, was a snapshot covering two years of Ontario data from April 1, 2021, to March 31, 2023, meaning she can’t say if the situation has worsened over time or if it’s occurring outside Ontario. But anecdotally, some physicians elsewhere in Canada say they’ve seen the same trend.
Rita McCracken, a family physician in East Vancouver and a primary-care researcher at the University of British Columbia, said that more of her patients, unable to find new doctors, are asking to remain on her roster after they move. Others move, join new practices, then call her when their new physicians retire or switch their focus to something other than cradle-to-grave primary care.
“Then they came back to me to say, ‘Will you please take me back, because I’m having to wait six hours in emergency to get my refills. I’ve been trying to go to walk-in clinics, but the lineups are full by the time I get there.’ They’re pretty desperate.”
Part of the shift reflects a pandemic-era change in medical practice, as doctors and patients alike have grown more accustomed to phone and video appointments. Dr. McCracken said long-distance doctoring, while not ideal, can suffice for patients in good health or with stable chronic illnesses. “But where things really fall apart,” she said, “is if something starts to go wrong, or there’s a new acute presentation.”
That’s when patients who live far from their doctors turn to the emergency room as a last resort for primary care, Dr. Gupta’s research found. For example, just more than 9 per cent of Ontario patients who live between 151 and 200 kilometres from their family doctors visit the ER for non-urgent reasons compared with 5.6 per cent of patients who live less than 10 kilometres from their doctor.
Cancer screening can also fall by the wayside. For example, Dr. Gupta found that just more than 60 per cent of eligible women who lived less than 10 kilometres from their doctor got a pap test to screen for cervical cancer compared with 48 per cent of women who reside more than 200 kilometres away.
Similar disparities were found in screening rates for breast and colon cancer, Dr. Gupta added.
The Ontario government has been trying to tackle the family doctor shortage with a suite of initiatives, including announcing $110-million in funding this year for 78 new and expanded interprofessional primary-care teams, as well as increasing the number of spots for family medicine residents and planning to open two new medical schools in Brampton and Vaughan in the coming years.
The province has said in the past that its figures – extrapolated from surveys – indicate about 1.3 million Ontarians are without a family doctor, fewer than the OCFP’s figures.