When Barry Armstrong was 22 and working as a repair apprentice at Algoma Steel in Sault Ste. Marie, Ont., he didn’t think much about his health.
But in 1961, eight years before public health care was established in the province, he was approached about joining a new union-sponsored clinic that would offer primary care with no out-of-pocket costs. Given Mr. Armstrong earned $4,000 a year, the $135 he was asked to contribute to fund the building of the new facility was a big ask – equivalent to more than $1,000 today – but he decided to think long term.
That clinic, eventually named the Group Health Centre, opened in 1963, and would make history as the first centre of its kind in Canada, combining primary and specialty care under one roof to thousands of steelworkers who had negotiated a lower wage in exchange for health care at the GHC for themselves and their family members. The several thousand original founding members would become known as “first brickers.” To this day, their special status awards them free parking tokens that can be used at any of the centre’s three facilities.
The Group Health Centre during construction at 240 McNabb Street in Sault Ste. Marie on May 3, 1963.Gord Gallaway/Group Health Centre
More than six decades later, Mr. Armstrong, now 85, has long since retired. And with his age advancing, his health is top of mind. But instead of resting easy, knowing that his $135 investment would ensure he had health care in his final years, as of June 1, he will no longer be a patient of the Group Health Centre.
At the beginning of this year, the centre’s leadership dropped a bombshell on the community: On the last day of May, 10,000 of the GHC’s 60,000 patients would be derostered, or cut off from accessing primary care at the centre, because of a shortage of family practitioners that has stretched the facility’s resources. Several thousand members have already lost access to primary care in the past few years because of practitioners retiring or leaving health care, and the upcoming derostering likely won’t be the last.
Now, Mr. Armstrong is reckoning with the fact that the sense of security he invested in so long ago has vanished almost overnight. “I know I’m never going to have a family doctor before I die,” he said.
The derostering announcement shocked the 114,000 residents of Sault Ste. Marie and the surrounding Algoma district, given GHC’s 61-year track record of being one of the largest providers of primary and specialty care in the area. And it’s sparked a lawsuit from the union, some members of which helped build the clinic in the first place.
“The Group Health Centre was stolen from us,” said Mike Da Prat, president of the United Steelworkers Local 2251. He joined the centre in 1967 and now, at 76, is among those who will lose access, along with his wife, daughter, son-in-law, grandchildren and great-granddaughter. “Whether people like it or not, we own that building.”
Mr. Armstrong, 85, will no longer be a patient of the Group Health Centre as of June 1.
At the moment, patients are derostered based on which primary care providers are leaving, or have left. But earlier this month, union members voted in favour of filing an injunction and lawsuit to stop derostering first brickers, and instead prioritize them and move them to other doctors’ lists.
For now, they are still among the thousands of people whose future health care is uncertain. It’s a dire situation that mirrors a trend happening across the country, with millions of people unable to access primary care, putting their long-term health at risk and adding strain to already-stretched emergency rooms.
Sault Ste. Marie Mayor Matthew Shoemaker believes the steps taken by the provincial government aren’t nearly enough to address the primary care crisis in Northern Ontario, which is too geographically removed from Toronto to garner an urgent response from the province’s health ministry.
All over Canada, fewer doctors are choosing to go into family medicine and many are leaving the profession, citing its punishing hours and never-ending paperwork. The Ontario College of Family Physicians has warned that by 2026, 25 per cent of people in the province could be without primary care, with remote and rural areas affected the most.
Ontario has taken some steps to address the situation, including the launch of an artificial intelligence program to transcribe and summarize patient visits to help doctors save time, and the announcement of a new medical school at York University opening in 2028.
But for Matthew Shoemaker, mayor of Sault Ste. Marie, these actions aren’t nearly enough to address the primary care crisis in Northern Ontario, which he said is too geographically removed from Toronto to garner an urgent response from the province’s health ministry.
“I can guarantee you that if there was a loss of this same proportion of patients in Southern Ontario, or maybe even the same number of patients, it would have had the minister there the same day.”
Although the derostering isn’t official until May 31, many patients have discovered they’ve already been cut off because their doctors are overbooked or have left the clinic. For Mr. Armstrong, who recently couldn’t get an appointment and spent five hours in a hospital emergency room to get a prescription for a painful rash, the new reality looks bleak.
“Nobody watches your back when you don’t have a doctor,” he said.
Family physician Dr. Melissa Hemy examines nine-month-old Kinsey Cross during a regular check up at the GHC.
On a recent spring morning at the Group Health Centre, Jennifer Cameron, a nurse working with surgeon Matthew Laviolette, is on the phone with the IT department, trying to connect her computer to Audrey Hepburn – the printer, not the late actress. Instead of being identified by its brand name and numbers, each printer throughout the main building is named after a celebrity – Nicolas Cage and Gwyneth Paltrow are others – which is a fun way to more easily differentiate them and remember where they’re located.
It’s a quirky anecdote, but it illustrates the kind of ingenuity that has kept GHC humming all these years. The outdated design of the original building means the nurses and doctors tend to work in cramped quarters, so leadership has had to come up with creative solutions to use every square metre to its maximum potential. That’s why the building services staff work out of an alcove under the stairs that was retrofitted into an office reminiscent of Harry Potter’s bedroom.
But efficiencies and creativity can only go so far, and as the May 31 cut-off date nears, the exhaustion and unease are palpable.
GHC leadership has had to come up with creative solutions to maximize space, which is why the building services staff work out of an alcove under the stairs that was retrofitted into an office.
On a different morning that same week in April, family doctor Melissa Hemy is scrambling to see her patients before dashing to take her son, who recently broke his arm, to his own medical appointment. Down the hall, nurse Mary Lewis is on the phone with a patient who’s having a bad reaction to a new medication. Adrianna Schamp, the family doctor working with Ms. Lewis, didn’t prescribe the drug, but as the patient’s primary care provider, it falls on her desk to find an alternate treatment.
Later, as Ms. Lewis sits to tackle a mountain of tasks that have piled up over the weekend, including communicating test results to patients and filing referrals for specialist appointments, a woman who is accompanying an elderly family member to an appointment places a handwritten note on her desk. On it, the woman explains she recently lost her family doctor and asks to be added to Dr. Schamp’s roster.
“I probably get five of them a day just asking me if she’s taking patients on,” Ms. Lewis said.
Primary care nurse Gillian Schryer prepares eight-year-old Holden Siitse for his vaccinations as his grandmother Cheryl Siitse stands by. Ms. Siitse says she is losing her family doctor at GHC and most of her family doesn’t have a primary care physician.
Upstairs at another GHC family practice, nurse Gillian Schryer prepares a vaccine for Holden Siitse, an eight-year-old who is here to catch up on some of the routine immunizations he missed during the pandemic. The local health unit recently sent suspension warning notices to all students in the area who are behind on their vaccines, keeping nurses like Ms. Schryer busy trying to meet the extra demand.
Holden’s grandmother, Cheryl Siitse, brought him to the appointment and had hoped she would be able to see her family doctor right after. Ms. Siitse, 59, has been a patient at GHC for the past 40 years, but recently learned her family doctor would be retiring. She thought she would be able to ask her doctor to write her a batch of prescriptions to keep her medication in stock, but her appointment was cancelled at the last minute.
Ms. Siitse sees a vascular surgeon and an endocrinologist in Sudbury, a more than three-hour drive away, so she’ll have to try to contact them to manage the nine prescriptions she currently takes.
“I find it shocking that a doctor could just leave patients, just like that,” Ms. Siitse said. “But I guess there are no replacements.”
What’s particularly troubling about the problems affecting the Group Health Centre is that it’s a health care model that should be a natural safeguard against the loss of doctors and nurses. The centre’s 31 family physicians and 5 nurse practitioners – all of whom are on salary – work closely together, each taking on as many as 1,800 patients. If a nurse calls in sick, a team of supervisors finds a replacement.
If one of the centre’s patients have an urgent concern and need an appointment, they can access the centre’s same-day clinic. There’s diagnostic imaging on site and a blood lab, as well as a social worker and other outpatient programs.
Minor procedures, such as cyst removals or vasectomies, are also done at the centre, reducing strain on the Sault Area Hospital. And having a team of 26 specialists on site means family doctors can often bypass the referral process by consulting with their colleagues while a patient waits in an exam room. After family physician Jodie Stewart took a photo of a concerning skin lesion and brought it upstairs to one of the dermatologists, the patient received a skin cancer diagnosis within a few days instead of waiting several months.
Dr. Stewart said the only reason they were able to hold off on the mass derostering until now is because of the clinic’s innovative set up.
Family medicine physician Dr. Jodie Stewart examines patient Jeannette Tummillo, 76, at Stewart’s practice at the GHC. Dr. Stewart also serves as the CEO and Board Chair of the Algoma District Medical Group.
“Our community is very shocked and they should be shocked and they should be angry about this,” said Dr. Stewart, who is also the president of the Algoma District Medical Group, representing physicians at the centre. “But it hasn’t happened sooner because of the Group Health Centre and the support model that it offers the physicians.”
In the creation of his 2002 Royal Commission on the Future of Health Care in Canada, Roy Romanow consulted with the leaders of the Group Health Centre and cited its unique model as an example for comprehensive care that the rest of the country could learn from.
But if it works so well, why is it facing the worst crisis in its history?
Lil Silvano, president and CEO of the GHC, says the derostering is the result of a “perfect storm,” with some planned retirements and unexpected departures coming as fewer locum doctors, who take on temporary assignments in underserved areas like the Sault, were available to work there.
Lil Silvano, President & CEO of the GHC, says the derostering of its patients is the result of a 'perfect storm'.
“All of those sources of where we’ve been able to provide care basically dried up,” Ms. Silvano said.
As to why there aren’t new recruits to fill their spots, more than a dozen nurses and physicians working at the Group Health Centre and the Superior Family Health Team – another large family practice in the Sault – pointed to a series of unnecessary demands put on primary care physicians, and policies that punish doctors for trying to work together.
At the Superior FHT, started by former GHC physicians, 7,000 patients are on the roster and another 3,000 access the clinic through outpatient programs. The team’s leadership say they don’t receive enough money from the province to meet the growing demand – and they face punitive measures if they try to work with the GHC to provide timelier care.
Stacy Tkachyk, the team’s physician group co-lead, has developed an expertise in intrauterine device insertions. Considering there are only two full-time obstetricians in the Sault and surrounding area, she does a lot of IUD insertions to reduce the pressure faced by specialists and help patients get care. Despite the need in the community, Dr. Tkachyk doesn’t see many patients from the GHC because of a longstanding provincial policy that dissuades this type of co-operation.
Under the government’s family health team model, physicians are paid based on the number of patients on their roster instead of the number of services performed. But if those patients see another family provider, such as at a walk-in clinic or for an IUD insertion with Dr. Tkachyk, the province will claw back the cost of that visit.
The policy was designed to incentivize family health providers to be available as much as possible, including after hours and on weekends. But in the context of a crumbling primary care system, it’s also leading to longer wait times and less access for patients.
“We’re humans. We can’t work 24/7. So on a weekend when I actually need a day off, if my patient gets a bout of shingles, they have to go to a walk-in. I get dinged for that because I need a day off,” said Dr. Tkachyk.
Alan McLean, clinical lead of the Superior FHT, runs a memory clinic. But they almost never get referrals from GHC because the government will impose a penalty. “So they send everyone to the geriatric clinic at the hospital, making their wait time eight months to a year when we can see them in a month or two.”
Dr. Alan McLean, clinical lead of the Superior Family Health Team, and co-lead Dr. Stacy Tkachyk, at the SFHT building in Sault Ste. Marie.
Doctors at the Superior FHT are often reluctant to refer patients to GHC’s family physician-led programs for the same reason. In some cases, family doctors will accept the monetary hit, given the need in the community is so high. But it shouldn’t be this way, Dr. Tkachyk said.
As for the overwhelming administrative burden on doctors, Ontario has recently announced new initiatives to cut down on paperwork, such as the expanded rollout of artificial intelligence scribes and a plan to limit the ability of employers to ask for sick notes.
It might make a dent in the pile of paperwork, but doctors say bolder action is needed.
Physicians spend 19 hours a week, on average, on administrative tasks, according to the Ontario Medical Association. Group Health Centre family doctor Annie Cook, who recently relocated to the Sault after working in primary care in small town in England, has noticed a major difference in the types of forms physicians in Ontario are expected to handle.
“If you want to see a chiropractor, why does your insurance company need me to sign off?” Dr. Cook asked.
Paperwork will never be eliminated. But Dr. Cook questioned why more isn’t being done to make the process more efficient. Britain uses a centralized referral system, which means that primary care providers have to fill out one form, instead of spending hours tracking down the right specialist who might accept a new patient.
“I didn’t have to go hunting for who was accepting referrals, which is half of what we do,” she said. “We send a referral off and then we get a letter back a month later saying they’re not accepting referrals and they have to find somebody else to send it to and it’s just this back and forth, which is bananas.”
A sign welcoming people to Algoma’s friendliest city, Sault Ste. Marie. With the May 31 deadline fast approaching, deepening worry is settling across the city.
With less than a week to go until the May 31 deadline, deepening worry is settling across the Sault.
A task force spearheaded by MPP Ross Romano meets regularly to try to come up with a solution. And GHC leadership is in talks with the province for a request filed months ago to have $8-million in new funding to support primary care. (The province recently rejected a separate $3-million proposal from the GHC leadership).
In a statement, Hannah Jensen, spokesperson for Ontario Health Minister Sylvia Jones, said the province is committed to working with the GHC to ensure anyone who wants primary care can get it, adding that the government will have “more to share on these next steps in the coming days.”
Mr. Da Prat with the United Steelworkers Local 2251 is focused on legal action that could stop the Group Health Centre from derostering the original members whose wages literally funded the building of the facility.
Jonathan DellaVedova, a pediatrician at the Group Health Centre and grandson of a first bricker who became a patient himself as a baby, remains an ardent defender of the centre’s model, but knows that recruiting new physicians isn’t going to alleviate the crisis anytime soon.
“There just won’t be enough family doctors to cover all of the patients in this province overnight. So you have to start looking at other solutions,” he said.
And while the primary care crisis is affecting much of the country, Dr. Stewart noted it’s more extreme in the north, in part because it can be hard to recruit primary care providers to work in an area that is so vastly different than an urban environment.
Dr. Jodie Stewart says the primary care crisis affecting much of the country is more extreme in the north, where it can be hard to recruit primary care providers to work outside an urban environment.
“Until you’ve tried to deliver health care in this environment, you don’t know what it’s like to be sitting with a critically ill patient who needs a specialist that doesn’t exist in your community in the middle of a snowstorm,” she said. “That’s a situation you can’t imagine if you only work in downtown Toronto.”
One small glimmer of hope came when two of the former GHC physicians, whose departures affected 3,000 patients, announced this month they will open a new clinic and take those individuals on at their new standalone practice. But that isn’t a long-term solution to what is clearly a more systemic primary care crisis across Canada.
As Dr. Stewart sees it, there is only one way forward: Dismantle the current structure of primary care, which puts physicians at the top of the hierarchy and makes them the point person for everything. Instead, she says, health professionals should work as team members who are each responsible for patients based on their skillset. In other words, if a patient has a sore knee or needs mental health support, they should be able to call a physiotherapist or social worker directly, instead of waiting for a referral from their family doctor.
“If we need to service all the people with the same number of family doctors that we have, it’s just using everyone in the system to their highest capacity,” she said. “Everything should circle around the patient.”
It will mean challenging some longstanding practices, including letting health professionals other than doctors bill OHIP, but it must be done, Dr. Stewart said, along with more funding from the province.
“We have an amazing model that has supported physicians and prevented this from happening years ago,” Dr. Stewart said. “We would just like it to be supported and, to be honest, I’d like nothing better than just to go back to my office and see my patients and do my job.”
Dr. Phil Catania says goodbye to nine-month-old Easton Hurley and mom Holly Hurley after a routine check-up. Dr. Catania, 78, is retiring for the second time, and as of May 31 his patients will be derostered.