But as a Canadian citizen, he has spent much of the past two years looking for a new doctor since his family doctor retired. So elusive is the effort, Martinez said, he sometimes resorts to seeking care in Guatemala. “Not being able to get proper health care is very concerning, especially comparing it to the subpar health care we have in Guatemala,” Martinez said. Martinez has asthma and ADHD. He said he currently relies on virtual consultations with Guatemalan doctors, who can give advice but cannot prescribe outside the country. He said he can’t get his ADHD medication refilled in Canada without a family doctor. Instead, Martinez relies on friends and family abroad to send him asthma inhalers, which can be bought in Guatemala without a prescription. “It’s life-threatening,” Martinez said. Martinez doesn’t have a family doctor, so he relies on friends and family to send him asthma inhalers from Guatemala. (Francis Ferland/CBC) There are more than 1,200 family doctors listed in Ottawa on the College of Physicians and Surgeons of Ontario (CPSO) website, but a CBC News analysis found only three are currently accepting new patients. The wait time to be matched with a family doctor in the Ottawa area can be twice as long on average as the wait in the greater Toronto area, according to Ministry of Health data obtained by the CBC. The issue has doctors and patients renewing calls for changes to the primary care system.
Few doctors accept patients
According to the CPSO registry, 1,246 physicians listed family medicine as a specialty and operated a practice in Ottawa. Since the registry is not always up-to-date, CBC cross-referenced its data with family practice listings in Ottawa. CBC was able to identify 484 different practice locations, of which 124 were confirmed to offer family medicine. There were 584 doctors in the CPSO associated with these practices. The majority of the remaining, unseen physicians from the registry did not list a confirmed family practice. This includes physicians who report working primarily in hospitals, sports medicine clinics, and other fields. Among the 124 clinics offering family medicine, only three reported accepting new patients. Each of these three clinics had a single physician accepting new patients at the time of publication. As of 2018, patients in and around Ottawa waited on average longer to be matched with a family doctor than people elsewhere in the province. According to data from the Department of Health obtained by the CBC through a freedom of information request, the Champlain Public Health Region — which includes Ottawa and three neighboring health units — recorded the longest average wait time of any region in the province. Health Care Connect wait times in the Champlain region have averaged 225 days over the past four years — higher than any other health region in Ontario. Champlain also had the lowest pass rate among the 14 provincial health districts. More than 35,000 registered patients were never matched with a family doctor — about one in three in the region.
“It’s an endless pit of need”
Health professionals who spoke to the CBC said the lack of family doctors means many more patients are now showing up to see specialists with serious conditions – some of which could have been treated earlier in primary care. “Family medicine is what we do — we keep people from falling through the cracks of the system, and then the cracks got so big,” said Dr. Claudia Hubbes, a family physician at Ottawa’s Rosemount Clinic. We stop people from falling through the cracks of the system, and then the cracks got so big.- Dr. Claudia Hubbes, Rosemount Clinic Hubbes said her clinic had to invest in a new phone system just to handle the overwhelming number of cold calls from the public asking if anyone was taking new patients. To accommodate the demands of her patients, Hubbes said she now works longer shifts, sometimes up to 13 hours a day. “It’s a never-ending pit of need and people who are desperate,” Hubbes said. “You’re doing your best, but it’s not enough.”
How to solve the problem
Complex factors underpin the acute shortage of family physicians in the Ottawa region, said Dr. Claire Lindy, chair of the department of family medicine at the University of Ottawa. On paper, Lindy said “it looks like there are enough family doctors” to serve the capital. But he said many of those trained in general family medicine work in other fields. The actual number of doctors providing comprehensive, continuous family medical care is, in her words, “much, much fewer.” Liddy said many figures showing the number of “unattached” patients in Ottawa who do not have a family doctor are actually underestimates. Not everyone without a doctor is enrolled in Health Care Connect, he said. Large numbers of Quebec patients seeking care in Ottawa are also being left out of the picture, Liddy said, although they are increasing demand for family doctors. Despite hosting a medical school, Ottawa struggles to retain family medicine graduates, Liddy added. One possible reason that many critics have pointed to is the pay incentive, or lack thereof, in family medicine. The so-called fee-for-service model, which requires family doctors to charge the province per patient visit, is unattractive to new doctors because of the workload and rising administrative costs. “New graduates really haven’t been interested in participating in these models because it’s not very viable from a business perspective,” Liddy said. New graduates have really not been interested in participating in these models because it is not very viable from a business perspective.- Dr. Clare Liddy, University of Ottawa It is also the payment system used by many family physicians approaching retirement age. Liddy said new family doctors are interested in joining equity-based practices, meaning doctors are paid based on the number of patients on their roster as opposed to the amount of daily appointments. According to Ministry of Health figures, there are 52 of these capital-based practices operating in Ottawa. WATCHES | Payment models and physician recruitment:
New graduates aren’t attracted to the old models of family medicine, says department head
Dr. Clare Liddy, chair of the department of family medicine at the University of Ottawa, said the old models of family medicine are not “viable from a business perspective” for new graduates.
Alternative models are limited in Ontario
Some models, such as a ‘family health team’, also receive funding for allied health professionals such as nurses, social workers, pharmacists or psychologists to work with family doctors. Liddy said these supports help provide better care to patients and create a more attractive work environment for family physicians. But these alternative models are very limited in Ontario — new family health groups have not been allowed to open in the province for over a decade. During the pandemic, more than two dozen family doctors across Ontario wrote a letter to then-Health Minister Christine Elliott, calling on the province to open up the capitation payment model to all primary care doctors. The petition gathered nearly 8,000 signatures. The Department of Health would not comment on whether it would consider relaxing restrictions on capital payment models. The statement said it is trying to speed up the process for health care workers trying to register in Ontario — including those trained outside the province or internationally. Ontario will now allow foreign-educated doctors to receive training in Ontario, but only “in exchange for a commitment to practice medicine in an Ontario community outside of Ottawa or Toronto and adjacent municipalities.” The ministry also said it is creating a total of 455 new medical school positions over the next five years. Meanwhile, Martinez said he doesn’t expect to be matched with a doctor through the Health Care Connect waiting list anytime soon. He’s still looking for a doctor himself — he drives around and looks for signs at clinics, makes phone calls and communicates with people he meets. He said he hopes to find one through the connections he has made in his community. “It’s not the government providing the support,” Martinez said. “It’s the Canadian people who are actually giving the support.”
