Ontario family doctors letting patients go as caseloads become unmanageable

As millions of Ontarians struggle to a find a family doctor, those lucky enough to have one are facing a new problem: being cut from their physician’s roster due to unmanageable caseloads.

It was a breakup that Claude Silveria was not expecting. In a letter, his long-time doctor informed him that he would no longer be taking him as a patient.

“I was quite shocked because I’ve been there for like over 25 years,” Silveria told CityNews.

In the letter, his general-practitioner doctor said their last day together would be February 1, 2023. “With a heavy heart,” the doctor cited personal reasons for the change.

“I will be decreasing my patient roster size and working hours significantly,” his doctor wrote. “If you are receiving this letter, then you have been selected randomly for termination.”

Silveria said he was upset when he received the news.

“I know people who don’t have GPs,” he said. “I’ve been so lucky my entire life to have a GP and I was like ‘Oh no, now I’m one of those people who has to go to walk-in clinics all the time.'”

Silveria, who lives in Toronto, said he was also surprised to see people across the Greater Toronto Area posting online that they were in the same situation.

Physicians who drop patients from their rosters are contributing to a growing problem. The College of Family Physicians of Canada tells CityNews 5-million Canadians don’t have a family doctor, including almost two-million Ontarians.

College president Dr. Christie Newton said burnout, early retirements, and fewer medical students entering family medicine, are contributing to this. In 2022, 33.3 per cent of medical students chose family medicine, the lowest rate since 2008 and down from 40.2 per cent in 2015. For doctors already in practice, the workload has become a burden.

“We’re seeing burnout at rates that we haven’t seen forever,” said Newton, adding she’s not surprised some doctors are decreasing the sizes of their practice.

“Some of our practices have gotten quite large. Meanwhile patients are living longer and as they’re living longer, they’re getting more things,” Newton explained. “As a result, we can’t manage as many patients as a decade ago.”

The College of Physicians and Surgeons of Ontario has guidelines for doctors who are shrinking their patient rosters. They state physicians must:

• Exercise professional judgment to select which patients to remove from the practice;
• Employ a method of selecting patients that is fair, transparent, and compassionate;
• Take into account the medical needs of each patient; and
• Consider any other relevant factors, including the patient’s vulnerability, and the patient’s ability to find alternative care in an appropriate timeframe.
• Further, the College states that physicians must not selectively or disproportionately discharge difficult or complex patients.

Lack of family doctors puts pressure on the hospitals

People who don’t have a family doctor end up putting pressure on the hospital system further downstream, said Dr. Amit Arya, palliative care lead at Kensington Health.

“Primary care is the backbone of our entire health care system,” he said.

“Everything is interconnected, and we often see people coming into the emergency room who need to be admitted because unfortunately they could not get an appointment with their family doctor [or] because the wait time was too long,” he explained. “Or they did not have a family doctor and they needed a medication adjustment; [or] they needed some bloodwork and monitoring which could be done in primary care, but it didn’t happen because of these access issues.”

Dr. Arya said he is particularly worried about the upcoming holiday season’s impact on clinic hours. “Many people will be taking a well-deserved break and you know, getting some rest, and I worry about the impact of that on our healthcare system and in our hospital system as well.”

“The family doctors that I know are working very, very hard and are already stressed over the limit. There is simply not enough capacity in the system,” said Dr. Arya.

Fight over funding continues

Healthcare advocates say more funding is needed to address the concerns and encourage medical students to open family practices. Ontario, and all of Canada’s provinces and territories, are currently negotiating with the federal government over healthcare funding transfers. The provinces and territories want a higher level of funding from the federal government. So far no deal has been reached.

The Ontario Medical Association is also calling for significant funding increases.

“Every day that passes without an agreement between governments is another day Canadian patients are left waiting unreasonably long for the medical care they need,” the association wrote in an open letter signed by the OMA and its counterparts across the country.

Ontario’s Ministry of Health tells CityNews in a statement that the province has added more than 1,060 family doctors, though the ministry did not specify whether those are net-new positions, or simply replacements as doctors leave the profession. The statement also highlighted that the province is easing restrictions on getting doctors from other regions or countries licensed in Ontario. It plans to invest $42.5 million in expanding medical schools, starting in 2023.

“This expansion will add 160 undergraduate seats and 295 postgraduate positions over the next five years, making it the largest expansion of undergraduate and postgraduate education in 15 years,” the statement reads.

Newton noted that investments down the road don’t help today’s patients.

“They’re not really addressing what Canadians need right now, which is a family doctor in the community to serve as that first point of access and manage their day-to-day care needs,” she said.

With files from Jessica Bruno and Meredith Bond