"Several communities in Ontario, particularly those where teaching hospitals are located, are being unfairly treated due to an antiquated and inaccurate way of calculating the Family Doctor to Population ratio now set by the Province"

Provincial Standards for Family Doctors Flawed

6 May 2007

• Policy Paper
• Authored by the London Chamber of Commerce Federal / Provincial Affairs Committee
• Approved by 2006/2007 London Chamber of Commerce Board of Directors in February 2007
• Presented to and adopted by the Ontario Chamber of Commerce Conference in May 2007

The Issue

Ontario has too few Family Doctors. Several communities in Ontario, particularly those where teaching hospitals are located, are being unfairly treated due to an antiquated and inaccurate way of calculating the Family Doctor to Population ratio now set by the Province at 1:1380 – in other words one Family Doctor for every one thousand three hundred and eighty people in any given community.

The current provincial standard fails to take into account that these same communities are considered regional health care centres and therefore have considerably more pressure on them to provide a wide range of health care services to Ontarians beyond those that live in that particular City. As most of these teaching hospitals are in some way affiliated with Universities and Colleges, there is the added responsibility of providing medical care to over 63,000 students in these same communities.

Specialty services such as Regional Cancer Centres and Children's Hospitals also require a large number of doctors but here again they are not practicing family medicine – they are specialists and yet they are counted in the overall totals when calculating the provincial standard for under-serviced communities.

Furthermore, the provincial standards fail to recognize that while teaching hospitals do indeed have doctors on duty, they are not practicing primary care family medicine. Indeed their focus is on Specialty or Teaching roles in relation to tertiary care facilities.

Background

Although raw numbers of physicians listed as Family Practitioners with the Council of Physicians and Surgeons of Ontario (CPSO) indicates that there are sufficient numbers, a closer examination reveals that less than half of those listed are in primary care family practice – a number that in London, Hamilton, Toronto or Ottawa is insufficient to meet the growing health care needs of their regional population.

There is no question that the issue of chronic shortages of family practitioners is prevalent right across Canada. The cause of these shortages has been outlined by both the Medical Council of Canada and the Chair of the Department of Medicine at the UWO School of Medicine.

They include:

• 10% cutbacks in medical schools in 1993-96 due to errors in projections;
• The large physician population reaching retirement age;
• Declining family physician incomes vs. increasing incomes for specialists (Some experts peg the annual family doc. income at between $80-85K per year)
• Family physicians working fewer hours

As a result a number of Ontario communities are experiencing hardships due to the growing lack of Family Doctors.

We are also aware that several communities in Ontario have taken on a variety of initiatives to bolster their complement of family physicians.

Although Ontario has seen marginal improvements to the total number of doctors

available in the province, there remain over one million Ontario residents without a doctor – down from 1.2 million in 2005.

And there is more sobering news in the recent Ontario Medical Associations (OMA) report:

• In 2005, Ontario had a net loss of 14 doctors to other provinces; B.C. had a net gain of 113 doctors.
• Since 2003, physician supply has been increasing, but Ontario continues to rank seventh in Canada in number of MDs per 100,000 people.
• More than 20 per cent of Ontario doctors are over the age of 60 and 11 per cent are over 65.

The medical association estimates Ontario still needs more than 2,000 doctors to end the shortage. The lack of physicians is having a wider effect across the health system, including long waits to see specialists, emergency room overcrowding and a large patient population without access to a family doctor, the OMA report said.

Summary

While Ontario seems headed in the right direction, the chronic shortage of Family Physicians in Ontario will not disappear in the short term. The provincial government must continue to accelerate efforts to graduate more doctors, retain more of the doctors it already has and repatriate those that have left for the United States and other jurisdictions. In addition, it will need to address the earnings inequities between family doctors and specialists, work with accredited bodies to ensure that we gain access to as many foreign trained health care professionals as possible and sort out those issues associated with OHIP payments.

In the short term however the provincial government can correct the inequitable situation that exists between those communities that are designated as under-serviced vs. those that are not. Clearly communities that are designated as under-serviced have a huge advantage over the rest both from a health care perspective and an economic development perspective.

Under-serviced communities are presently entitled to a maximum of a $55,000 incentive package per case (doctor) with which they can attract doctors to their community. These monies can be used to pay down (off) graduate loans, moving expenses, turn-key options and a variety of other bonuses and benefits.

Obviously these communities have a distinct competitive advantage over other communities and consequently the tens of thousands of residents in those non-designated communities that by virtue of a flawed formula are left without a family doctor.

When looking at just London's situation in isolation, if we take the original total number of doctors listed in the CPSO registry (the number the province uses to determine if a community is under-serviced) the total is an impressive 491 doctors – well within guidelines for under-serviced designation. When we deduct all of the doctors included in our list of exemptions in the recommendations that follow, the real number is 192 doctors available for family practice – well under the provincial threshold and again, leaving some 30,000 to 70,000 Londoners vulnerable and without access to a family doctor.

Recommendations

The Ontario Chamber of Commerce Urges the Governments of Ontario to:

1. Re-calibrate the formula used to determine if a community is deemed to be under-serviced or not - maintaining the current ratio of one doctor to every thirteen-hundred and eighty residents (1:1380)
2. In calculating the number of doctors in any given community, exclude doctors who are fully employed in a teaching capacity with universities or colleges as they are not available for service as a family physician.
3. Similarly exclude, specialists in areas such as cancer research, children's hospitals, transplant programs, pediatrics, anesthesia, radiology and nuclear medicines, surgery, orthopedic surgery, internal medicine, neurology, emergency, psychiatry, palliative, Ob/Gyn and those doctors working in regional health units, WSIB, regional coroners offices, dentists, Extendicare, ear clinics and retirees as they are not available for family practice.
4. Use the most up-to-date population count in determining their ratio.

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