With ERs under strain, primary care also 'in crisis,' health experts warn

With emergency room wait times soaring in Ontario, many doctors are sounding the alarm over the obstacles primary health care providers face in alleviating some of the strain on hospitals.

"Like the rest of our healthcare system, we are seeing that family medicine is facing a crisis," says Dr. Mekalai Kumanan, president of the Ontario College of Family Physicians.

Kumanan says there are a number of issues plaguing primary care, including a shortage of family doctors, a backlog of non-emergency care delayed by the pandemic, lack of team-based care settings and an early onslaught of respiratory illnesses.

"Ultimately, we know we see better health outcomes in patients who are connected to family physicians," said Kumanan.

Currently, 1.8 million patients don't have a family doctor, a number Kumanan says is likely to increase to three million by 2025.

She says fewer medical students are choosing family medicine, while younger family physicians are moving away from the discipline to work in other fields — and others are retiring or facing burnout.

In addition, many family practices have been working through a large accumulation of diagnostic tests that have been delayed as the province's healthcare system was bombarded during the pandemic.

Dr. Allan Grill, the chief of family medicine at Markham Stouffville Hospital says despite clinics like his, running at full capacity, it takes an extraordinary amount of work to catch up.

"At the same time you're trying to catch up on cancer screenings, you still have people coming in with respiratory illness," says Grill.

Both he and Kumanan say backlogs like these would benefit from a team-based healthcare approach, a model both say has helped with backlogs, but is only available to 25 per cent of the population.

The model provides extra funding from the Ministry of Health for clinics to hire health professionals such as nurses, nurse practitioners, dietitians, occupational therapists, pharmacists and social workers to work alongside family physicians. They say it connects doctors with better healthcare support, which ultimately provides better patient outcomes.

"We can delegate things. That opens up time for us," says Grill.

Others say we still need to readjust policies brought on by the pandemic, including the early pivot to virtual care.

Most family physicians in Ontario are seeing patients in person, though some clinics still insist on conducting appointments virtually if a patient is exhibiting symptoms or if they aren't able to produce a negative COVID test.

"Our family doctor doesn't accept patients in person with cough, runny nose, flu or COVID symptoms," one Toronto walk-in clinic told CBC News.

Dr. Anna Banerji, an infectious disease specialist and associate professor at the University of Toronto's faculty of medicine, says these policies are a remnant from early in the pandemic. 

"At the beginning, it was understandable because we didn't understand how severe COVID could be and the fact that someone could get it and potentially have long symptoms or die from it."

Now, she says primary caregivers should be vaccinated and able to see patients in person using appropriate personal protective equipment, including masks and gowns.

"We need to switch gears now," said Banerji. "I think that especially when we're having a crisis with influenza, RSV and COVID."

Other options available to avoid emergency rooms

Grill says offices that can't accommodate in-person visits at the moment should be encouraged to provide other options.

"I would say to those providers that if your office can't accommodate the usual volume of sick or acutely ill patients with respiratory symptoms, please make sure you communicate to your patients where else they can go."

He says there are interventions short of the ER, such as cough, cold and flu clinics that provide care for the type of illness Ontario is currently inundated with.

Dr. Dina Kulik, a Toronto-based pediatrician and the director of Kidcrew Pediatrics, says there are ways to continue seeing symptomatic children so they can avoid the emergency room.

She says her clinic has children with symptoms come in at certain appointment times to avoid getting immunocompromised or healthy kids sick.

"Before 3 p.m., there are no sick children in the office."

She says it's still best for patients to be examined in clinics so they can avoid overcrowded emergency rooms.

"It's best to avoid the [emergency ward] when you can, unless your child really does need emergency intervention." she says. 

Kulik says most of the illnesses currently affecting children are viral and will get better over time without antibiotics.

Another part of the problem with ER wait times, says Kulik, is the anxiety around RSV. She says many families are taking their children to ERs out of fear they may have contracted the virus.

But Kulik says this won't help confirm a diagnosis.

"Unless a child is admitted, they're not going to be swabbed for RSV or other viruses. Most things can be managed at home, but I think there's a lot of fear."

Simple prevention still best tool, doctors say

Even as some clinics continue to only see non-symptomatic patients or conduct appointments over the telephone, nearly all doctors say the best way to avoid spreading sickness and contributing to strain on Ontario's health-care system is simple prevention.

"If you're sick, wear a mask. Keep your hands very, very clean and really take a couple of days off if you're not feeling well because we're just spreading it around," said Kulik.

Despite a loosening of masking restrictions, many say it is still a very good idea as we get further into the fall and winter seasons when people spend more time indoors.

"My kids are in school masked and knock on wood, they haven't been sick yet this viral season," Kulik added.

Banerji also says there are a lot of young children who are not getting the COVID vaccine or flu shot. She says getting more children immunized would make a huge difference in helping the wait time crisis.

"Everyone has COVID fatigue, including myself," she said. 

"I wish it would go away, but it's not gone, it's here. So we need to do the most we can."

Grill says all of these preventative measures can help take the strain off an overloaded healthcare system.

"It gets overwhelmed and you end up spending more money out of a publicly funded system that we are trying to save."

The last thing Ontarians can do, Grill adds, is contact local elected officials.

"Ask your MPP if this is the system that Ontarians should dream about. Can we do better?"