Family doctors deny they're causing Ontario's emergency room problems

Family doctors are pushing back against claims that they are partly responsible for the woes of hospital emergency rooms across Ontario by limiting patients' in-person appointments.

Ontario Health has just released a new set of statistics showing another month of record-high wait times in the province's emergency departments.

The figures show patients who were admitted to hospital in May spent on average 20.1 hours in the ER before getting a bed in a ward. That matches the highest average wait time ever recorded in Ontario — which was at the peak of the Omicron wave of COVID-19 in January — and is more than seven hours longer than the wait reported in May of 2021. 

While health-care experts say the root causes of the emergency room backlogs include staffing shortages and full hospital wards, some people in the health system are pointing to family doctor access as a contributing factor. 

In response to CBC News coverage of the situation in Ontario emergency rooms, some patients reported they had to go to the ER because their family doctor wouldn't or couldn't see them in person. 

But Dr. Liz Muggah, president of the Ontario College of Family Physicians (OCFP), says a shortage of family doctors plays a far bigger role in the emergency room crunch than any limits on in-person medical appointments.   

"Obviously, it's a problem if patients are not able to get in to see their family doctors in person in a timely way, said Muggah in an interview with CBC News.

"The vast majority of family docs are seeing patients in person and are striking that right balance between virtual and in person," said Muggah. 

According to surveys by the OCFP, there's a range of factors putting a heavy workload on family doctors in Ontario right now: 

• Family doctors are seeing a rise in the severity of illnesses among their patients, a result of deferred procedures or delays in seeking treatment during the pandemic.
• The province is seeing a fresh wave of COVID-19 infections and a surge in other respiratory illnesses that had been suppressed by mask-wearing.
• Family practices are facing some of the same human resource challenges seen elsewhere in the health system, with shortages of nurses and administrative staff.

"The whole health system is under strain, enormous strain, and that includes family doctors," said Muggah. 

That strain can have an impact on the ability of patients to get in to see their family physicians, something that Sharon Mannell experienced first-hand. 

Mannell's family doctor in Kitchener, Ont., diagnosed her over the phone with a sinus infection and issued a prescription. But when the infection didn't respond to the medication and worsened, she says she still couldn't get an in-person appointment with the doctor, and his staff recommended she go to the emergency department instead.

"I would have preferred to go see my doctor about it. Plus, to me, the emergency department is for emergencies," said Mannell in an interview. 

She said the experience left her frustrated and a bit scared. 

"If this is what's happening now, what's going to happen in the future? I'm a senior. I'm probably going to need my doctor more often as the years go by. And if I can't see him now, what's it going to be like later on?"  

While others around Ontario are no doubt encountering similar situations with getting a doctor's appointment, research led by Dr. Tara Kiran of the University of Toronto's department of family and community medicine found the patients of family doctors who opted for virtual care the most during the pandemic were not more likely to end up in the emergency room.  

"I empathize with people who are having difficulty accessing their family doctor, I know that's incredibly frustrating," said Kiran in an interview. "The data we've looked at tells a different story than the anecdotes that we're hearing."

Kiran was commissioned to do the research in the fall of 2021 when Ontario's hospital ERs were also seeing a wave of patients and critics were pointing fingers at some family doctors for using a "virtual-first" appointment method: screening patients online or over the phone and only allowing some to come for in-person visits. 

Related research led by Kiran found that the vast majority of family doctors in the Toronto area were seeing patients in person even at the height of the pandemic's biggest waves (that study is posted online and has been accepted for publication but has not yet been peer-reviewed).

There's evidence that emergency rooms are affected far more by the number of people who don't have a family doctor.

Before the COVID-19 pandemic hit Ontario, some 1.3 million people in this province did not have a family physician, according to estimates by Statistics Canada. Although more recent official figures aren't available, there's broad agreement among experts in the health system that the number of Ontarians without a family physician has only risen since then. 

The pandemic prompted a reported increase in the rate of family doctors leaving practice, whether for retirement, personal health concerns or burnout. Meanwhile, there has been a steady decrease in the number of medical students choosing to focus on family practice over the past seven years. 

The doctors say those trends do not bode well for improving family physician access, given Ontario's growing population.

"Your family doctor is the beginning, the middle and the end of your whole health care journey. If you don't have that entryway, you're going to end up in the ER," said Muggah. 

"It becomes the emergency department's role to try to deal with these chronic illnesses. This is a huge problem," she said. 

About 25 per cent of patients currently coming to the emergency rooms of Richmond Hill and Cortellucci Vaughan hospitals north of Toronto do not have a family doctor. That's vastly higher than the five per cent figure pre-pandemic, according to information provided by Dr. David Rauchwerger, medical director of the Mackenzie Health emergency department.

The crunch is being felt in emergency rooms around the province, including London and southwestern Ontario as well as Waterloo region and Wellington County. Some ERs in small communities cut back their hours because of staffing shortages, as did the urgent care centre at Brampton's Peel Memorial Hospital on Sunday.