Analysis: The impact of not having a family doctor: Patients are worse off, and so is the health system

A stethescope and cutout paper dolls

Fixing the family doctor shortage can save lives and money at the same time. (Shutterstock)

About 6.5 million Canadians — roughly one in six — do not have access to primary medical care.

It’s a problem that puts their health at greater risk and renders the entire public health-care system less efficient than it could be, both economically and in terms of the quality of care for everyone.

In other words, if we can fix the shortage of family physicians, we can save lives and money at the same time.

Shortage of family physicians

Many factors are contributing to our current shortage.

For one, Canada’s health system needs not only more family doctors, but also more nurses and other health-care professionals. However, it lacks the capacity to collect and analyze data that’s required for integrated and proactive health human-resource planning.

A woman with gray hair in a white coat and stethoscope listening to a person with their back to the camera
The family medicine workforce is aging: Nearly one in six family doctors in Canada is 65 or older and nearing retirement. (Shutterstock)

The increasing complexity and responsibility of family medicine, including a much greater administrative burden, has also made careers in family medicine less attractive. In 2015, 38 per cent of graduating medical students chose a career in family medicine. By 2022, that number had dropped to 30 per cent.

We are also losing practising family physicians. The rate of retirement increased through the pandemic. (Many doctors lost income during shutdowns but were still responsible for lease and staff costs.) The current family medicine workforce is also aging: Nearly one in six family doctors in Canada is 65 or older and nearing retirement.

Family doctors and health care

Research has shown that patients who have a regular general-practitioner relationship for more than 15 years need about 30 per cent less after-hours care or hospital admissions and experience approximately 25 per cent less mortality compared to those who had a regular general practitioner for just one year.

Having access to family medicine provides four ingredients essential to good care: continuity, access, comprehensiveness and co-ordination.

While other specializations concentrate on narrower aspects of medicine, family physicians specialize in comprehensive medicine, and engage with patients directly over time. Family doctors know how to manage a huge range of symptoms and conditions across the span of a lifetime.

In fact, a recent study in the United States rated family medicine as the most complex of all medical specialties, requiring the highest degree of judgement and integrated knowledge.

A doctor seen from behind with a woman and a child
Having access to family medicine provides four ingredients essential to good care: continuity, access, comprehensiveness and co-ordination.(Shutterstock)

The work, while challenging, is valuable and makes the rest of the health-care system more efficient.

Having a person or a team get to know your story over time is incredibly powerful. When I see patients I’ve known for a long time, we can get a lot done quickly. They tell me what’s worrying them, and together we can decide quickly if a familiar issue calls simply for assurance and encouragement, or whether something has changed and needs addressing.

We make these decisions based on symptoms and past medical history — factoring in elements such as stress, family situations, grief and expectations for health. Because patients know and trust me, I can tell them, “I think XYZ is going on, but if you see these symptoms or changes in the next four weeks, I want to hear about it.”

That trust provides the opportunity to reassure and the chance to separate something benign from something worrisome, which in turn offers incredible efficiency back to the system. Family physicians aren’t sending folks for long lists of unnecessary investigations, because we know our patients’ stories.

Benefits for patients and the health system

There is a belief in some circles that if we only shared one common medical record, every patient’s story would become available to all, resolving the issue of providing continuity.

But having one person or team look after a patient’s primary care and keeping a good history is not the same as having many people looking after that patient and adding to that record in many settings and situations.

Patients without a family doctor must try to access the health-care system by going to an ER or walk-in clinic. That often means a long wait, only being able to address one issue at a time and possibly that the treatment they will be offered will resolve the immediate concern, but won’t necessarily address the root of the issue.

Further, those patients likely miss the chance to tell a chapter of their health story to someone who will remember if a similar issue comes up in the future.

Family doctors are also experts in prevention. They know how to look for things that could become problematic down the line. Lack of access to family medicine puts people at greater risk of having diseases such as cancer go much longer without being diagnosed or treated.

Finally, as anyone with a loved one dependent on help for the essential activities of daily life can tell you, co-ordinating care is a critical and effective function of family medicine.

Whether it’s referring patients to resources or specialized help or orchestrating something as personal and impactful as the choice to die at home, family doctors are experts in translating your health story into plans to assemble and oversee your broader health-care team.

The return on investment in a strong primary care foundation is an increase in the average lifespan, a greater sense of health overall and a reduction in costs in all other parts of the system.

The lack of family physicians is a problem worth solving.The Conversation

Cathy Risdon is a professor and Chair of Family Medicine at McMaster University. This article is republished from The Conversation under a Creative Commons license. Read the original article.

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