Ontario: the biggest loser in primary care

Ontario’s healthcare system is facing a growing crisis, particularly in family medicine. Increasing administrative burdens, ineffective digital systems, poor compensation, and rising burnout rates are pushing many family physicians toward early retirement or away from comprehensive care. These pressures have dire consequences for patient access, with approximately 2.5 million Ontarians currently without a primary care provider—a number expected to exceed four million in the coming years.Ontario has about 2.5 million people without regular access to a primary care provider, the so called “unattached” or “orphaned” patient population. This population is expected to grow to be over 4 million people over the next few years. Lack of access to primary care services largely resulted from a shortage of family physicians. The shortage of family physicians, worsened by the COVID-19 pandemic, has left the province struggling to meet the needs of a growing and aging population with increasingly complex medical conditions. Family doctors are working longer hours under immense stress, with little meaningful support from the government. Instead of addressing the root of the problem, the provincial government attempted to argue in the 2024 arbitration with the Ontario Medical Association (OMA) that Ontario was flush with “lazy” family doctors. Fortunately, this misguided claim was dismissed by the independent arbitrator.Read: Doctors are working fewer hours but not for the reason you might thinkOver the past few years, statements from Ontario’s Premier and Health Minister would have one believe that it was raining family physicians and Ontario was awash with doctors. They often claimed that 10,000 physicians had set up practice in Ontario in recent years. And they continue with misinformation and obfuscation on this issue. However, data from the Canadian Institute for Health Information (CIHI) paints a starkly different picture—one that has been largely ignored by both the media and medical associations.For the first time in two decades, Ontario experienced a net loss of family physicians in 2023, with approximately 240 leaving the profession in a single year. This decline is the largest in recent history, and while other provinces have faced minor reductions, Ontario stands out as the hardest-hit jurisdiction—the biggest loser!Looking at the last five years, we see that Ontario has recorded an average annual increase of 73 family physicians per year, for a total net increase of 364. Given that the typical family physician serves about 1,200 patients, that is enough physicians to service about 450,000 people.However, Ontario population has increased by about 1,300,000 people over this same period, which would require over 1,000 new family physicians just to maintain the status quo yet alone shrink the existing shortage and improve access problem.Twenty years ago, faced with a similar crisis, the government took decisive action that led to real improvements. Medical school enrollment was expanded by 50%, the number of IMG (International Medical Graduate) positions was doubled, and innovative payment models—such as capitation and blended models—were introduced to support family physicians.Today, however, no such action is being taken. Instead of concrete solutions, the government continues to offer endless plans with little follow-through. Empty promises have replaced meaningful reform—nothing more than a “bag of magic beans” that supposedly holds the key to solving Ontario’s primary care crisis at some distant point in the future.Most recently, just before calling an election, Premier Doug Ford appointed Dr. Jane Philpott, a well-respected physician, to lead yet another initiative aimed at addressing the issue. Her mission? To connect millions of unattached patients with primary care providers—by 2029. Another action plan, but still no real action.Ontario’s primary care system is in free fall, and without decisive action, it and its population will remain the biggest loser for years to come.Boris Kralj (PhD) is an adjunct assistant professor, McMaster University, department of economics and founder & principal consultant, Perspicacity Intelligence & Analytics.

Ontario: the biggest loser in primary care

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