As any doctor, health care administrator or patient could tell you, rural health care is increasingly on life support in Ontario, and there’s no relief in sight.
As the CBC reported in December, last year ended up being the worst year yet for emergency room (ER) closures in Ontario, according to a report by the Office of the Auditor General of Ontario. Specifically, one in every five hospitals with an ER or urgent care centre (UCC) suffered unplanned shutdowns last year.
Moreover, over the past three years, at least 38 Ontario hospitals with emergency rooms or UCCs have shut down at some point. That amounts to about one in five of the province’s 176 publicly funded facilities. And most of those closures have occurred in rural areas.
At the same time, 2024 also appears to have been a record year for closures of UCCs, which are medical clinics that offer same-day urgent treatment for such injuries as sprains and broken bones as well as illnesses like fevers. CBC reported that six Ontario UCCs reduced their regular hours in 2024, closing for a total of more than 10,000 hours. While UTCs do not serve the same function as ERs, they have become a critical access point for many patients in a province where a shocking 2.5 million people now lack a family doctor.
Yet, as dire as the family health problem has become, it can still be fixed. Indeed, other provinces have found a way.
The family doctor issue is basically an HR problem. Doctors are leaving their practices in droves for several reasons-- working conditions are poor, pay is low, hours are long, and the paperwork burden is hefty and getting worse.
Fortunately, we know how to solve those problems. How? Let’s run through some solutions here.
For starters, pay family doctors better. BC, for example, pays doctors for the time they spend on administrative work. You can then pay doctors differently for patients with complex needs, etc.
Second, make doctors’ work easier. Centralize all medical referrals electronically and reduce all the administrative work. The Ontario Medical Association (OMA) has been seeking a centralized, electronic referral system for years so that doctors can see what wait times are, who is busy and who is not, and specialists can ask for info and tests ahead of time.
Third, reduce doctors’ workloads. Nurse practitioners (NPs) have already been picking up some of this load, especially in rural areas. The Ford government could have compensated the NPs through OHIP. Indeed, the federal government has just clarified that the provinces should pay NPs through provincial health plans like OHIP. Yet the Ford government has refused to do so, meaning NPs have had to rely on private pay.
Fourth, boost funding for family health teams throughout the province. Family health teams enable more patients to be seen using a team of health practitioners. Ford has been increasing funding for family health teams, but it's just a drop in the bucket. As a result, the number of Ontarians without a family doctor could nearly double to 4.5 million by 2026, according to the OMA.
To be fair, it's not that Ford is doing absolutely nothing about health care. It's just that he's doing very little, and he’s doing it very slowly.
For instance, the premier just hired Dr. Jane Philpott in late October to chair and lead a new primary care action team. This means it took him six long years to hire a consultant to solve a problem that we’ve known how to solve for a long time.
To cite another example, Ford has increased a grant program to lure more family doctors to the north and rural areas. But it's very little, late and likely won’t have much impact.
Yes, it will cost billions to fix Ontario’s family doctor shortages. But spending that sum will lead to fewer expensive emergency room visits, much greater family health coverage and much more preventive care. So, overall, it will end up costing the provincial health care system far less and lead to much better health outcomes for all Ontarians.
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