Urgent Action Needed to Address the Family Medicine Crisis in Canada

2023-07-10

Council of the Federation
Premier Heather Stefanson, Chair and Premier Tim Houston, Vice-Chair
c/o Council of the Federation Secretariat
Suite 630, 360 Albert Street
Ottawa, ON K1R 7X7

Dear Premiers,

We, the Presidents of the Colleges of Family Physicians across Canada, write to you with growing concern regarding the crisis in family medicine across our country. As representatives of family physicians in every province, we are witnessing firsthand the devastating impact on Canadians who are unattached to a family physician. It is imperative that immediate and concerted action be taken by the Council of the Federation to address this critical issue.

Family physicians serve as the cornerstone of our health-care system. They provide comprehensive, continuous, and personalized care to individuals and families, promoting preventive measures and managing complex clinical issues, acute disorders, chronic diseases, emotional issues, transient illnesses, and social challenges. The doctor-patient relationship built over time is essential for effective and efficient health-care delivery.

Regrettably, the number of Canadians without a family physician has reached alarming levels, and this trend is worsening. Results from a national survey conducted between September and October of last year estimate that more than one in five Canadian adults – 6.5 million people – do not have a primary care provider. The consequences of this shortage are far-reaching, affecting the health and well-being of individuals, families, and communities across the nation. The lack of access to a family physician not only exacerbates existing health disparities but also contributes to increased health-care costs, decreased patient satisfaction, and compromised patient outcomes.

We are encouraged by the recent commitment of the federal government to increase the Canada Health Transfer (CHT), prioritizing the improvement of primary health-care services and expanded access to team-based care for Canadians. The federal government has made it a priority to address the shortage of primary care providers because it recognizes that access to primary care improves health outcomes for all Canadians. We believe that this commitment presents an opportune moment for collaboration between the federal government and the Council of the Federation to develop a comprehensive strategy to alleviate the family physician shortage crisis for the benefit of patients, providers, and our broader healthcare system.

To build upon this commitment, we believe the Council of the Federation must take the following actions:
 

1. Commit to Collaborative Action: Acknowledge the severity of the family physician shortage as a national crisis and prioritize it on the Council's agenda. Collaborate with the federal government, provincial and territorial health authorities, regulatory bodies, and relevant stakeholders to develop comprehensive and sustainable solutions.
2. Fund Interprofessional Collaborative Teams (Team-Based Care): Support the expansion of team-based models of care, wherein patients can access primary care from family physicians, nurse practitioners, and a larger team of interprofessional health-care providers that may include nurses, social workers, dietitians, pharmacists, as well as administrative and other supports. These health-care providers work as a team to meet patients' health and social needs, including their mental health needs. Done right, team-based care can expand the capacity of family doctors to care for more patients and at the same time provide value for money by speeding up access to care and offering a wider range of programs and services to promote health and manage chronic disease.
3. Invest in Fair Remuneration that Incentivizes Team-Based Practice and Complexity of Care: Increase compensation to reflect inflationary pressures and encourage medical students to pursue careers in family medicine by offering competitive financial incentives. Canadian family physicians report decreasing revenue more than their international counterparts1 -- a wage recalibration is long overdue. Increased compensation along with the other changes we propose are essential to help stabilize the crisis and reverse the trend of decreasing interest in comprehensive, longitudinal family medicine.
   
   In addition, invest in expanding medical school enrolment, residency training positions, and ongoing professional development opportunities for family physicians.
4. Reduce Administrative Burden: Recent surveys show that family physicians can spend up to 19 hours of their week on administrative work – much of which is unpaid and unnecessary. Family doctors recognize that some administrative work will always be necessary to support patients. However, there are better, more efficient ways of doing things. We recommend governments across Canada seek to standardize or reduce forms, update outdated digital health record and referral systems, support team-based care, and increase financial support for innovative AI-based solutions that will improve the efficiency of patient visits and free up more time for direct care.
5. Implement Recruitment and Retention Strategies: Implement targeted recruitment and retention strategies to attract family physicians to underserved areas and rural communities. Address the root causes of physician migration, including excessive workload, burnout, and inequitable compensation. Provide incentives for family physicians to establish and maintain their practices in underserved regions.

The family medicine crisis poses a clear threat to the health and well-being of all Canadians. It is imperative that the Council of the Federation takes decisive action to ensure access to quality primary care for everyone. By addressing this crisis collaboratively, we can enhance the health outcomes of our population, improve patient experiences, and create a sustainable health-care system for future generations.

We kindly request an opportunity to meet with you to discuss the urgency of this matter and explore potential strategies for resolution. Together, we can work towards a Canada where every Canadian has access to a primary care team with the unique expertise of a family physician at hand.

Thank you for your attention to this pressing issue. We look forward to your leadership and commitment to working together.

Sincerely,
           
cc. The Hon. Doug Ford, Premier of Ontario
The Hon. François Legault, Premier of Québec
The Hon. Blaine Higgs, Premier of New Brunswick
The Hon. David Eby, Premier of British Columbia
The Hon. Dennis King, Premier of Prince Edward Island
The Hon. Scott Moe, Premier of Saskatchewan
The Hon. Danielle Smith, Premier of Alberta
The Hon. Andrew Furey Premier of Newfoundland and Labrador
The Hon. Caroline Cochrane, Premier of the Northwest Territories
The Hon. Ranj Pillai, Premier of Yukon
The Hon. P.J. Akeeagok, Premier of Nunavut