Family doctors are pushing back against claims they are partly responsible for the woes of Ontario’s hospital emergency rooms by limiting face-to-face patient appointments.
Ontario Health has just released a new set of statistics showing another month of record long wait times in the province’s emergency departments.
The figures show that patients who were admitted to hospital in May spent an average of 20.1 hours in the emergency department before getting a bed on the 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 recorded in May 2021.
While health care experts say the main reasons for the backlog in emergency rooms include staff shortages and full hospital wards, some people in the health system point to access to family doctors as a contributing factor.
In response to CBC News’ coverage of the situation in Ontario’s emergency rooms, some patients reported having to go to the emergency room because their family doctor was unwilling or unable to see them in person.
But Dr. Liz Muga, president of the Ontario College of Family Physicians (OCFP), says the shortage of family doctors is playing a much bigger role in the emergency room crisis than any restrictions on in-person medical appointments.
Dr. Liz Muga, president of the College of Family Physicians of Ontario, practices as a family physician with the Bruyère Family Health Team in Ottawa. (Supplied/OCFP)
“It’s obviously a problem if patients can’t get in to see their family doctors in person in time,” Muga said in an interview with CBC News.
“The majority of family physicians see patients in person and strike the right balance between virtual and in-person,” Muga said.
According to OCFP research, there are a number of factors that are stressing family physicians in Ontario right now:
- Family physicians are seeing an increase in the burden of disease among their patients as a result of postponed procedures or delays in seeking treatment during the pandemic.
- The province has seen a new wave of COVID-19 infections and a surge in other respiratory illnesses that were suppressed by the wearing of masks.
- Family practices face some of the same human resource challenges seen elsewhere in the health care system, with shortages of nursing and administrative staff.
“The whole health system is under pressure, huge pressure, and that includes family doctors,” Muga said.
This strain can have an impact on patients’ ability to get into their family doctors, something Sharon Manel has experienced firsthand.
Sharon Manell’s family doctor’s office sent her to the emergency room of a hospital in Kitchener, Ont., for treatment of a sinus infection. (Greg Bruce/CBC)
Manell’s family doctor in Kitchener, Ont., diagnosed her with a sinus infection over the phone and issued a prescription. But when the infection didn’t respond to the medication and got worse, she says she still couldn’t make an in-person appointment with the doctor, and his staff recommended she go to the emergency room instead.
“I’d rather go to my doctor about it. Also, to me, the ER is for emergencies,” Mannell said in an interview.
She said the experience left her frustrated and a little scared.
“If this is happening now, what will happen in the future? I am senior. I will probably need my doctor more often as the years go by. And if I can’t see it now, how about later?”
While others around Ontario undoubtedly face similar situations with getting a doctor’s appointment, research led by Dr. Tara Kieran of the University of Toronto’s Department of Family and Community Medicine found that patients of family doctors chose virtual the most care during the pandemic are no more likely to end up in the emergency room.
“I feel for people who have difficulty accessing their family doctor, I know it’s incredibly frustrating,” Kieran said in an interview. “The data we looked at tells a different story than the anecdotes we hear.”
Dr. Tara Kiran, the study’s principal investigator, is also a family physician and associate scientist at St. Michael’s Center for Urban Health Solutions. (Ed Middleton/CBC)
Kieran was commissioned to do the research in the fall of 2021, when Ontario hospital emergency rooms also saw a surge of patients and critics pointed the finger at some family doctors for using a “virtual first” appointment method: screening patients online or by phone and allows only a few to come for personal visits.
A related study led by Kieran found that the vast majority of family physicians in the Toronto area saw patients in person even during the peak waves of the pandemic (this study has been posted online and has been accepted for publication, but has not yet partner). reviewed).
There is evidence that emergency departments are affected far more than the number of people who do not have a family doctor.
Before the COVID-19 pandemic hit Ontario, about 1.3 million people in that province did not have a family doctor, according to Statistics Canada estimates. Although more recent official data is not available, there is broad agreement among health care experts that the number of Ontarians without a family doctor has only increased since then.
The pandemic has prompted a reported increase in the rate of family physicians leaving practice, whether due to retirement, personal health issues or burnout. Meanwhile, there has been a steady decline in the number of medical students choosing to focus on family practice over the past seven years.
About 25 percent of patients who currently come to the emergency department at Cortellucci Vaughan Hospital do not have a family doctor, according to Mackenzie Health’s emergency department medical director. (Patrick Morrell/CBC)
Doctors say these trends don’t bode well for improving access to a family doctor, given Ontario’s growing population.
“Your family doctor is the beginning, middle and end of all your health care. If you don’t have that entrance, you end up in the emergency room,” Muga said.
“The role of the emergency department becomes to try to deal with these chronic diseases. It’s a huge problem,” she said.
About 25 per cent of patients currently coming to the emergency departments of Richmond Hill and Cortellucci Vaughan hospitals north of Toronto do not have a family doctor. That’s significantly higher than the five percent before the pandemic, according to information provided by Dr. David Rauchwerger, medical director of Mackenzie Health’s emergency department.
The crisis is being felt in emergency departments across the province, including London and southwestern Ontario, as well as Waterloo Region and Wellington County. Some emergency rooms in small communities have shortened their hours due to staff shortages, as the emergency center at Brampton’s Peel Memorial Hospital did on Sunday.
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