Rodrigo Martinez said Canada’s reputation for quality health care was partly the reason he moved with his family to Ottawa from Guatemala in 2015.
But as a Canadian citizen, he has spent much of the past two years searching for a new doctor ever since his family physician retired.
So elusive is the endeavour, Martinez said, at times he’s resorted to seeking care in Guatemala.
“To not be able to get proper health care is very concerning, especially comparing it to the lower tier health care that we have in Guatemala,” said Martinez.
Martinez has asthma and ADHD. He said he’s currently relying on virtual consultations with Guatemalan doctors, who can give advice but can’t prescribe out-of-country.
He said he can’t get his ADHD medication renewed in Canada without a family doctor.
Instead, Martinez is leaning on friends and family abroad to ship him asthma inhalers, which can be bought in Guatemala without a prescription.
“It’s life threatening,” said Martinez.
There are more than 1,200 family doctors listed in Ottawa on the College of Physicians and Surgeons of Ontario (CPSO) website, but a CBC News analysis has found only three are currently accepting new patients.
The wait time to be matched with a family doctor in the Ottawa region can be twice as long on average as the wait in the Greater Toronto Area, according to Ministry of Health data obtained by CBC.
The issue has doctors and patients renewing calls for changes to the primary health-care system.
Few doctors accepting patients
According to CPSO’s registry, 1,246 doctors listed family medicine as a specialty and run a practice in Ottawa.
Since the registry is not always up to date, CBC cross-referenced its data with family practice listings in Ottawa.
We stop people from falling through the cracks in the system, and then the cracks just got so big.– Dr. Claudia Hubbes, Rosemount Clinic
CBC was able to identify 484 different practice locations, of which 124 were confirmed to offer family medicine. There were 584 doctors in the CPSO linked to those practices.
The majority of the remaining, unaccounted doctors from the registry did not list a confirmed family practice. This includes doctors who report they work primarily in hospitals, sports medicine clinics and other fields.
Among the 124 clinics that offer family medicine, only three indicated they were accepting new patients. Each of those three clinics had a single doctor accepting new patients at the time of publication.
Since 2018, patients in Ottawa and the surrounding region have on average waited longer to be matched with a family doctor than people elsewhere in the province.
According to data from the Ministry of Health obtained by CBC through a freedom of information request, the Champlain public health region — which includes Ottawa, Cornwall, Lanark and other eastern Ontario areas — recorded the longest average wait time among all regions in the province’s Local Health Integration Network.
Health Care Connect wait times in the Champlain network were an average of 225 days over the past four years — higher than any other health network in Ontario.
Champlain also had the lowest success rate among the 14 provincial health networks. More than 35,000 patients registered were never matched with a family doctor — about one in three in the region.
‘It’s an endless pit of need’
Health-care professionals who spoke with CBC said the shortage of family doctors means many more patients are now showing up to see specialists with severe health conditions — some of which could’ve been dealt with earlier in primary care.
“Family medicine is what we do — we stop people from falling through the cracks in the system, and then the cracks just got so big,” said Dr. Claudia Hubbes, a family physician at Rosemount Clinic.
Hubbes said her clinic has had to invest in a new phone system just to manage the overwhelming number of cold calls from the public inquiring about whether anyone is taking new patients.
To accommodate the demands of her patients, Hubbes said she now works longer shifts, sometimes up to 13 hours a day.
“It’s an endless pit of need and people that are desperate,” said Hubbes. “You’re doing your best, but it’s just not enough.”
How to solve the problem
Dr. Clare Liddy, chair of the department of family medicine at the University of Ottawa, said old models of family medicine aren’t “viable from a business perspective” for new graduates.
Complex factors underpin the acute shortage of family doctors in the Ottawa region, said Dr. Clare Liddy, chair of the department of family medicine at the University of Ottawa.
On paper, Liddy said “it looks like there are enough family doctors” to serve the capital.
But she said many of those who are trained in general family medicine are working in other fields.
The actual number of physicians providing comprehensive, continuous family medicine care is, in her words, “much, much fewer.”
Liddy said that many figures showing the number of “unattached” patients in Ottawa who don’t have a family doctor are actually underestimated. Not everyone without a doctor has signed up for Health Care Connect, she said.
Large numbers of patients from Quebec seeking care in Ottawa are also left out of the picture, said Liddy, though they add to the demand for family doctors.
New grads really were not interested in joining those models because it’s not very viable from a business perspective.– Dr. Clare Liddy, University of Ottawa
Despite being home to a medical school, Ottawa has a hard time retaining family medicine graduates, Liddy added.
A potential reason many critics have pointed to is the pay incentive, or lack thereof, in family medicine.
The so-called fee-for-service model, which mandates family doctors bill the province per patient visit, is unappealing to new doctors due to workload and rising administrative costs.
“New grads really were not interested in joining those models because it’s not very viable from a business perspective,” said Liddy.
It’s also the payment system used by many family doctors approaching retirement age. Martinez is just one of many “orphaned” patients left without a doctor.
Liddy said new family doctors are interested in joining practices that are capitation-based, which means doctors are paid based on the amount of patients on their roster as opposed to the amount of daily appointments.
According to data from the Ministry of Health, there are 52 of these capitation-based practices operating in Ottawa.
Alternate models restricted in Ontario
Certain models such as a “family health team” also get funding for allied health professionals such as nurses, social workers, pharmacists or psychologists to work in tandem with family doctors. Liddy said these supports help provide better care to patients and create a more attractive working environment for family doctors.
But these alternative models are heavily restricted in Ontario — no new family health teams have been allowed to open in the province for over a decade.
During the pandemic, more than two dozen family doctors across Ontario penned a letter to then health minister Christine Elliott, calling on the province to open up the capitation payment model to all primary care physicians. The petition garnered nearly 8,000 signatures.
The Ministry of Health would not comment on whether it would consider loosening restrictions on capitation payment models.
The statement said it was trying to speed up the process for health-care workers trying to register to practise in Ontario — including those educated outside the province or internationally.
Ontario will now be allowing doctors educated abroad to receive residency training in Ontario, but only “in exchange for a commitment to practise medicine in an Ontario community other than Ottawa or Toronto and its adjoining municipalities.”
The ministry also said it is creating a total of 455 new spots in medical schools over the next five years.
Meanwhile, Martinez said he doesn’t expect to get matched with a doctor through the Health Care Connect wait-list any time soon. He’s still searching for a doctor himself — driving around looking for signs at clinics, making phone calls and reaching out through people he meets.
He said he’s hopeful he will find one through the connections he’s made in his community.
“It’s not the government that’s giving the support,” said Martinez. “It’s the Canadian people that actually give the support.”
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