ontario health-care

Creeping privatization is threatening family medicine in Toronto

In a move that is becoming all too familiar, it came to light earlier this year that 1,600 patients were without a family doctor seemingly overnight when a family medicine practice decided to charge a $4,995 annual fee. And it is likely to continue to happen unless something is done.

It is estimated that 20 per cent of Ontario residents cannot access a family doctor for primary care. It’s a crisis, and it is also exposing what some call a loophole in the system that allows private and for-profit clinics to offer said services as part of an annual fee. No long waits, no emergency room visits just to see a doctor.

And it’s starting to hurt more as this trend that is seeing current family doctors start to deregister large swaths of patients and move to a private clinic model picks up speed, which translates to thousands of patients per family doctor joining the four million others in a similar situation. This shortage has caused significant strain on the health-care system, with more patients turning to emergency rooms for non-urgent care, leading to overcrowded hospitals and increased wait times. Adding to the complexity of the situation is the rise of private health services.

Many doctors are streamlining their practices, catering to a smaller (some suggest wealthier) and healthier patient base willing to pay large fees for more personalized care. Many others can’t find young doctors to take over their practices so they can retire.

Private clinic clients pay an annual fee and get complementary health-care services including such things as a health assessment, physiotherapy and chiropractics. Supplementary to that, the services of a family doctor are available with such bonuses as a day or two wait time for an appointment and on-call services.

The primary care services of the family doctor are still billed to OHIP and paid by taxpayers. Some suggest this trend, often referred to as “boutique” or “concierge” medicine, is creating a two-tiered health-care system that is accessible only to those who can afford it. A report by the Canadian Institute for Health Information (CIHI) indicates that private health-care spending in Canada is growing at a faster rate than public health-care spending, a trend that is evident in Ontario.

It’s something Dr. David Barber, chair of general and family practice of the Ontario Medical Association, is against.

“I don’t like the private health-care stuff like clinics. The government, they need to intervene and quickly because we are going to see more and more and more, and it’s just not going to solve anything,” he said. “It will definitely make the health of Ontarians worse, undoubtedly, because the people who need care aren’t the wealthy ones who can afford these profit-oriented clinics. So it’s really quite sad in my opinion.”

Historically, the provincial governments including Ontario’s, have two areas of concern above all else: education and health-care. But this situation has developed since the provincial government opened the door to it decades ago with clinics from south of the border setting up executive clinics.

It’s not just that private health clinics from the United States are opening here in the name of executive health. It’s that current family doctors are severely truncating their practices and moving into these “private” settings leaving longtime patients without any continuity of care. The Ontario NDP brought it to light earlier this year when hundreds of patients were abandoned.

“About 1,600 patients had to go out on their own, at a time when Ontario has a massive family doctor and primary care provider shortage,” said Toronto member of provincial parliament Jessica Bell. “Ontarians should be using their OHIP card to see their family doctor, not their credit card.”

Family doctors are facing a system that has become increasingly complex and continue to be devalued compared to other areas of medicine, said Dr. David White, professor emeritus, department of family and community medicine, University of Toronto.

“I think it’s happening in Canada, despite not being what the population wants, and I think governments are, in some cases, allowing it if they’re oriented more toward private sector solutions,” said White, of the private clinics. “And in other cases, they are certainly not prepared to shut it down because it would look like they were just making life more difficult. So it really is a problem of how we appropriately fund, particularly the primary care aspect.”

Barber, who is in the faculty of medicine at Queen’s University, said the system is making it unattractive for young doctors to move into family medicine.

“There’s nobody that wants to take on a cradle-to-grave practice anymore,” he said. “It’s just not joyful, it’s not any fun, it’s stressful, it’s a failing business model.”

The increasing trend to private clinics has sparked a renewed debate over universal health care. But it is also exposing a provincial government that has long under-funded and deprioritized family medicine. And the results are dire.

Next month: In part two, we look at why family doctors don’t want to be family doctors any longer and what the health-care system’ needs now.

Article exclusive to STREETS OF TORONTO