Canadian Family Physicians Seeing Fewer Patients on Average

The number of patients that family physicians see has declined, according to the latest report by the Canadian Institute for Health Information (CIHI) on the state of the healthcare workforce. This decline, which results from changing workforce dynamics, suggests the need for different approaches to medical care. Expanding the authority of pharmacists and nurse practitioners (NPs) to treat minor ailments is one of several strategies that Canadian provinces have tried to improve access to primary care providers.

The average number of patients seen by family physicians declined by 18% from 2013 (1746.1) to 2022 (1429.6). The change partly reflects the needs of an aging population that is more susceptible to complex and chronic medical conditions, which require more time per patient. Clinicians are seeing fewer patients, while each visit requires more time for questions, tests, and observations. Clinicians’ administrative burden has increased as well.

The CIHI report also noted a recent decline in the number of family physicians in Canada after decades of steady growth. This number decreased from 48,292 in 2022 to 48,264 last year; it was the first such decline since 1997. That net loss of 28 physicians has a large impact when measured against growing demand for care, Tara Kiran, MD, Fidani chair of improvement and innovation at the University of Toronto, Toronto, Ontario, Canada, told Medscape Medical News.

For example, the number of family physicians per 100,000 dropped from 124 in 2022 to 120 last year. “Although that doesn’t sound like a big difference, it is a concerning trend,” Kiran said. “What we need is more family doctors per capita.”

Kiran led the OurCare project, which conducted a national research survey in 2022. Among its findings were that only 77% of respondents reported having a family physician or NP.

Moreover, getting access to treatment was not always easy, even for those with a family physician or NP. Of this group, 40% said that they had tried to book an appointment with a clinician in their practice in the past 12 months because of an urgent issue. Only 35% of them got a same- or next-day appointment. About one fifth (21%) of those seeking urgent care from a practice where they had an established relationship had to wait 2 or more weeks or were never able to get one, OurCare reported.

A key message from studies such as the CIHI report and OurCare research is the need for changes that will entice more people to work in primary care and stay in this field, said Kiran. Increasing pay for family medicine would provide only part of the solution. There also should be efforts to make this work more enjoyable, said Kiran, who is a family physician and scientist at St. Michael’s Unity Health Toronto, Toronto, Ontario, Canada.

“Most of us go into family medicine because we love seeing patients and interacting with people,” said Kiran. “But so much of the job now is sorting through paperwork and struggling to support our patients to navigate through the healthcare system because they can’t get the care that they need.”

Team-Based Care

In an interview with Medscape Medical News, Joss Reimer, MD, MPH, president of the Canadian Medical Association, called for reducing the administrative burden on physicians. She cited as a positive example of recent legislation in Ontario, Quebec, and Nova Scotia to eliminate the requirement of sick notes from clinicians to cover short absences from work. 

Nova Scotia officials had estimated that its clinicians were spending 100,000 hours per year writing sick notes. The province’s new rule is that employers can no longer request a sick note unless an employee is absent for more than 5 working days or has already had two absences of 5 or fewer working days in the previous 12-month period.

“Getting rid of sick notes for those short-term self-resolving illnesses could have a big impact on accessibility in the health system,” said Reimer. “That was an encouraging thing we saw in three provinces that we hope to see across the board.”

Reimer also strongly advocates for the increased use of team-based care. The daughter of a rural family physician, Reimer noted that for decades, Canada relied heavily on solo practitioners. But the current demands and complexities of medicine are served better through teams, she said. 

Reimer herself has moved from solo practitioner to team member, which allows her to work with a dietitian, an occupational therapist, nurses, and a pharmacist. This approach benefits patients and practitioners, who can learn from each other and provide better care, she said.

“I could see my patients to manage their pregnancy, their blood pressure, and heart rate, but then they would go to the dietician to talk to them about diabetes-friendly low-cost diets for their pregnancy-related diabetes. Then they would see our pharmacist, who would help teach them how to use a glucometer to check their blood sugar,” said Reimer.

Nurses and Pharmacists

For Bill VanGorder, the advocacy and education officer for the Canadian Association of Retired Persons, the CIHI report highlighted the opportunities to have nurses handle more primary care.

Quebec, Ontario, and Saskatchewan have established new NP-led clinics in areas with limited access to family physicians, according to the report. Newfoundland and Labrador, Ontario, and British Columbia have also granted registered nurses prescribing powers with accompanying training programs.

“The other thing the government has to do is to educate the public on the benefits of using NPs because there’s still a feeling that somehow that’s not at the same caliber as going to a family physician,” said VanGorder. Canadians need clear explanations of what NPs are qualified to do and how they work with physicians when patients’ care requires a handoff or coordination for treatment, he added.

The CIHI report also observed that allowing pharmacists to prescribe more medicines may improve access to primary care for patients, adding that more study is needed on this issue.

Provinces should consider adopting expanded prescribing authorities that have worked in other parts of the country, Joelle Walker, vice president of public and professional affairs for the Canadian Pharmaceutical Association, told Medscape Medical News.

For example, residents of British Columbia, Alberta, and other provinces can seek contraception directly from a pharmacist, but this is not yet an option in Ontario. “There’s no reason why pharmacists in Ontario shouldn’t be able to prescribe for contraception,” said Walker. “There’s a very disjointed approach.”

Kiran, Reimer, VanGorder, and Walker reported having no relevant financial disclosures.

Kerry Dooley Young is a freelance journalist based in Washington, DC. Follow her onLinkedIn, Bluesky, andThreads.