Author: Samira Prasad

Blog post for Healthy Debate by Dr. Tara Kiran

he pandemic has changed much of the way we live – including the way we deliver family doctor care.

When COVID-19 case counts were high, we avoided asking people to come see us in-person where possible. Instead, we pivoted to virtual care – namely care delivered by phone or video. Reducing in-person care had many COVID-19 benefits. Patients and staff were less likely to be inadvertently exposed to someone who was positive, we could better maintain physical distancing in cramped waiting rooms, and we could preserve personal protective equipment that was expensive and hard to get early in the pandemic.

Of course, there were non-COVID benefits, too. Many patients liked the convenience and appreciated not having to take time off work, arrange for childcare, commute or pay for parking or transportation.

Our research has shown that, in the first few months of the pandemic, the use of virtual care sky-rocketed, increasing 56-fold. The total number of family doctor visits fell when the pandemic was declared. But by fall of 2020, visit volumes were back up to pre-pandemic levels – only now a large portion was virtual. The amount of care delivered virtually has fluctuated throughout the pandemic with more care delivered virtually when COVID-19 case counts were high. As of this past March, about 46 per cent of all family doctor visits were virtual.

Op-ed in The Hill Times by Dr. Tara Kiran

Family doctors are the front door of our health system. They’re where you go when you are sick. And they keep you from getting sick in the first place — providing immunizations, screening tests and care for chronic conditions like diabetes or asthma.

Family doctors connect you to other parts of the health system so you can get extra help when you need it. They know you as a person and can help guide you through tough decisions.

But for too many people in Canada, that front door is now closed. Even before the pandemic, 4.6 million people in Canada didn’t have a family doctor. The pandemic has just made things worse.

Research we published earlier this month found twice as many family doctors stopped working during the first six months of the pandemic compared to what would have been expected based on trends from the past decade.

On Oct. 11, MAP Centre for Urban Health Solutions announced the 2022 winners of the second annual MAP Awards: Kristy Yiu, Anna Yeung, and Ayan Yusuf. These awards recognize three outstanding MAP staff, students or volunteers who have excelled in their roles and demonstrate a passion and commitment to applying MAP’s values in their work.

Kristy Yiu (she/her), Research Coordinator on Dr. Sharmistha Mishra’s team, is the winner of the MAP Values in Practice (MVP) Award, an award to recognize an individual who exemplifies and advocates for MAP values in their work and interactions. Her colleagues shared that “Kristy has been a great team member, a fabulous mentor, a huge asset to our team, and is so deserving of this award and recognition.” They also note that she “creates an environment based on listening (over just a focus on productivity) and a path to mutual understanding. In her team leadership, she has helped shape a culture of powerful and open discussions on empowerment, equity, and social justice – including in our global health partnerships.”

Dr. Anna Yeung (she/her), Research Manager on Dr. Ann Burchell’s team, is the winner of the Peer Mentor Award, an award to honour an individual who works hard to help colleagues learn, feel valued, and do well at work. Anna’s colleagues shared that “Anna holds individual check-ins with staff and students to understand their challenges and celebrate accomplishments, offering to help workshop solutions together. She seeks out opportunities for trainees and fellow staff to gain experience aligned with their professional development goals that will benefit their careers.” A member of her team noted that “having seen how much she gives of herself to others… I believe that her kindness and generosity deserves recognition—she ‘sees’ others around her and, in turn, I would like her to be ‘seen’ for all she does for our team.”

Ayan Yusuf (she/her), Research Coordinator on Dr. Stephen Hwang’s team, is the winner of the Community Partnership Award, awarded to an individual who consistently models exemplary community partnership practices and integration of the perspectives of community and people with lived expertise into their research. Members of her team shared that she “brings extensive theoretical knowledge and a strong perspective about the importance of community engagement to MAP, but it is Ayan’s ability to translate that theory into practice that has been particularly impressive,” and that “she is constantly interrogating her own approach and gently but firmly pushing all of us at MAP to invest and improve in community engagement.”

Congratulations to the winners, and to all of the 2022 MAP Award nominees!

Blog post for Healthy Debate by Dr. Tara Kiran

The family doctor shortage in Canada has been in the news a lot lately, highlighting the struggle for many to find one.

An aging population, declining numbers of medical students entering family medicine, and an uptick in family doctors stopping work are all indications of a problem that is only going to get worse. Unless we do something about it.

There are many potential solutions. We need to increase the number of family medicine role models in medical school. We need to offer new grads the option of going into practice that doesn’t involve running their own small business. We need to improve family medicine pay relative to other medical specialties. We need to make it easier for family doctors to take a vacation while having their patients cared for.

But there’s one solution that comes up over and over again. We need to expand interprofessional teams.

Right now, most family doctors in Canada are small-business owners who run their own practices. They may work with a group of other doctors, sharing expenses for office space and reception staff but most run their own practice. However, few work with other health professionals like social workers, dietitians, pharmacists or nurse practitioners in their practice.

Yet the evidence is clear that family doctors working in teams with other health professionals is better for patients and better for clinicians.

Our own research has shown that patients who have a doctor working with an interprofessional team were more likely to get recommended diabetes care. They were also less likely to visit the emergency department.

Op-ed in the Toronto Star by Dr. Tara Kiran

Family doctors are the front door of our health system. They’re where you go when you are sick. And they keep you from getting sick in the first place, providing immunizations, screening tests and care for chronic conditions like diabetes or asthma.

Family doctors connect you to other parts of the health system, so you can get extra help when you need it. They know you as a person and can help guide you through tough decisions.

But for too many people in Canada, that front door is now closed. Even before the pandemic, 4.6 million people in Canada didn’t have a family doctor. The pandemic has just made things worse.

Research we published last week found that twice as many family doctors stopped working during the first six months of the pandemic, compared to what would have been expected based on trends from the past decade. Other research we’ve done has found that one in five family doctors are thinking about closing their practice in the next five years.

At the same time, our population is aging, and fewer medical students are choosing family medicine as a career. Even those who do are more likely to specialize in something afterward rather than open a family practice.

From The Globe and Mail

Female doctors in Ontario made less on average than their male counterparts in 35 medical specialties tracked by the Ministry of Health, a Globe and Mail analysis of physician billings has shown.

This was true even in specialties such as obstetrics and gynecology, where the majority of practising doctors were women.

The most male-dominated disciplines were also the ones that paid the best. Based on the average compensation within each specialty, male doctors dramatically outnumbered female physicians in all 10 of the most highly remunerated areas of practice.

Meanwhile, female-dominated specialties were both rare and among the least lucrative. Overall, women outnumbered men in only six of the 35 disciplines and half of those female-dominated specialties fell among the 10 lowest paid. The constant was that women made less money.

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Michelle Cohen, a family doctor in Ontario who researches the gender pay gap in medicine, said the gender gaps in medicine have been well-established by numerous studies, but there are still those who push back.

“One of the first things you’re going to hear as a criticism is: this is fee-for-service. You do a service, you bill a code and you get the money. It seems fair … but there is built-in bias,” Dr. Cohen said.

For example, Dr. Cohen’s research has found that certain procedures – particularly those performed on female bodies – pay less. In a 2020 paper that Dr. Cohen co-authored with Tara Kiran, they noted that a surgeon in Ontario is paid $50.90 for an incision under general anesthetic on a vulvar abscess, but $99 for a scrotal abscess. And a biopsy on a penis paid $39.60, but one on the vulva paid $26.85.

One enduring myth, said Dr. Kiran, is that the wage gap can be explained by the fact that men tend to work longer hours. It’s true that male physicians do work longer hours, but not enough to account for the gap. A British Columbia study that looked at primary-care physicians in 2017 found that women made 36 per cent less than men, but worked just three hours less per week.

From CBC Metro Morning

Dr. Tara Kiran was a member of the now-disbanded Science Table. She says that the health system needs more primary care physicians to manage implications of COVID.

Listen Here

From CTV Your Morning on Monday

Believing that “better is possible,” a family doctor and other researchers are asking Canadians to share their experiences with the country’s primary health-care system – and what they want from it – as a way to help guide future reform.

Dr. Tara Kiran, a family physician at St. Michael’s Hospital in Toronto and one of the doctors behind the OurCare research survey, told CTV’s Your Morning on Monday, while the COVID-19 pandemic “shone a light” on some of the cracks that exist in the current system, it also presents an opportunity to try and repair it.

“I do think that better is possible. I think that we can reimagine a future system and that the time is now,” she said.

The survey comes after Kiran and others recently published a study that found more than 170,000 patients in Ontario lost their family doctors in the first six months of the pandemic, equating to nearly three per cent of the province’s practicing family physicians.

From The Globe and Mail

Ontario’s independent COVID-19 Science Advisory Table highlights the work of primary-care practitioners during the pandemic in its final report, and warns of challenges ahead as treating patients with the virus moves from intensive-care units to family doctors’ offices.

The report highlights long-standing challenges in Ontario that pose a threat, not just to the routine functioning of the health system but to future pandemic preparedness.

The province needs more primary-care practitioners to meet the growing needs of patients, says the report released on Monday. The province must also better integrate primary care into the health care system, it says, noting that there is little infrastructure in place that would allow policy-makers to share information with family doctors, trusted sources for their patients.

The report contains three related briefs: what Ontario family doctors did during the first two years of the pandemic; the factors that affected their capacity to deliver care; and the lessons policy-makers should heed to strengthen primary care as the pandemic evolves. Danielle Martin, a senior author on the report, provided expertise on primary care to the science table.

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“People’s confidence in the vaccine often comes down to trust, and family doctors have these trusting relationships with people,” said Tara Kiran, another author of the new report and a family physician and researcher at St. Michael’s Hospital, part of Unity Health Toronto.

From Unity Health Toronto – by Ana Gajic

Now that the kids are back at their desks, parents and teachers may be wondering: How far have they lagged behind after two years of pandemic interruptions?

Dr. Sloane Freeman, a scientist at the MAP Centre for Urban Health Solutions and a pediatrician at St. Michael’s, wants to find out. She received funding from the Canadian Institutes for Health Research (CIHR) to study whether Ontario high school students’ academic test scores changed over the course of the pandemic and how students experiencing marginalization were impacted.

We spoke with Dr. Freeman to understand the role education plays in health, and how the pandemic may have affected both.

Anecdotally, before you started this research project, what were you seeing in terms of children’s academic achievement during the COVID-19 pandemic?

Dr. Freeman: The pandemic has influenced all of society and every determinant of health. Education is one important one. Schools were closed. Kids didn’t have access to in-person education and virtual education was really hard for a lot of children.

We’ve already started to see the impact, especially in younger children, in terms of learning differences. I think those can be positively addressed in this school year. It is absolutely not a lost generation of children that isn’t going to succeed academically. We just need to be mindful of the impact the pandemic had on academics, on social, emotional, mental and physical health, and they’re all related.

As a pediatrician, what kind of issues have you been seeing over the last couple of years that you didn’t see as much of before COVID?

Dr. Freeman: I have noticed a spike in anxiety in younger children. It is more common to see anxiety in adolescents. Now I’m seeing a lot more mood impacts and certainly anxiety in younger kids, even as young as kindergarten. That impacts education as well – it’s harder to concentrate, focus, to feel good about learning, when you’re worrying about other things.

What gaps in knowledge are you hoping to fill by exploring the literacy scores, math scores and the academic achievement of children in Ontario through your research?

Dr. Freeman: We’re looking to see what happened to the academic achievement of Ontario’s youth  since the pandemic, and whether there were differences in standardized test scores before and during the pandemic. Our study captures high school aged kids, because that’s when the standardized tests were done over the pandemic.

One of the main points that we’re trying to address is whether there are differences and whether they were influenced by socioeconomic factors, mainly income. Did the gap that traditionally exists between children from higher and lower income families get bigger during the pandemic? Did it narrow? Did it change at all? Those are the questions that we’re trying to address.