Author: Samira Prasad

From CBC News Toronto

With Ontario’s health-care system already in crisis, a new study suggests that nearly 20 per cent of family doctors in Toronto will be closing their practices in the next five years.

The research is a major concern for some in the health-care field as it suggests the current problems people have finding a family doctor will only get worse.

“I’m really worried,” said Dr. Tara Kiran, the lead author of the study, which was led by St. Michael’s Hospital along with Unity Health Toronto and published in the journal Canadian Family Physician.

“There are already 1.8 million people in Ontario who don’t have a family doctor. To me, it’s a wake-up call that we really need to work hard to address this issue,” Kiran said.

More than 1,000 family physicians were surveyed in January 2021. A total of 439 respondents answered questions about their future plans, with 77 doctors — or 17.5 per cent — responding that they plan to close their practice within the next five years.

Nearly four per cent of physicians in that group said they plan to close in the next 12 months.

The study found that the doctors who are planning to leave tend to be older, so demographic retirement trends are a factor. But the research also found that many physicians who say they’re on the way out run their own private practices. 

From CTV News Toronto

A new study found nearly 20 per cent of family doctors in Toronto are considering closing their practices in the next five years.

“I’ve looked, it’s almost impossible to get one,” Storm Sorichetti said as she held her 5-year-old daughter Isaballa.

Sorichetti and her daughter are among the 1.8 million Ontarians without a doctor and using walk-in clinics instead.

“It’s very frustrating,” she says. Adding, “you can never get a full record of either my daughter or myself.”

A recent study published in the journal ‘Canadian Family Physician’ based on a survey of family doctors from 2021 says, “17.5% (of the respondents) were planning to close their existing practices within the next 5 years.”

“Policy makers need to prepare for a growing family physician shortage and better understand factors that support recruitment and retention,” Dr. Tara Kiran, a family doctor and the lead author of the study, said.

“I think we definitely are losing family doctors who are practicing in that traditional cradle to grave office based family practice,” she said.

The most likely to leave were older male doctors, who run a family practice on their own. With many retiring early, and fewer new graduates choosing to take their place.

Kiran says, “If you choose to retire even two or five years earlier than you would, that can actually at a large scale have an impact on the healthcare workforce and as a result an impact on the population who really need family doctors.”

This study did not look into why doctors may choose to close their practice, but another survey done by the Ontario Medical Association suggests that strain brought on by the pandemic may be a contributing factor.

From The Globe and Mail article

Almost 20 per cent of Toronto family physicians are considering closing their practices in the next five years, according to a new study warning that more residents of Canada’s largest city could soon have trouble finding a doctor.

The findings are based on a survey of family physicians conducted in January, 2021 – at the height of the second wave of the pandemic. Of 439 doctors in Toronto who answered a question about their plans for the future, 77, or 17.5 per cent, said they were thinking of winding down their practice.

“To me, that was a really surprising number,” said Tara Kiran, the lead author of the study, which was published Monday in the journal Canadian Family Physician.

In a related study published in September, Dr. Kiran and her fellow researchers at Unity Health Toronto and the non-profit research institute ICES mined Ontario Health Insurance Plan (OHIP) billing data to discover that almost three per cent of the province’s doctors had stopped practising during the first six months of the pandemic, about twice the normal rate.

Which is why Dr. Kiran, a family doctor at St. Michael’s Academic Family Health Team in Toronto, was startled to find significantly more doctors were thinking of giving up on office-based primary care.

“Here it was 17 per cent, almost one in five doctors, considering closing their practice,” she said. “If you’d asked me for an estimate before doing the survey, I would not have estimated something nearly that high.”

From Unity Health Toronto

A survey of Toronto family physicians found that almost 20 per cent are considering closing their practice in the next five years.

The survey, led by St. Michael’s Hospital, a site of Unity Health Toronto, and published in Canadian Family Physician, surveyed more than 1,000 family physicians at the height of the province’s second wave of COVID-19. Nearly 450 doctors responded about their future practice intentions, with one in five stating they planned to close their practice in the next five years.

The findings come as Ontario patients struggle to secure primary care – recent data shows nearly 1.8 million Ontarians are without a family doctor. The survey builds on recently published research by the authors that found the number of Ontario’s family physicians who stopped working doubled during the first six months of the COVID-19 pandemic compared to previous years – accounting for more than 170,000 patients losing access to a primary care provider.

“It’s worrying that almost one in five family physicians who we surveyed in 2021 were thinking of closing their practice in the next five years. Family medicine is the front door of our health system and for too many people that front door has been closed. Our findings suggest things are only going to get worse,” says Dr. Tara Kiran, lead author of the study and a scientist at the MAP Centre for Urban Health Solutions at St. Michael’s Hospital.

The survey, delivered by email, phone and fax, shows the mean practice size of each family physician was 1,215 patients. More than 75 doctors answered that they planned to close their practice in the next five years, meaning over 93,550 patients in Toronto could lose access to a primary care provider. The study notes that in 2015/16, Toronto had approximately 3,500 primary care physicians. Extrapolating the survey findings to the broader group of Toronto’s family physicians means more than 600 family doctors who care for upwards of 730,000 patients could close their practice in the next five years.

From the CBC article

The City of Toronto’s current response to homeless encampments is not only inadequate but is also causing further harm to the unhoused people who are most affected, a new report says.

The report by the MAP Centre for Urban Health Solutions, looks at the supports available to people living in encampments last year, how some of those services were helpful and also ways they could be improved. 

“The biggest thing people needed and wanted was permanent housing and that was the thing they did not get,” said Zoe Dodd, a community scholar with the centre.

The report, released Friday, follows the controversial eviction of homeless encampments from three Toronto parks in the summer of 2021. Many unhoused people chose to live in those encampments rather than risk contracting COVID-19 in the city’s shelters. According to the 83-page report, 127 surveys were conducted, along with 23 interviews with current or former encampment residents across Toronto. Researchers also interviewed 16 outreach workers and volunteers from a variety of organizations and groups.

“I think the stark thing is that people felt pretty abandoned in terms of the help they needed, but then there were neighbours and people who stepped up,” Dodd said.

The report says the study demonstrates the community-based outreach supports provided to encampment residents during the COVID-19 pandemic were highly beneficial for their survival and well-being, and that residents had a great appreciation for the social relationships that developed with outreach volunteers and workers.

From the Toronto Star article

The provincial government and the Ontario Medical Association have agreed to decrease payments to doctors for one-off virtual appointments — a move meant to stem the tide of virtual-only clinics and encourage doctors to provide comprehensive ongoing care to patients.

As of Oct. 1, the one-off virtual visits are being paid at a reduced rate of $15 to $20 when the “physician renders a service to a patient where there is not an existing patient-physician relationship,” according to the Physician Services Agreement.

“An ongoing relationship with a family physician is the foundation of a good health-care system as it provides both comprehensive care and continuity of care,” the OMA said in an email.

“This is significantly better quality of care than episodic walk-in services,” said the association, a reference to both virtual and in-person walk-in clinics.

The new fee structure is a departure from the pandemic, when temporary fee codes “paid physicians on par with face-to-face fee codes,” according to the OMA.

There is a range of fees charged by physicians. “The most common visit fee-code billed by family physicians is $36,” the OMA said.

Physicians who see their patients on an ongoing basis will continue to get paid the same amount for a virtual visit as an in-person one, as will specialists who see patients who get a referral.

But critics say the province’s new approach to the virtual fees is a disincentive for physicians who are adding capacity to the system by offering in-person care as well as virtual appointments to patients who aren’t their own.

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“In the first few months of the pandemic, virtual care really skyrocketed,” said Dr. Tara Kiran, a family physician and scientist at St. Michael’s Hospital, Unity Health Toronto. “One of our studies found that virtual care increased 56-fold during those first early months of the pandemic.”

Kiran is also the Fidani Chair of Improvement and Innovation at the University of Toronto.

In Ontario, virtual care, mostly by phone, continues to account for more than 40 per cent of primary care visits.

The Ontario government set a target for a 60-40 ratio between in-person and virtual care for family doctors in the new Physician Services Agreement, although Kiran said that no one really knows what the right mix is.

But she did say that evidence points to better outcomes for patients who have an ongoing relationship with a family doctor.

“I don’t actually think you could get the same care when you see someone at a virtual walk-in clinic compared to your own family doctor,” said Kiran. “There are some very big differences. One is that they don’t have your personal and health history, either from personal knowledge or from your file. And that can result in different decisions than your family doctor might make, having known you.

“And there’s a lot of literature that supports how relationship-based care, care that is continuous with the same doctor over time, leads to better outcomes,” said Kiran, including better care for chronic conditions and preventative care, as well as lower emergency department use and even lower mortality.

Kiran is head of a project called OurCare, an online research survey that asks for input from Ontarians about their experiences with family doctors as well as their views on how to improve the health-care system.

From The Globe and Mail Article

Some Ontario physicians are concerned pending changes to virtual care will make it difficult for a wide swath of patients to access a health provider, adding tocontinuing challenges facing the province’s health system.

The province is restricting payment for telephone-based doctor visits later this year and requiring physicians to be able to see patients in person if necessary, which would make it impossible for virtual-only clinics to operate.

There have been growing concerns throughout the pandemic that some doctors are leaning too heavily on virtual care and refusing to see patients in person or using virtual clinics to see patients on a one-off basis, which is linked to poorer health outcomes. The changes are, in part, designed to encourage face-to-face interaction and reduce the frequency of one-off calls with patients.

As of Dec. 1, Ontario’s health insurance plan will no longer fund initial telephone visits between new patients and their physician. Only video calls will be eligible for payment under the new permanent virtual care funding model.

Follow-up phone calls between patients and doctors will only be eligible for 85 per cent of the fee doctors can bill for video calls or in-person visits.

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!