Author: Samira Prasad

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.

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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.

Op-ed in Healthy Debate by Dr. Tara Kiran

Do you have a family doctor or nurse practitioner that you can talk to when you need care or advice about your health?

Even before the pandemic, 15 per cent of people living in Canada said the answer was no. And unfortunately, all indications are that things have gotten worse.

New research from our team published this week shows that the proportion of family doctors who stopped work nearly doubled in the first six months of the pandemic compared to the previous decade. Other research we’ve done found that in 2021, almost 20 per cent of family doctors in the Toronto-area are thinking of closing their practice within the next five years.

Now, two and a half years into the pandemic, there are many anecdotal reports of doctors leaving practice. The reasons are varied and relate to burnout, administrative overload and general “moral distress” at not being supported to deliver the kind of care they want to.

At the same time, fewer medical students are choosing family medicine and even those that do are less likely to work in a practice where they commit to providing comprehensive care for a panel of patients that they see for the long term.

These problems don’t affect everyone in the same way. We found that the proportion of family doctors who stopped work was much higher in some communities, including rural communities in Northern Ontario and near Georgian Bay. Our research has shown that new immigrants and people living in low-income neighbourhoods are less likely to be meaningfully connected to a family doctor. So are people with Opioid Use Disorder and those recently incarcerated – two groups of people who have higher health needs.

Global News interview with Dr. Tara Kiran

From the Canadian Press, featured on CBC News Toronto and The Globe & Mail

Ontario family doctors left the profession at the start of the pandemic at double the rate of the years before COVID-19 hit, new research indicates.

About three per cent of family doctors across the province — 385 doctors — stopped practising between March and September 2020, according to a study led by Unity Health Toronto that was published Monday in Annals of Family Medicine.

That accounted for an estimated 170,000 patients losing access to primary care, and was higher than the 1.6 per cent of family doctors who stopped working during a comparable period each year between 2010 and 2019.

“The pandemic has made a bad situation even worse in primary care,” said lead author Dr. Tara Kiran, a family doctor and researcher at St. Michael’s Hospital, which is part of the Unity Health Toronto network.

“We really need to address this issue by supporting more people to go into family medicine and primary care.”

The work builds on figures released last week that showed as of March 2020, nearly 1.8 million Ontarians did not have a family doctor and another 1.7 million Ontarians have a family doctor older than 65 years old.

“This is a big problem for patients in Ontario,” Kiran said.

From the CTV Toronto article

More than 170,000 patients in Ontario lost their family doctors in the first six months of the COVID-19 pandemic, a new study has found.

The study, led by Unity Health Toronto and non-profit research institute ICES, found the number of family physicians who stopped working doubled between March and September 2020 compared to the same time period the previous year.

This equals nearly three per cent of Ontario’s practicing family physicians, officials said.

On average, between April and September from 2010 through to 2019, researchers say about 1.6 per cent of family physicians stopped work.

“Nearly 1.8 million Ontarians don’t have a regular family physician,” Dr. Tara Kiran, lead author of the study and a family physician at St. Michael’s Hospital of Unity Health Toronto, said in a statement.

“Our findings suggest things are only going to get worse, which is really concerning because family medicine is the front door to our health system.”

The study found that about 385 of 12,000 physicians stopped their practice, and that those who did were more likely to be aged 75 or older and care for under 500 patients.

From The Globe and Mail article

A new study of the earliest formal program to offer prescription opioids to drug users suggests their health improved under the medication, one of the study’s authors says. But some experts warn it’s too early to draw conclusions about the efficacy of safe supply programs.

Researcher Tara Gomes of Toronto’s Unity Health network said the study she helped conduct showed that emergency department visits, hospitalizations and some health care costs declined among those who took the prescription opioids. She said it was the first study she knew of to study the long-term effects of offering a safe supply of opioids to drug users, a system that is being rolled out in several places across the country in an attempt to reduce the toll of the opioids crisis, which claimed 29,000 lives from 2016 through 2021.

Though safe supply might not be the solution for everyone, “this really shows that this program can be beneficial for people at a high risk of overdose,” said Ms. Gomes, speaking in advance of the study’s Monday release.