An Election-Timed Primary Care Epiphany
In predictable form, with an election announced, Ontario Health Minister Sylvia Jones and the Province’s Primary Care Action Team leader Dr. Jane Philpott have indicated the Ford government will be kicking in $1.8 billion to “connect two million more people to a publicly funded family doctor or primary care team within four years”.
This should be good news for Ontarians who have already been waiting years, in some cases a decade, for a family doctor. Perhaps. But some may be asking whether history is repeating itself.
Here is the question that has to be asked and sufficiently addressed. Without more fundamental reform to health care, how can the true cost of sustaining the proposed structure and services of more community-based primary care teams be maintained? Recall that one of the reasons primary care reforms failed to deliver improved access involves the number of Family Health Teams being limited by the Ontario Ministry of Health and family physicians being restricted in joining them. Undoubtedly, cost was a factor.
Consider the history of primary care teams in Ontario in the context of the current announcement.
Two decades ago, in April 2005, in the midst of an ongoing shortage of family physicians, the government of Ontario under Liberal Premier Dalton McGuinty announced its commitment to Family Health Teams to serve 2.5 million more Ontarians. The news release at the time indicated that Family Health Teams were the “cornerstone of the government’s plan for health care”. It was creating a “health care system that helps people stay healthier, delivers good care when people need it and will be dependable for generations to come.”
Unfortunately, the commitment fell flat as the government under Dalton McGuinty and his successor Kathleen Wynne failed to provide the funding necessary to create sufficient primary care teams to address the needs of all Ontarians. Remarkably, this failure was despite the creation of the Health Premium to assist in generating more tax revenue, sometimes referred to as the “McGuinty health tax”. What it did accomplish was the creation of more tiers of patients. Some patients had access to a Family Health Team or other teams; some had access to a family physician; and others had no access to primary care at all and still don’t.
In a recent Globe and Mail article, “We must confront the reality that Canada has a four-tier health care system”, Dr. Anthony Sanfilippo, cardiologist, and former associate dean at Queen’s University, suggests that the two major forces causing havoc within our health care system are the shortage of family doctors and economic duress.
Four tiers of patients are identified:
Those with a family doctor and sufficient resources to access alternative diagnostic services or procedures, often outside their home provinces
Those with no family doctor but with financial means to compensate by purchasing services through agencies, online services, or private providers
Those with a family doctor but constrained financial resources who are limited to treatment pathways their physician can navigate within the constraints of the public health care system
Those without a family doctor and with scarce financial resources who are at risk of enduring significant hardship without the ability to address their health issues
Dr. Sanfilippo makes two important points that include concepts surrounding choice and integration with respect to options for care.
“As options for medical diagnoses and therapies expand, pressure on the single-payer, universal-care model will only intensify.”
And,
“We’re not studying jurisdictions where the two systems seem to work harmoniously with the result that better outcomes are achieved at lower public cost.”
Importantly, he asks if we will continue to avoid dealing with the system’s fundamental problems by using short-term, case-by-case interventions. The current Ontario government’s $1.8 billion for primary care teams is case in point. To make a truly historic transformation to connect every person in the province with a primary care provider, the funding must be sustained and even increased over the coming years as the population grows and ages, particularly with the increased use of AI.
While the current election-style announcement may be a legitimate attempt to demonstrate a commitment to universal publicly funded primary care, the track record of the Ontario government to fund the services of family physicians sufficiently to retain them in primary care in the community is suspect.
After over six years in power, would the current government have Ontarians believe that it has had a primary care epiphany, or did it just not see the family physician crisis coming? Or did it simply have other priorities?
Government has moved forward without heeding the concerns of family physicians relating to their crushing administration burden. It has instead expanded primary care to other providers using public funding that it wouldn’t provide for family physicians services to help attract and retain them in the first place.
The demise of community-based family medicine is a very real risk after years of government inaction and disrespect, particularly in negotiations. Whether the Jones/Philpott primary care teams will hasten or help the exodus of family doctors from primary care remains to be seen and is, at best, unpredictable.
The usual stakeholders have provided positive statements regarding the current announcement as they did a generation ago but with a more tepid response from the Ontario Medical Association, and rightly so.
The OMA CEO states: “We urge the government to work with the OMA to retain the family doctors we have, encourage those who left to come back, and demonstrate a viable future for those considering this field.” The CEO’s statement ends with, “we look forward to the results of this announcement”.
Perhaps the OMA is aware of the similar past efforts to address access to family practice but which failed to deliver as hoped. The results do matter. Without new ideas and recognition of innovative solutions found elsewhere in the world it is unlikely that the shortage of family physicians will be solved or that the funding for primary care providers will be sufficient to meet coming demand.
The need for more providers is acute but without more family physicians retained and attracted to community practice there will be negative repercussions to overall access to primary care. In addition, if primary care teams succeed in connecting 2 million more patients to care, additional funding to address wait times will be required as people previously without access to primary care are referred for diagnostics and additional treatments and surgeries. The results may be positive for the patients who can finally access primary care but the waits are likely to be longer upstream.
When Ontario first heralded its new primary care model, Dr. Philpott expressed her anticipated hopes for primary care teams stating, “In every community, your primary care team will be your front door to care, where you have a team of clinicians providing care you can access in a timely way, close to home.” Millions of Ontarians are also hoping so and they should be asking what is different this time.
Consider, by way of reference, the McGuinty government’s April 2005 announcement had a similar vision: "Family Health Teams provide a continuum of care, so they can do more to promote health and prevent disease, as well as treat illness," said George Smitherman, Minister of Health and Long-Term Care. "That saves lives and precious health care dollars. We're changing the way health care is delivered.”
The reality is that twenty years later, the state of primary care is more fractionated and inaccessible than ever before. Economic conditions are a greater concern especially as tariffs proposed and potentially imposed by the US have an impact. The sheer numbers of physicians and nurses and treatments required to address the health needs of a growing and aging population with increasingly complex conditions will be an ongoing challenge in a single payer system and with bare bones productivity from our aging and long-COVID population.
Health care is too important to the lives of Ontarians to leave it to the idiosyncrasies and ideologies of whatever politicians are at the helm with their associated lobbyists.
What is needed is a broader base of funding that will give patients the freedom of choice and that is integrated and balanced with public healthcare services. Government needs a greater relative focus on building the necessary health care workforce including physicians, nurses, personal support workers and others rather than using health care workers to gain political points at election time. Improving the country’s health care system cannot depend on the commitments of a 4-year election cycle.
It is in this context that Canadians should consider the $1.8 billion dollar announcement that has been made… to get us beyond the vote and, perhaps to last four years…if we’re lucky.
Ontarians need to be asking, “Then what?”
References
“Ontario Investing Over $1.8 Billion to Connect Every Person in Ontario to a Family Doctor and Primary Care Teams”, Ontario Newsroom, News Release, January 27, 2025
“Increasing Health Care Access Using Family Health Teams”, Ontario Newsroom, News Release, April 15, 2005
“We must confront the reality that Canada has a four-tier care system”, Globe & Mail, January 24, 2025
“Health-care costs for Typical Canadian Family Will Reach Almost $18,000 This Year”, Fraser Institute Quarterly, Winter 2024
https://www.fraserinstitute.org/studies/price-of-public-health-care-insurance-2024
Dr. Merrilee Fullerton’s book “A Physician in the Political Arena” can be read here.