Q&A: As more Ontario family doctors near retirement, new ones are needed to care for aging patients

A new study shows a troubling shift in Ontario's family doctor workforce. Published in the journal Canadian Family Physician, the research shows more than 1.7 million Ontarians are seeing family physicians who are aged 65 or older, and many of those patients are elderly themselves requiring more complex care.

The study also confirms that as family doctors near retirement in this province, there aren't enough new physicians to replace them. While it paints a grim picture of family care, it also recognizes there are possible solutions now that the reality is better understood.

Dr. Kamila Premji is the lead author of the article Trends colliding: Aging comprehensive family physicians and the growing complexity of their patients. She joined CBC's London Morning host Andrew Brown to talk about the study and how we can prepare for the future of family medicine.

The following has been edited to length and clarity.

Andrew Brown: What were you looking at in this study?

Dr. Kamila Premji: Our study looked at trends in Ontario's comprehensive family physician workforce between 2008 and 2022. When I say "comprehensive family physicians," I mean that cradle-to-grave, longitudinal care that you typically think of when you think of a family doctor.

What we found is that our workforce is aging. Older family physicians are making up an increasing share of that workforce, and correspondingly, we have an increasing number and proportion of patients whose family physicians are poised to retire.

As you mentioned, 1.74 million patients have a family doctor who's already aged 65 or older. We also saw that aging family physicians appear to be hanging on longer than expected; 7.2 per cent are now age 70 and older, up from 6.4 per cent in 2019, and they're looking after over 700,000 patients.

AB: Are these doctors hanging around because they feel like they have to?

KP: There's some anecdotal evidence about that. There have been media reports about family physicians who are trying to retire but cannot find someone to take over their practice. So they're hanging on a bit longer to see if they can get somebody in to take over their roster. But it's difficult, especially when, according to another of our findings, there aren't very many early-career family physicians entering the field — or certainly not enough.

AB: When our family doctors get older, what are the implications? What does that mean for the system?

KP: What's interesting, and maybe it shouldn't be surprising, is that their patients age with them. So they're also looking after older, more complex patients. We saw in our data that near-retirement-age family physicians care for a disproportionate number and percentage of the most complex, older patients compared to the rest of the workforce. As they get older, their own practices become more complex.

That means we might actually need more than one physician to take over an aging, complex practice.

As people age, they develop more complicated medical problems. They require more tests, more treatments, more specialists involved in their care, and the family physician is coordinating all of that. So the workload increases.

LISTEN | Dr. Kamila Premji talks about her recent research on family medicine on London Morning:

AB: When it comes to replacing our older doctors with young ones, how are we doing there?

KP: Data shows signs that the rest of the workforce may not be able to absorb the patients of these near-retirement physicians. Since 2019, for the first time, growth in the overall workforce has stagnated. That doesn't mean we're not adding new family doctors, we are, but fewer of them are going into that cradle-to-grave, comprehensive family medicine field.

And for the first time in our study, we saw that the number and proportion of younger comprehensive family physicians, those under 35, has declined. Overall, there are fewer family physicians who are trained in family medicine actually practising it. That's happening across most career stages, not just among younger physicians, but also mid-career ones who are leaving comprehensive family medicine for other types of work.

AB: How concerning is all of this to you?

KP: It's quite concerning. I think it indicates that we need to look at what the workforce needs in order to support it and expand its capacity to absorb the patients of these near-retirement physicians. That means we need to look at both recruitment and retention.

We need to recruit more family physicians into the system, those finishing medical school and choosing a residency, and those finishing a family medicine residency and deciding what type of practice they want. It also means retaining, or even drawing back, family physicians at the mid-career stage who have left family medicine or don't want to practice that full scope anymore. We need to support them to come back or continue in that kind of work.

AB: Right now, we are short a lot of family doctors in this province, right?

KP: Exactly. We know from our data that approximately 2.5 million Ontarians are already without a family physician. And when we look at our data on the near-retirement workforce and the remaining capacity, it looks like that's going to get worse in the coming years. We must implement some solutions fast.

AB: Do you see anything to be hopeful about?

KP: I think family medicine is a really interesting and appealing specialty, but we don't do a very good job of promoting it. The variety, the complexity, it makes it interesting. The long-term relationships you develop are unique to this field of medicine, and I think we can be doing a better job of promoting that to incoming physicians.

We also need to support the workforce, and there are solutions underway. Some that have worked in other jurisdictions include compensating family physicians for work they're doing outside of direct face-to-face care, which has increased. British Columbia just implemented a system like that, and they've drawn people back into comprehensive family medicine.

Team-based care is another solution, giving family physicians funding to hire support staff like nurses, nurse practitioners, admin assistants, social workers, pharmacists and nutritionists. All of that would help support their work, increase capacity and reduce burnout.

Dr. Kamila Premji is a family doctor, a fellow at the Institute for Clinical Evaluative Sciences, an assistant professor at the University of Ottawa, and a PhD candidate in family medicine at the Schulich School of Medicine and Dentistry at Western University.