Ontario’s
has received a lot of media and public attention, but Premier Doug Ford’s increasingly credible effort to fix the problem is mostly flying under the radar.
Back in January, the government announced it would
spend $1.8 billion over four years
to provide family doctors for two million Ontarians who don’t have one. At the time, it sounded more like a placeholder than a real plan. It was something simple for PC candidates to say when voters asked them about the long-standing doctor shortage during the snap election scheduled for the following month.
The government’s claim that it could expand primary care coverage to include more than 300,000 people in 2025-26 didn’t seem credible given the many stories of burned-out family doctors facing the high cost of running a practice, low pay and the burden of unpaid paperwork. Many were reportedly disillusioned by years of successive governments failing to take the problem seriously.
The impression was one of a primary care system struggling to maintain current service levels and incapable of doing more. In the face of all of that, the government said it would simply ask for proposals to create new medical clinics or expand existing ones to handle more patients.
The response has been
In June, the government announced that it had approved 130 proposals for expansion, enough to meet its first-year target of serving 300,000 additional patients.
That was an encouraging start, although the targets for the remaining three years are much higher, with 500,000 the goal for next year and 600,000 for each of the two years after that.
Despite the strong beginning, one had to wonder what would drive the continued expansion, given all the known negatives. Then, earlier this month, news came of a deal that will almost certainly be a game changer for primary care and Ontario patients.
Last fall, the provincial government and the Ontario Medical Association (OMA) reached an arbitrated settlement that provided a big pay increase for doctors, nearly 10 per cent in the first year. What was unclear was
how higher pay would translate into increased primary care capacity
.
Negotiations between the province and the OMA have continued and at last, the government is listening to family doctors and addressing their concerns in a way that will encourage doctors to enter family practice.
The doctors and the government have nearly finalized a comprehensive plan to make family practice much more financially attractive. Among the changes are payment for administrative work, higher payments for services provided, after-hours premiums and financial incentives to add new patients.
With all the new incentives combined, the government says Ontario’s family doctors will be the best paid in the country. The administrative fee alone is substantial. The average family physician does about 20 hours a week of administrative work, which will now be compensated at $80 an hour.
The negotiations on the enhancement deal aren’t yet complete, but the OMA says the new approach will help attract and retain family doctors.
, chair of the OMA’s family medicine section, says “The model introduces meaningful investments, improved revenue streams, and long-overdue recognition for the time we spend on both clinical and non-clinical care. Importantly, it also opens additional space for physicians to join FHOs, broadening access to comprehensive primary care across Ontario.”
The FHOs, or family health organizations, that Barber refers to are the key to the government’s new approach. They are primary care teams that can include doctors, registered nurses, physiotherapists, social workers and pharmacists. It’s a smart approach that lets patients get a variety of services at one location.
About 6,500 of the province’s 17,000 family physicians work in FHOs, but the new money will certainly boost that number.
The Ford government has done the right thing in offering family physicians incentives to do more and increasing their pay so family practice can compete with other medical specialties. That, combined with expanded training positions for family doctors, constitutes a rational approach to a critical labour shortage.
That’s almost shocking in a socialized medicine system that is usually all about limiting spending and rationing care. Perhaps politicians have finally realized that it’s a rare person who would say, “I don’t need a family doctor. I want government spending restraint instead.”
The Ford government still has a long way to go to meet the need for primary care, but it has finally created a structure that seems likely to succeed. It won’t be cheap. With additional budget money added this year, the four-year expansion cost is now $2.1 billion, but at least it’s spending aimed at measurable and necessary results.
Randall Denley is an Ottawa journalist. Contact him at randalldenley1@gmail.com