Aging family physician workforce challenges primary care in Ontario

A new ICES study has found that 1.74 million patients in Ontario are attached to family physicians aged 65 or older, and that many of those patients are elderly and have complex medical needs. 

The study, published in Canadian Family Physician, explored key trends in the characteristics of comprehensive family physicians (FPs)-those providing care for a broad range of ages and health needs-and the patients attached to them. 

The researchers found that for the first time, there was no growth of the comprehensive FP workforce, and an overall decline in the number of early career physicians (under 35 years old.) 

A major challenge Ontario faces is an aging family physician workforce that is nearing retirement. Although we found family physicians are practicing longer than expected – into their 70s, in fact – as these physicians retire, the number of patients without a family doctor will increase, especially as fewer early career physicians are choosing family medicine."

Dr. Kamila Premji, a family physician, ICES fellow, assistant professor in family medicine at the University of Ottawa, and PhD candidate in family medicine at Western University's Schulich School of Medicine & Dentistry 

A primary care system in flux 

The study included over 11 million Ontario patients as of March 2022, and 9,375 comprehensive FPs. This was an updated analysis of similar cohorts from 2008, 2013, and 2019. 

Along with a decline in the overall growth of the FP workforce and greater proportion at retirement age, the findings also showed that females made up the majority of the comprehensive workforce. Overall, a declining proportion of FPs are practicing comprehensiveness, from 77% in 2008 to 65% in 2022. 

A recent study by some of the same researchers showed that many FPs are choosing to work in hospitals instead of practicing comprehensive family medicine. 

"The data helps us to better understand the shortages we are facing, and informs strategies like team-based care, which can better support family physicians who provide comprehensive care and can reduce burnout," says Premji. 

Compared to the overall FP workforce, the authors found that near-retirement FPs were caring for a higher proportion of patients aged 65 or older, and many with chronic obstructive pulmonary disease, congestive heart failure, diabetes, and frailty. 

"Looking to the future, we are concerned that the primary care system may not be able to absorb these medically complex patients who are attached to retiring family physicians, which will only exacerbate the current crisis," says senior author Dr. Bridget Ryan, adjunct scientist at ICES and an associate professor at Western's Schulich School of Medicine & Dentistry.