Back in September, Globe and Mail reporters Karen Howlett and Kelly Grant wanted to know why so many Canadians are struggling to find a primary care practitioner in a country that has more family doctors than ever before.
They eventually found out that no data exist in Canada to explain the mismatch between the numbers on paper and what is happening on the ground.
Their starting point was the country’s national health data agency. The Canadian Institute for Health Information (CIHI) releases an annual report titled Physicians in Canada. Its data on the number of family doctors are based on the Scott’s Medical Database, which collects information from organizations such as the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada and medical schools.
CIHI’s latest report, for 2021, contains comprehensive information on everything from the number of family doctors in each province to a breakdown by age and sex and where they trained, which Globe data journalist Yang Sun analyzed.
But a simple head count of family doctors told the reporters nothing about how many hours those physicians actually devoted to family medicine or where they worked.
They heard plenty of anecdotal evidence suggesting that a significant portion of the family medicine work force no longer practices office-based, primary care. Doctors are working instead in hospitals, walk-in clinics, nursing homes and sports medicine clinics.
The reporters approached health ministries and medical associations in every province, asking whether they were able to say what percentage of family physicians practice primary care full time in a clinical setting that allows continuity of care from infancy to old age.
Quebec supplied data to The Globe showing that just 33 to 39 per cent of general practitioners devoted 90 per cent or more of their work to primary care between 2000 and 2020. The analysis was based on invoices doctors submitted to Quebec’s medical services plan for primary care over two decades.
Globe reporter Tu Thanh Ha was able to use the billing data to examine how policy-makers in Quebec – the province that has historically had the highest percentage of people without a regular physician – have responded to the crisis.
No other province provided The Globe with hard data on how many hours family doctors work and what numberdivide their time between primary care and working elsewhere.
A spokesperson for the Alberta Health Ministry said, “This is not something we can track directly.” A spokesperson for the Manitoba Department of Health said, “We don’t have this information readily available.”
In British Columbia, the association that represents physicians came up with a ballpark figure. Doctors of BC said 3,489 family doctors – roughly 44 per cent of the number registered in B.C. – were eligible to bill the provincial Medical Services Plan for primary care in 2021. But the association said it did not know how many of these doctors were working in walk-in clinics or hospitals.
B.C. and the other provinces provided their own head counts of family doctors; in most instances these were lower than CIHI’s. What’s included or excluded in the numbers, as well as the timing of data collection, could account for the discrepancies, CIHI spokeswoman Claire Brassard said.
A CIHI study comparing its numbers to two provinces, for example, notes that Ontario excludes doctors aged 80 years and over, but CIHI includes them. And Manitoba includes doctors who are semi-retired, while CIHI does not.
Anna Delaney, a spokesperson at the Newfoundland and Labrador Medical Association, said she has seen discrepancies with the CIHI data in the past when it comes to reporting the number of doctors. According to the medical association, the province had 609 family doctors as of April 5, 2022, she said. CIHI pegged the figure at 695 for 2021.
B.C. Health Minister Adrian Dix said his ministry and Doctors of BC are “engaging in a provincial data strategy” to get a better understanding of gaps in primary care. But for the foreseeable future, provinces will continue planning without good data on family physicians.
The federal government launched an initiative in September, 2020, to develop a pan-Canadian health data system with particular emphasis on tracking health workers, including defining the tasks performed by family doctors. But when federal Health Minister Jean-Yves Duclos asked his provincial colleagues to approve the data system at a meeting earlier this month, momentum all but vanished. The provinces reiterated their call for more funding from Ottawa for health care with no strings attached. Mr. Duclos said Ottawa was prepared to boost funding, but only if the provinces committed to the data system. The meeting ended at an impasse.
Source: The Globe and Mail