In the heart of Ontario, a longtime family doctor runs a thriving family medicine practice that has served the community for decades. With more than 1,500 patients under care, the practice has been a cornerstone of local health care. Yet, despite its established reputation and the pressing need for primary care providers in the area, the aging physician eyeing retirement is struggling to find someone willing to take over his practice. 

“Nobody wants to take on the practice. This is a big problem. We graduate, just in Kingston, 50 family doctors a year,” said Dr. David Barber, chair of the section on general and family practice of the Ontario Medical Association and faculty member of family medicine at Queen’s University.

“But nobody wants to take on a cradle-to-grave practice anymore because it’s just not joyful. It’s not any fun, it’s stressful, and it’s a failing business model.”

This predicament encapsulates a growing crisis in Ontario’s health-care system — a severe shortage of family doctors willing to take on traditional, cradle-to-grave primary care roles. But there are solutions. 

According to recent estimates, the province is set to face a shortage of family doctors, with projections indicating that by 2026 one in four Ontarians may be without a family physician. 

New data from Upstream Lab at Toronto’s St. Michael’s Hospital shows that more than 130,000 Ontarians live more than 200 kilometres from their family doctor, the distance between Toronto and areas such as Parry Sound or London. 

“It’s too far and it’s impacting how Ontarians receive care because they are not seeing their family doctor — or any family doctor —  as often as patients who live closer,” said Dr. Archna Gupta, family doctor and researcher with Upstream Labs. “Our data shows that without a family doctor nearby patients may need to rely on hospital emergency departments more frequently and do not get screened for cancer as often.”

Although the Ontario government has made some investments in teams to support family doctors and a commitment to cut the unnecessary paperwork, more change is needed, according to  a new report from Ontario College of Family Physicians (OCFP). 

“Every Ontarian deserves a family doctor,” said Dr. Mekalai Kumanan, president, Ontario College of Family Physicians. “System-wide issues are stretching family doctors far beyond capacity. We need to address the pressing issues facing family doctors today.”

One solution proposed is to dramatically reduce the amount of paperwork. According to OCFP,  family doctors spend up to 19 hours a week doing paperwork. Additionally, many family doctors are reporting they are leaving the profession because compensation has not kept pace with inflation.

Barber noted that many family doctors face immense pressure due to the increasing complexity of medical practice and administrative burdens. 

“Family physicians are paid less than other specialists, and the support for primary care is relatively low,” he said. 

This financial strain has driven many doctors to consider private clinics, where they charge annual fees for services not covered by public health insurance. 

Barber emphasized the drawbacks of this trend. “Private clinics essentially give access to the wealthy, which makes no sense and leads to poorer health outcomes for those who can’t afford it,” he said. 

He highlighted the impact on the public health-care system, noting that these clinics pull family doctors away from public practice, making the shortage worse.

Dr. David White, professor emeritus, department of family and community medicine, University of Toronto, expressed concern about the impact of not having a family doctor on patients, particularly those who are already vulnerable.

“The people who need care aren’t the wealthy ones who can afford these clinics,” he said. 

Despite this, the majority of family doctors in Canada operate as private businesses and are not supported in the same way. 

“The government needs to show some courage and shut these clinics down,” said Barber; otherwise, the situation for everybody else is just going to get worse and worse.”

White suggested increasing the number of residency positions for family medicine and providing incentives for new graduates to practise in underserved areas. He said that the government’s investments in infrastructure and medical schools are good steps but not enough for immediate relief. 

“It doesn’t really matter how many family medicine residents graduate if nobody wants to go and practice family medicine,” he said.

Many new doctors are choosing specialties like hospitalist medicine, emergency medicine and sports medicine, which they perceive as more financially viable and less stressful. 

“The issue is that they need to make practising full-scope, cradle-to-grave family medicine attractive again,” Barber said.

Both doctors agreed that the government needs to do more. 

“The number of family doctors getting close to retirement is getting pretty large,” said Barber. “At some point, they’re going to have to look after themselves and take their well-deserved retirement.”