Shortage of family doctors pushing more patients to overburdened ERs, physicians say

Michael Tryon is on the hunt for a family doctor.

The Edmonton man learned in June that his family doctor is retiring at the end of November, and Tryon has been searching for a new one for himself, his wife and his son ever since.

"We have been watching for signs on the street … that say 'New doctor in this practice' or 'Taking new patients,' " he said, noting they've also tried joining Facebook groups to ask if anyone knows any doctors taking new patients.

Tryon and his wife are getting older and he says they don't want to be left in the lurch. 

"We need to find somebody. We need to keep looking," he said. "[You] don't want to turn up in an ER unless you're dying or you've got a broken bone or you've got something serious." 

Tryon is one of the nearly five million Canadians without a family physician, according to the College of Family Physicians of Canada. And those doctorless patients are turning up in already-stressed emergency rooms across the country with routine concerns and problems. 

Routine requests in ERs

Dr. Sean Wilde, an emergency physician in Lethbridge, Alta., estimates that up to one-third of patients in his ER are without a family physician.

He said some are coming in with routine requests, such as refilling prescriptions, filling out forms for work or insurance purposes or checking a concerning mole.

It's not uncommon to have people come in and say, 'I know I don't really need to be in the ER but I need this done. I need to see a physician and I don't have any other options​​​.'- Dr. Sean Wilde

"It's not uncommon to have people come in and say, 'I know I don't really need to be in the ER but I need this done. I need to see a physician and I don't have any other options,' " Wilde said.

"It obviously increases our volume. It increases the wait time. It's more challenging to find space to treat people and everyone has to wait a little bit longer."

The scope of the problem is also swamping walk-in clinics.

Joanna Kiraly, director of operations for Medicentres Family Care Clinic, said its clinics in Alberta, Manitoba and Ontario are seeing an increase of doctorless patients.

"It's definitely increased our wait times a bit and it's increased our volumes for our physicians," she said. "It's definitely a challenging time in health care right now."

To deal with demand, Kiraly says the clinics started a program where nurses, overseen by physicians, see patients with minor issues.

"We believe that will help support and perhaps relieve some of that pressure on the ERs," she said.

'System is broken'

Edmonton emergency physician Dr. Aisha Mirza has seen that pressure first-hand.

"When I go on shift, there can be 40 to 50 to 60 patients in the waiting room that haven't been assessed by a physician yet," she said.

The severity of the family doctor shortage is glaringly obvious to Mirza, who says, "Honestly, I'm surprised these days when a patient does have a family doctor." 

Honestly, I'm surprised these days when a patient does have a family doctor​​​​.- Dr. Aisha Mirza

She said consistent care from a regular family doctor, rather than persistent use of the emergency room, is the best-case scenario for a patient

"They're getting Band-aid solutions to chronic problems and that's frustrating for both the patient as well as the physician," she said.

"Patients who go time and time again to either an urgent care or emergency room without having a real physician that they trust are extremely vulnerable to having things missed and becoming more sick and ultimately not getting the appropriate care that they need," she said.

"I don't think that's sustainable at all and I think it's a true sign that the system is broken when you're seeing patients doing that."

Pandemic exacerbated issue

Dr. Christie Newton, president of the College of Family Physicians of Canada, said there were shortages of family doctors before the pandemic, which "really did just highlight the cracks that were already in the system."

She said that in the last two years, some family physicians became burned out and retired or retired early, while others transitioned into other areas of practice, such as emergency care, palliative care or maternity care.

Medical students see family doctors moving into other specialties, Newton said, and end up choose against community-based family practice themselves.

"The shortage of family doctors directly results in more patients going to the emergency department," she said, noting that the college is working with provincial, territorial and federal governments on solutions to the problem.

These range from incentives that aim to keep doctors in their family practices, to providing relief staff that can backfill so doctors can take time off. 

Like Mirza, Wilde agrees that more general practitioners would not only help with the pressure on emergency rooms, it would be better for patients in the long run.

"There is some frustration that we're already busy. We're already feeling burned out at times and there's this extra load on us that would ideally be better served elsewhere," he said.

"Even though we can kind of provide Band-aid care in a sense and help them with whatever urgent issue has come up or that they need help with immediately, we can't provide that follow-up care as a family physician would be able to."