Canadian health care was already shifting away from solo GPs. The pandemic made it worse | TBEN news


The current picture of a general practice practice in Canada reflects a shift away from solo work that may have been accelerated by the strenuous demands placed on healthcare workers during the height of the COVID-19 pandemic.

In a report released Thursday, the Canadian Institute for Health Information examined the pandemic-induced impact on the supply, distribution and movement of some health workers in the country.

Findings between 2020 and 2021 include:

  • Overtime hours hit the highest level in more than a decade, according to Canada statistics.
  • More than 1,800 nurses switched to self-employment or office jobs.
  • A growth slowdown in the supply of GPs combined with a temporary decrease in their services during the first lockdown.

Dr. Lawrence Loh, CEO of the College of Family Physicians of Canada, said the profession is trying to adapt to the challenging number of patients who do not have a primary care provider or easy access to their primary care physician.

The consequence for Canadians and the health care system is that more people are waiting longer in emergency departments, Loh said. For some of those patients, waiting means their disease has gotten worse or they’re not being treated as well as they could have been had they had better access to general practitioners and nursing specialists.

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GPs are doing their best, Loh says, but the pandemic has accelerated retirements in the profession, which has been underfunded for decades.

“The days of the solo family doctor doing it himself with the receptionist, that’s getting more and more challenging,” Loh said in an interview. He was the medical officer in health heavily affected Peel regionwest of Toronto, during the first deadly waves of the pandemic.

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The pandemic exposed the pressure that has been building for more than a decade, the authors of the CIHI report said.

The report’s authors noted that the average annual growth rate of GP supply slowed from 3.4 percent between 2012 and 2014 to 1.3 percent between 2019 and 2021.

“Efforts must be made to monitor and manage the health workforce…essential to cope with the unprecedented demands we have seen,” said Lynn McNeely, health worker information manager at CIHI.

At the same time deliver rates of practice nurses (NPs) increased by nearly 10 percent during the study period, making it one of the fastest-growing health care worker groups.

Nurses could ease the pressure: report

In some provinces, nurse practitioners diagnose and treat many illnesses and injuries, refer to specialists, and prescribe most medications.

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Growth in NPs is possible reduce pressure on health care systems and improving access to primary care, particularly in rural and remote areas, the report’s authors suggested.

Loh said advances in medical knowledge mean more people are living longer with chronic illnesses that need treatment.

In addition, the time taken up by the GP has increased, with more administrative work, such as filling out insurance forms.

When TBEN News recently visited Dr. Laura Sang, a new family doctor in Saint Hippolyte, Que., about 50 miles north of Montreal, started up her computer at about 6:30 a.m. and looked at 12 documents, two results, and four incoming messages. ‘at night.

Filling out the forms, preparing patient files to respond to requests from insurance companies denying a claim, and running the small business that is a family practice with all its IT and staffing demands also compete for Sang’s time, for which they are not is being paid.

Keeping paperwork takes time to see patients, GPs say. (Mark Quinn/TBEN)

Doctors say they are pulled into multiple roles

Since Sang is only paid for the time she spends with patients, she keeps track of how long their visits last, what she’s done for them, and what health issues they have, ranging from sleep deprivation and mental health issues to infections and cancer. It all affects billing.

“I find myself sometimes more in the role of a psychologist because patients can’t afford them,” Sang said. “Sometimes it’s… pharmacist trying to review all their meds. I’m sort of a secretary figuring out, OK, what appointments I’ve requested have been done, what specialists have they seen, what are they still missing?”

Loh, Sang and others say solutions to the primary care crisis include:

  • Improving the practice environment to retain current physicians and recruit recent graduates in a field in which they feel safe and comfortable enough to continue.
  • Relieve the administrative burden in some way, for example by having social workers fill in certain forms.
  • Moving to interdisciplinary teams where GPs work together with dieticians, practice nurses, occupational therapists, social workers and physician assistants, so that doctors can spend more time with patients and take a break.

The authors of the report also provided information on nurses, occupational therapists, pharmacists and physiotherapists.