More than 1 in 5 Canadians do not have access to primary care, survey finds

More than 1 in 5 adults in Canada lacked access to primary care, with large regional gaps in access, according to new research in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.231372.

Translating to the Canadian population, our research estimates that more than 6.5 million adults across the country do not have access to a family doctor or nurse they can see regularly. And even those fortunate enough to have a family doctor struggle to get timely care for urgent concerns or care on evenings and weekends.”

Dr. Tara Kiran, a family physician and researcher at the MAP Center for Urban Health Solutions in St. Michael’s Hospital, Unity Health Toronto and the University of Toronto

As part of an 18-month Canada-wide initiative to develop a vision with patients and the public for primary care called OurCare, researchers conducted a survey to understand people’s values ​​and experiences with primary care. They analyzed data from more than 9200 people via survey, with 73% of surveys in English and 27% in French providing a national overview.

“What is surprising is the provincial variation in access to primary care,” says Dr Kiran. “Primary care is the front door to the health care system—the first point of access for acute problems, chronic disease management, disease prevention, and helping people access other services. It’s just a no-brainer that in some parts of the country, that door is now closed to almost a third of the population”.

In Quebec and the Atlantic provinces, nearly 1 in 3 people reported not having a primary care doctor, even after the authors adjusted for differences in age, gender, education and other demographic characteristics of survey respondents. People in Ontario were more likely to report having a primary care physician. Men, people under the age of 65, and people in poor health were less likely to have a primary care physician.

People with primary care clinicians also reported challenges accessing care, as most practices did not offer appointments outside of regular 9-5 weekday hours, and more than half of respondents said they could not make an emergency appointment within 3 days of the booking attempt. Many turn to clinics, which do not provide continuity of care, which patients reported was important.

The research team notes that 90% of survey respondents would feel comfortable receiving care from another member of a primary care health team, which has been suggested internationally as one solution to the primary care crisis. However, less than 15% of respondents reported that their primary care clinician worked with a social worker or pharmacist or dietitian. There was significant provincial variation, with the odds of working with any health professional lower for people living outside of Ontario and Quebec.

“The crisis in access to primary care goes completely against the values ​​that people in Canada hold dear – that everyone should have access to health care no matter where they live or who they are,” says Dr. Kiran.