Want more family doctors in Ontario? Pay them better, say physicians

As the number of people across Ontario without a family doctor reaches a record high, Premier Doug Ford's government is facing a fresh push to make family practice more attractive to physicians by improving compensation.

The contract that covers how doctors are paid in this province, known as the physician services agreement, expires at the end of March. The government is in negotiations with the Ontario Medical Association (OMA), the doctors' bargaining agent, on a new deal. 

Family doctors' pay in particular is in the spotlight in those talks, in a way that it hasn't been for a long time.

That's in part because there's a growing chorus of physicians arguing that compensation is one of the key root causes why at least 2.2 million Ontarians don't have a family doctor, a number forecast to nearly double in just a few years.

"The reality is the current contract that we have is modelled on the economics of 2001 and not on 2024," said Dr. Sohail Gandhi, a family doctor in the town of Stayner, near Collingwood, and a former president of the OMA. 

"The workload has gone up, the need for extra staff has gone up and the gross billings that we get haven't been able to keep up," said Gandhi in an interview with CBC News. 

Over the past 10 years, inflation as measured by Statistics Canada has totalled about 25 per cent. During the same period, the average family physician's yearly billings to OHIP have risen just 5.1 per cent, according to figures provided by the OMA. 

A typical Ontario family doctor's practice runs like a small business, with costs for staff, rent and other overhead paid out of their revenue from OHIP billings. But unlike the typical small business, Ontario family doctors can't just arbitrarily boost their prices to bring in more money. 

The erosion of net income is a significant factor in some family doctors choosing to retire, shifting into another area of medicine, or opting not to open a family practice in the first place, says Dr. Ramsey Hijazi, a family physician in Ottawa and the founder of the Ontario Union of Family Physicians. 

"Our revenue is completely stagnant and all our costs continue to go up," said Hijazi in an interview. "Most businesses would go bankrupt." 

Dr. Mekalai Kumanan, who practices in Cambridge and is the president of the Ontario College of Family Physicians (OCFP), says many of her colleagues are questioning the financial sustainability of their practices. 

"What we're hearing from family doctors across this province is that they're actually struggling to keep up with the rising costs of running a clinic," Kumanan said in an interview. 

"With a really large number of patients who don't have access to family physicians, we certainly need to be thinking about retention and how we can keep family physicians in practice," she said. 

All the family physicians interviewed for this story say the financial pressures of running a clinic contribute to a growing reluctance among medical school graduates to choose family practice when they launch their careers.