Ontario Health has just released a new set of statistics showing another month of high wait times in the province’s emergency departments. The data shows that patients admitted to the hospital in May spent an average of 20.1 hours in the ER before being admitted to a ward. That matches the highest average wait time ever recorded in Ontario — which was at the height of the Omicron wave of COVID-19 in January — and is more than seven hours longer than the wait reported in May 2021. While health care experts say the root causes of emergency room delays include staff shortages and full hospital wards, some in the health system point to family doctor access as a contributing factor. In response to CBC News’ coverage of the situation in Ontario emergency rooms, some patients reported having to go to the ER because their family doctor was unwilling or unable to see them in person. However, Dr. Liz Muggah, president of the Ontario College of Family Physicians (OCFP), says the lack of family doctors plays a much bigger role in the emergency department difficulty than any restrictions on in-person appointments.
Dr. Liz Muggah, president of the College of Family Physicians of Ontario, practices as a family physician at Bruyère Family Health Group in Ottawa. (Provided/OCFP) “Obviously, it’s a problem if patients can’t get in to see their family doctors in a timely manner,” Muggah told CBC News. “The vast majority of family docs see patients in person and strike the right balance between virtual and in-person,” Muggah said. According to OCFP research, there are a number of factors that are placing a heavy workload on family physicians in Ontario right now:

Family doctors are seeing an increase in the severity of illness among their patients as a result of postponing procedures or delays in seeking treatment during the pandemic. The province is seeing a new wave of COVID-19 infections and an explosion in other respiratory illnesses that had been suppressed by mask use. Family practices face some of the same human resource challenges seen elsewhere in the health system, with shortages of nurses and administrative staff.

“The whole health system is under pressure, enormous pressure, and that includes family doctors,” Muggah said. This strain can have an impact on patients’ ability to get in to see their family doctors, something Sharon Mannell experienced firsthand. Sharon Manel’s family doctor’s office sent her to the emergency room of a hospital in Kitchener, Ont., for treatment of a sinus infection. (Greg Bruce/CBC) Mannell’s family doctor in Kitchener, Ont., diagnosed her with a sinus infection over the phone and gave her a prescription. But when the infection didn’t respond to medication and worsened, he says he still couldn’t get a doctor’s appointment, and staff recommended he go to the emergency department. “I’d rather go see my doctor about it. Plus, to me, the emergency department is for emergencies,” Mannell said in an interview. She said the experience left her frustrated and a little scared. “If this is happening now, what will happen in the future? I’m old. I’ll probably need my doctor more often as the years go by. And if I can’t see him now, what’s it going to be like later?”
While others around Ontario no doubt face similar situations with a doctor’s appointment, research led by Dr. Tara Kiran of the University of Toronto’s department of family and community medicine found patients of family doctors opted more for virtual care during the pandemic. they were no more likely to end up in the emergency room.
“I sympathize with people who are struggling to get access to their family doctor, I know that’s incredibly frustrating,” Kiran said in an interview. “The data we looked at tells a different story than the anecdotes we hear.” Dr. Tara Kiran, the study’s principal investigator, is also a family physician and research associate at St. Michael’s MAP Center for Urban Health Solutions. (Ed Middleton/CBC) Kiran was commissioned to do the research in the fall of 2021, when Ontario hospital ERs were also seeing a surge of patients and critics were pointing the finger at some family doctors for using a “virtual first” appointment method: screening patients online or over the phone and allowing only some to come for in-person visits. Related research led by Kiran found that the vast majority of family physicians in the Toronto area were seeing patients in person even at the height of the largest waves of the pandemic (this study was published online and accepted for publication, but has not yet been peer reviewed) . There is evidence that emergency rooms are affected much more by the number of people who do not have a family doctor. Before the COVID-19 pandemic hit Ontario, about 1.3 million people in that province did not have a family doctor, according to Statistics Canada estimates. Although more recent official figures are not available, there is broad agreement among health care experts that the number of Ontarians without a family doctor has only increased since then. The pandemic has caused a reported increase in the rate of family doctors leaving practice, either due to retirement, personal health issues or burnout. Meanwhile, there has been a steady decline in the number of medical students choosing to focus on family practice over the past seven years. About 25 percent of patients currently coming to the emergency room at Cortellucci Vaughan Hospital do not have a family doctor, according to Mackenzie Health’s emergency department medical director. (Patrick Morrell/CBC) Doctors say these trends don’t bode well for improving access to family doctors, given Ontario’s growing population. “Your family doctor is the beginning, middle and end of your entire health care journey. If you don’t have that input, you’re going to end up in the ER,” Muggah said. “The role of the emergency department is to try to deal with these chronic diseases. This is a huge problem,” he said. About 25 per cent of patients currently attending the emergency rooms at Richmond Hill and Cortellucci Vaughan hospitals north of Toronto do not have a family doctor. That’s up from five percent before the pandemic, according to information provided by Dr. David Rauchwerger, Mackenzie Health’s emergency department medical director. The crisis is being felt in emergency rooms across the province, including London and Southwestern Ontario, as well as Waterloo Region and Wellington County. Some ERs in small communities have reduced their hours due to staff shortages, as did the urgent care center at Brampton’s Peel Memorial Hospital on Sunday.