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Study shows:
Ontarians face losing needed #FamilyDoctors because of @Kathleen_Wynne Gov't #ONhealth cuts

http://doctorsandpatients.ca/ontario-losing-new-family-doctors ONpoli

Ontarians are increasingly concerned about the effects of the Wynne government’s health cuts. Patients’ access to care is being threatened. More than 800,000 Ontarians are in need of a family doctor to get the best care medical care and prevent future illness.

Without access to a family doctor, many health conditions will worsen. This costs Ontarians their health, and increases the demand on our health system. The Ontario government’s short-sighted health cuts are putting politics ahead of patients.

Tell Wynne’s government to put patients first:


An independent recent study of new Family Doctors shows how Ontario already faces losing the family doctors we need because of recent Wynne goverment health cuts and restrictions. Read about the study details below, as well as an editorial in the Huffington Post.

study report:
Practice Location Preferences of Family Medicine Residents of Ontario

Brenna A. M. Velker, MD, PhD


The Ontario government has imposed unilateral cuts to physician remuneration and practice opportunities, the most recent of which was announced in September 2015 and took effect October 1st, 2015 [1]. This follows previous cuts in 2012, and in January 2015. Physician commitment to patient care fundamentally limits both ethical and legal ability to take job action similar to other public sector employees. These cuts will have a significant impact on family physicians.

The most recent changes of particular relevance to family medicine are: (1) elimination of funds previously used to defray start up costs for practice in team-based models (FHO, Family Health Organizations), (2) elimination of the option to join team- based family medicine practices (FHO) and restriction of these positions to under serviced areas (the ministry's definition of an under-serviced area has been widely criticized by family physicians and patients), (3) global reduction in fees for physician services (reduction of 0.5% in 2012, 2.65% in January 2015, 1.3% in October 2015), and (4) global cap on physician billings, with the threat of claw back of funds should billings exceed this cap, and (5) significant changes to billing codes for preventative health through annual health check ups, ongoing diabetes care, and after hours and weekend care of patients, to name only a few [2]. While all of the above will have a significant impact on family medicine, additionally there have been concerns about a breakdown in communication and negotiation between physician representatives (OMA) and the government (MOHLTC), and the threat of what additional changes are around the corner.

Anecdotal evidence suggests that resident physicians in family medicine are feeling more apprehensive about setting up practice in Ontario given the current state of affairs. The purpose of this study was to determine what, if any, the effect of these changes on family medicine residents’ plans for practice following graduation would be.


An online survey was developed to address the question of if and how the government’s actions over the past months would affect the ideas of family medicine residents around where they were planning to start their practice. The survey was developed by a collaborative effort between family medicine residents, a family physician in a community based practice, representatives from the Ontario College of Family Physicians, the OMA Section on General and Family Practice, and the College of Family Physicians of Canada. A link to the survey can be found below [3].

Distribution was accomplished through a collaborative effort between the resident councils at each respective family medicine training program, the resident representatives from the OCFP and the CFPC, and through social media / word of mouth by residents in family medicine. The survey link was distributed only to family medicine residents in Ontario, and was limited to one response per computer. The link was open for participation over a two week period prior to, during, and directly following the most recent funding changes that took effect October 1st, 2015.

The primary outcome was change in practice location preference at the start of the resident’s training program compared to their ideas at the time the survey was completed. As a secondary outcome we also asked residents to quantify what effect the current changes had on their responses to the primary outcome measure. Quantitative data was compared using the Chi squared test in a 3x2 table (http:// www.socscistatistics.com/tests/chisquare2/default2.aspx), and a p-value of < 0.01 was considered statistically significant.


The total number of family medicine residents in Ontario was estimated using the CaRMS residency match data for both IMG and CMGs from 2014 and 2015, both first and second iteration (Table 1) [4]. This does not take into account leaves (sick, parental, etc...), attrition and transfers, but provides a reasonable estimate of the total. Overall, 343 survey responses were collected, representing nearly 1/3 of the total number of residents in Ontario. Each of the six family medicine training programs were represented in the dataset (Table 2). All postgraduate years were represented in the dataset (Figure 1A). Additional demographics that were felt to potentially have an effect on practice location preferences including age, gender, and hometown were collected (Figure 1 B-D). All of the above groups were represented in the dataset.

At the start of residency, 89% of residents planned to set up practice in Ontario following graduation. Of the remainder, 8% were unsure, while 3% planned to practice elsewhere. When asked about their current plans, resident’s responses were significantly different (p > 0.00001). Currently, only 33% of residents plan to stay in Ontario to practice. A significant increase in both the number of residents planning to leave Ontario (17%) and residents unsure of where they will practice (50%) was observed (Figure 2). When asked what effect the recent actions by the government had on their decision, over 90% identified it as a factor in their decision, and 68% identified it as the major factor (Figure 3).

The primary data points were stratified based on year of study (Figure 4) and hometown (Figure 5). Overall, more PGY1 than PGY2 residents indicated plans to leave the province following the government’s actions, however while all PGY3 residents were initially planning to stay in Ontario, only 44% still plan to stay and practice there following graduation. While the percent of residents from outside of Ontario who planned to leave the province nearly doubled, the percent of residents who identify Ontario as their hometown, but are planning to leave following graduation increased ten-fold from the start of residency to the current situation.


It is clear from the above results that the recent actions by the government have had a significant effect on Family Medicine residents’ plans for practice after graduation. Prior to these changes, almost 90% of residents had planned to stay and practice in Ontario, while current data indicate that 2/3 are now considering leaving. The effects are more pronounced in residents who identify their hometowns within Ontario, and those earlier on in their training are more likely to plan to find work elsewhere. These results indicate that not only can we expect to lose a significant number of our newly trained family doctors, but that this loss is only expected to worsen in the coming years.

Steps need to be taken to address the potential loss of Ontario Physicians, starting with a commitment from the MOHLTC to negotiate with, and involve physicians in the process. Through a collaborative relationship between primary care, specialists, nursing, allied health, government, and patients we can achieve a sustainable and effective health care system that respects each profession’s autonomy, while holding each other accountable for judicious utilization of limited resources.


  1. OMAmediarelease:Unilateralactionsummary
  2. MOHLTC Bulletins #11125-11135
  3. Surveypreviewlink: Practice Location Preferences of Family Medicine Residents of Ontario
  4. CaRMS Data

Table 1

Residency positions in Family Medicine

Table 2

Survey responses by residency program

Figure 1

Survey responses by demographic data. (A) Postgraduate year, (B) gender, (C) age, (D) hometown.

Figure 2

Self-identified practice locations at the start of residency (A) and currently (B).

Figure 3

Impact of recent government actions on resident’s planned practice locations.

Figure 4

Practice location preferences of residents stratified by year of postgraduate training.(A) At the start of residency, (B) Currently.

Figure 5

Practice location preferences of residents stratified by hometown. (A) At the start of residency, (B) Currently.

the Government doesn't care
half as much

To my MPP + Minister of Health,

I’m writing to express my shock and frustration at the way that you, as a politician elected to represent my family and myself, have so clearly let us down, with the Ontario government imposing drastic cuts to the medical care that my family and I need from our family doctors.

It is irresponsible of this government to make cuts to the health care that Ontario’s patients need from their family doctors at a time when our province’s health needs are increasing by 110,000 new seniors and 140,000 more Ontarians every year. Alberta and British Columbia have acted more responsibly to meet these needs, but Ontario’s government is failing its people with these health cuts.

Government cuts threaten my family’s access to medical care when we need it, by making it more difficult for communities to find and retain family doctors. These cuts also put after-hours care, end-of-life care, and health care for other vulnerable populations at risk.

With these health cuts, Government is abandoning more than 1 million Ontarians that need a family doctor, and threatens to undo the progress that helped 2.1 million Ontarians get a family doctor and get better preventative care over the past decade.

I’m standing with other patients and family doctors across Ontario, and asking you to patients ahead of politics.

As my MPP, I’m asking you to PUT PATIENTS FIRST!

Putting the budget ahead of patients is unacceptable. Government must fund our health system for the complex medical care that our growing and aging population needs.