“I’m a new family doctor. Working in Ontario’s system is terrifying, exhausting and heartbreaking”

When I started my undergrad at McMaster in 2008, I was planning to become an engineer. But, as I went down that road, I realized I wanted a job with more human interaction. Medicine seemed both challenging and rewarding. I eventually chose family medicine because I liked the idea that I’d get to do a little bit of everything and that my patients would include everyone from newborns to seniors—cradle to grave. I wanted to build long-term relationships with patients.

After finishing my residency in 2019, I took on locum positions, which is when you work at a clinic temporarily to cover for a physician who’s on leave or short-staffed. A lot of graduates do this, both to see what kinds of practices are out there and because it’s common now to take over a practice or join one. This fall, I’m setting up my own permanent practice at a downtown clinic where I was previously a locum. Read more: Dispatches from Ontario’s broken health care system

I’ve enjoyed all my positions, but it’s become clear to me that the system is broken. The fatigue and burnout are palpable. There are so many inefficiencies and sources of waste, so many things that could be done better. Even for life-threatening issues, it can take so long for patients to see specialists or get tests like CT scans and MRIs. As family doctors, we’re the ones interacting with patients while they’re waiting and trying to cope with their symptoms, frustrations and fears. And sometimes, while they’re waiting, their conditions worsen irreversibly. It’s terrifying, exhausting and heartbreaking.

One of the things doctors have asked for repeatedly is a centralized referral system for accessing specialist health care in the province. Right now, family doctors basically just refer to the handful of specialists they know. Ideally, the new system would have updated contact information and would let us know which specialists in our area are taking on patients and who has the shortest wait times. This would save weeks of waiting, even months. Countries like the UK already have this kind of system in place.

The other huge issue is how flawed the payment model options are for family physicians. One of the most popular ones is called fee-for-service, which pays $37.95 for the most common type of appointment, no matter the length of the appointment or the number of problems addressed. This kind of model doesn’t compensate physicians for spending time with patients; it pits physician and patient interests against each other. Some doctors pull in more money by powering through patients like it’s an assembly line, but that doesn’t necessarily result in good care. And the doctors who do address multiple issues in an appointment and pay proper attention to patients are taking a major financial hit.

On top of the erosion of our pay, we are doing an average of 19 hours of paperwork each week, which amounts to about two full days when we can’t see our patients. Plus, family doctors don’t have medical benefits, sick leave, paid vacation time or pensions. In medical school, I had heard whispers of how tough a family doctor’s financial situation could be, but I was excited to get going and start making money. Now, I look at my friends in non-medical fields and see them getting raises each year. I can’t help but wonder what my financial situation is going to look like in 30 years. Is this even a viable career?

Every four years, we go into contract negotiations with the government—­including decisions around our pay rates—and right now, we’re in arbitration. The Ontario Medical Association and the government have both presented their cases, and we’re waiting on the results. If things don’t turn around soon, I’ll have to consider other options. In the meantime, the system is better with me in it, in whatever capacity I can be.