Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022

Hina Ansari; Richard H. Glazier; Susan E. Schultz; Michael E. Green; Kamila Premji; Eliot Frymire; Maryam Daneshvarfard; Liisa Jaakkimainen; Tara Kiran

doi:10.1370/afm.240377

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RE: Implications for Primary Care in Canada and British Columbia
Ediriweera Desapriya

Published on: 27 May 2025

Published on: (27 May 2025)
Page navigation anchor for RE: Implications for Primary Care in Canada and British Columbia
RE: Implications for Primary Care in Canada and British Columbia
Ediriweera Desapriya, Research Associate, Department of Pediatrics, Faculty of Medicine, University of British Columbia Canada/BC Children's Hospital
The findings from Ontario resonate profoundly across Canada, including British Columbia, where the primary care crisis is acutely felt.

Exacerbating the Access Crisis: The decline in comprehensive FPs directly contributes to the alarming statistic that over 1 in 5 Canadians lack a regular primary care clinician (Kiran et al., 2024). In BC, this manifests as long waitlists for family doctors, reliance on walk-in clinics, and increased pressure on emergency departments for primary care-sensitive conditions.

Erosion of Comprehensive Care: Comprehensive primary care is the bedrock of a high-performing health system, associated with lower costs, fewer hospitalizations, and better health outcomes (Bazemore et al., 2015). The shift to focused practice undermines continuity of care, preventive health initiatives, and the holistic management of complex and chronic conditions.

Impact on Health Equity: Vulnerable populations, including those in rural and remote areas (where comprehensive FPs are already scarce) and individuals with complex health needs, are disproportionately affected by the decline in comprehensive care. This exacerbates existing health inequities, as the article notes the decreasing proportion of comprehensive FPs in rural areas.

Workforce Planning Imperative: The study's caution against relying solely on "head counts" of FPs for workforce planning is paramount. Policy must pivot to focus on the type of practice and the co...
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The findings from Ontario resonate profoundly across Canada, including British Columbia, where the primary care crisis is acutely felt.

Exacerbating the Access Crisis: The decline in comprehensive FPs directly contributes to the alarming statistic that over 1 in 5 Canadians lack a regular primary care clinician (Kiran et al., 2024). In BC, this manifests as long waitlists for family doctors, reliance on walk-in clinics, and increased pressure on emergency departments for primary care-sensitive conditions.

Erosion of Comprehensive Care: Comprehensive primary care is the bedrock of a high-performing health system, associated with lower costs, fewer hospitalizations, and better health outcomes (Bazemore et al., 2015). The shift to focused practice undermines continuity of care, preventive health initiatives, and the holistic management of complex and chronic conditions.

Impact on Health Equity: Vulnerable populations, including those in rural and remote areas (where comprehensive FPs are already scarce) and individuals with complex health needs, are disproportionately affected by the decline in comprehensive care. This exacerbates existing health inequities, as the article notes the decreasing proportion of comprehensive FPs in rural areas.

Workforce Planning Imperative: The study's caution against relying solely on "head counts" of FPs for workforce planning is paramount. Policy must pivot to focus on the type of practice and the comprehensiveness of care delivered, not just the sheer number of licensed physicians.

BC's Context and Reforms: British Columbia has actively pursued reforms to strengthen primary care, including the implementation of Primary Care Networks (PCNs) and new payment models (e.g., the Longitudinal Family Practice (LFP) payment model). The Ansari et al. (2025) study provides critical context for these efforts. If new payment models and team-based care can truly make comprehensive family practice more attractive, they could potentially reverse the trends observed in Ontario. However, the study's findings suggest that historical policy decisions (like restrictions on capitation models) have had long-lasting impacts, underscoring the need for careful evaluation of current reforms.

References:

Ansari, H., Glazier, R. H., Schultz, S. E., Green, M. E., Premji, K., Frymire, E., ... & Kiran, T. (2025). Family Physicians in Focused Practice in Ontario, Canada: A Population-Level Study of Trends From 1993/1994 Through 2021/2022. Annals of Family Medicine, 23(3), 181-190.

Bazemore, A., Petterson, S., Peterson, L. E., & Phillips Jr, R. L. (2015). More comprehensive care among family physicians is associated with lower costs and fewer hospitalizations. Annals of Family Medicine, 13(3), 206-213.
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Competing Interests: None declared.