Too many doctors in Toronto or not enough?

Family MDs deluged in `overserviced' area:
Report By Tanya Talaga Toronto Star Medical Reporter

Contrary to the official designation, there may not be an oversupply of full-time family doctors in Toronto.

Not only are the close to 2,700 general practitioners working within a stressed-out health system, they are seeing an additional 300,000 patients a year from just outside the city's borders.

The Toronto District Health Council is circulating a primary care consultation document to key officials that examines the role of family physicians and patient needs.

``If you talk to people who are trying to find a new family doctor in Toronto, for an oversupplied area it certainly isn't easy,'' said Linda Jackson, co-chairperson of the primary care steering committee, who prepared the report on behalf of the council.

The report will be made public this spring.

The council is also examining the distribution of doctors across the city to see if some areas are worse off than others.

``It is fair to say at this point, there is a variation in distribution and we are looking further into that to try and understand it,'' Jackson said.

However, it is too early to tell if the lower-income areas of the city are underserved compared to richer areas, Jackson cautions. ``We're looking at it and it's quite complex,'' she said.

`The government cut medical school enrolment several years ago, they instituted measures that have made it less attractive for new family doctors to set up practice, many residents are leaving the province and family physicians are retiring.'

- Dr. Sharla Lichtman Coalition of Family Physicians in Ontario

Dr. Sharla Lichtman of the Coalition of Family Physicians in Ontario said its officials are well aware there is a shortage of general practitioners in Toronto.

``The government cut medical school enrolment several years ago, they instituted measures that have made it less attractive for new family doctors to set up practice, many residents are leaving the province and family physicians are retiring,'' she said.

Yet Toronto has been designated as an overserviced family doctor area by the physician services committee, an advisory body of health professionals made up of health ministry officials and members of the Ontario Medical Association.

The status means doctors face penalties to discourage the start of new practices.

The last doctors' agreement with the Ontario government penalized new physicians who wished to set up practice in Toronto and other urban centres that are considered overserviced. Doctors would lose 30 cents of every dollar billed for medical services.

The council's research shows this has affected the supply of doctors in Toronto.

Early indications show there are fewer graduates establishing practices in the city. That translates into a smaller supply of new doctors affiliating with hospitals in family medicine.

Young family physicians with hospital affiliation are often a key to staffing emergency rooms, the report says.

``Our concern is with disincentives like that . . . there is less incentive to practise in Toronto. There could be more of an issue (with this) down the road,'' Jackson said.

The method commonly used to calculate the ratio of family doctors available to each Ontar io citizen makes it look as if there are more full-time physicians practising than there actually are.

In Ontario, doctor supply is commonly measured by head counts and physician-to-population ratios.

``Raw head counts are only part of the picture, and there is an awful lot more we need to know,'' said Dr. Ben Chan of the Institute for Clinical Evaluative Sciences, a health care think tank that has assisted the council in the report.

The influx of patients from the 905 belt should be looked at when considering the physician-per-patient ratio, the report suggests.

The number of people living outside the city who come in to see physicians may explain why there are an additional 300,000 patients for family doctors, Jackson said.

``You could live in Oakville but go see your family doctors downtown at lunch,'' she said. ``The population numbers increase and the physician numbers decrease when you look at people who are practising.''