Keswick doctor calls for increased provincial funding for family physicians

By Mike Anderson

Dr. Natasha Stribbell, who has been practicing family medicine for the past seven years at the Woodbine Medical Centre in Keswick, is calling for increased provincial funding for family doctors.

According to Dr. Stribbell, many family doctors struggle to pay operating costs, like rent, staff salaries and utilities, because provincial funding has remained stagnant despite higher costs and inflation.

“It’s imperative to recognize that family doctors are not just healthcare professionals but also small business owners who face significant financial challenges due to inadequate funding,” wrote Dr. Stribbell in a letter to MPP Caroline Mulroney.

“Our government representatives must take immediate action to ensure fair compensation for family doctors so that we can maintain a robust primary care system that effectively serves all Ontarians.”

Dr. Stribbell argues that chronic underfunding is causing many family doctors to consider relocating to other provinces, like Manitoba, Alberta, and B.C., where funding models are superior to Ontario’s.

She also says many Ontario medical students are not choosing to pursue family medicine, opting to work in hospitals that pay higher salaries and offer employee benefits, like pensions, paid vacation and sick leave.

“Society perceives doctors as millionaires, but that’s so far from the truth,” she said.

“When I graduated from 12 years of school, I was six figures in debt. I didn’t qualify for OSAP. I was lucky I could join a practice with seven other doctors to decrease some of the costs. If I ever wanted to go out on my own, I couldn’t; I can’t afford to have my own clinic.”

According to Dr. Stribbell, inadequate funding contributes to Ontario’s growing shortage of family physicians, making it harder for smaller communities like Georgina to attract family doctors to replace those retiring.

“I grew up here and have family. If you were going strictly based on finances, you’d be shooting yourself in the foot to stay. So, residency spots for family medicine are not being filled,” she said.

“You’re not attracting people to family medicine, never mind a rural or smaller community where the work is more and the access to the system is less.”

Dr. Stribbell predicts that the problem will only get worse.

The Ontario Medical Association (OMA), representing doctors in Ontario, agrees.

According to the OMA, 2.3 million Ontarians do not have a family doctor. That number is projected to reach 4.4 million by 2026.

While the average gross income for a family physician in Ontario is $307,149 (OMA: 2016-17), the average cost of running a single doctor’s practice exceeds $100,000.

In theory, family doctors, who bill per patient, could take on more patients to increase their incomes.

But Dr. Stribbell says that’s impossible; most family doctors are maxed out.

Dr. Stribbell, for instance, has nearly 2,000 patients on her roster and sees between 40 and 60 people daily.

“I’m not sitting here twiddling my thumbs,” she said.

“I do have a physician’s assistant with me, who I pay out of my own pocket, to assist with seeing extra patients because there are so many who just can’t get in.”

“Wait times are exceptionally longer if I take more patients. So, our income, or billings, need to reflect inflation to at least be able to pay operating costs.”

Dr. Stribbell also points out she doesn’t get paid for the two to three hours of paperwork she does each day after seeing patients.

And she can only bill a fraction of what other health practitioners bill for some services.

“I get 10 per cent of a visit, which equates to approximately $3. I also have a lot of patients who have moved and can’t find doctors, so I take their phone calls. I get $1.80 per call. A pharmacist who calls one of my patients gets paid $70. I have an issue with that.”

Dr. Stribbell says Ontario must adopt the same funding models as Manitoba, Alberta and B.C.

She wants the province to increase funding to 35 per cent of gross OHIP billings indexed to the consumer price index (CPI) to cover the increased costs of running a clinic and $150/hour for currently unpaid administrative work.

She also wants to see the province provide additional funding to help support the initial set-up costs of starting a clinic.

“There needs to be a financial incentive to open up a family practice,” she said.

“Other provinces have figured out the models. Apart from increasing funding, they are also paying for unpaid work and the paperwork that needs to be done,” she said.

According to a statement from MPP Caroline Mulroney’s office, the province is taking steps to address the shortage of family physicians in Ontario.

The province has increased the number of family doctors by 10 percent since 2018, in part by launching “the largest medical school expansion” in 15 years, with 60 percent of the new seats reserved for family medicine.

The province is also making it easier for internationally educated physicians and physicians from other provinces to practice in Ontario, which is expected to add 50 new physicians this year.

However, Dr. Stribbell says medical school expansion “means nothing” if physicians are choosing not to pursue family medicine.

“With a really large number of people facing the lack of a family doctor, perhaps the government should focus on retention instead of trying to attract new people,” she said.

“Barely 30 per cent of last year’s grads ranked family medicine as the first choice of their specialty training. In 2015, this figure was 38 per cent and has steadily declined for years.”

“That dwindling supply of family medicine residents, in turn, becomes an even smaller number of doctors choosing to enter family practice after finishing their residency.”

While the province recently reached an agreement with the OMA to provide a retroactive 2.8 per cent compensation increase for physicians in 2023-24, (February’s CPI was 2.8 per cent), Dr. Stribbell says it is not adequate and does not address the increased costs family physicians must pay to keep their practices open.

“It will give me even more incentive to tell everyone not to consider family medicine. We are stuck in a system where the government does not value us,” she said.

“Over the past ten years, inflation measured by Stats Canada has totalled about 25 per cent. During the same period, the average family physician’s yearly billings to OHIP has risen just 6.8 per cent.”

While Mulroney’s statement adds the province is working to reduce the administrative burden on physicians, Dr. Stribbel says there is still much more work to be done.

She wants to see faster referrals and better communications with pharmacies so that she can spend more time with patients.

“I trained in the U.S., and our systems are archaic compared to what I saw down there,” she said.

“It frees up so much extra time for doctors to take on more patients. If I didn’t have an extra 20 hours of paperwork, I would have 20 hours a week to see patients, and I’m only one person.”