Media briefings: Ask Ontario's doctors

Falling behind. Personally, through my work on the Black Scientist Task Force on CO 19 vaccine equity, the lack of race-based data delayed the recognition of the increased exposure and deaths in those who identified as Black, Indigenous, and people of colour. Countries like the UK and the United States systematically collect race-based health data, and they use it to inform health policy. That data has been essential in identifying the system where it fails Black women, particularly in reproductive and birthing care and in developing targeted solutions.

In the United States, Black women are nearly three times more likely to die from pregnancy-related causes than white women. We do not know the exact number in Canada and that uncertainty is part of the problem. But what we do know points to a similar troubling trend here in Ontario. A recent study found that Black women are overrepresented in maternal deaths in Ontario. Maternal mortality is a core measure of population health. It devastates families and communities and in many cases it is preventable. The same patterns appear in cancer care.

Limited evidence shows that Black women in Canada are less likely to receive pap smears and mammograms compared to other groups. And Black women from sub-Saharan Africa are less likely to be screened for both cervical and breast cancer. Because Canada does not consistently collect race-based data specifically related to cancer rates and screening, we can't clearly identify the gaps or how to best close them.

Organizations like the Canadian Cancer Society point to barriers facing racialized communities, including Black Canadians, such as a lack of culturally relevant care, systemic bias, and reduced access to trusted health information. We also know what does work. Evidence shows that culturally sensitive outreach and screening programs significantly increase participation among Black and immigrant patients. So talk to your doctor about screening. Ask questions. Make sure you're getting the preventative care you need. We also need to begin to analyze why Black women are receiving a lower standard of care.

Collecting race-based health data is not about division. It's actually the opposite. It is about visibility, accountability, and better care. If we want a health care system that truly works for everyone, Canada must start measuring who it is failing and why. Because without this data, inequity remains hidden. And Black women's lives depend on us finally measuring what we have ignored for too long.

I'm so excited to be joined by my other speakers on this briefing call today. I'm going to start by introducing my speakers one by one and they'll give you a little bit of a synopsis about what they're seeing, and then we'll open ourselves to questions and we'll really break down the barriers to healthcare for Black women and why they persist.

First, we have Dr. Cynthia Maxwell, vice president of medical affairs at Women's College Hospital and maternal fetal medicine specialist at the University of Toronto. She's amongst a few physicians who are researching the connection between a lack of race-based perinatal data and healthcare inequities for Black mothers and their infants in Canada. Dr. Maxwell, please. Thank you.

Thank you very much, Dr. Abdurrahman. It's a pleasure to be here and to bring light to a very concerning issue in the pregnancy and perinatal space. I am going to share with you some of the background and history related to Black birthing women and gender-diverse people and then bring us to the present to explore Black birthing in Ontario and in Canada. As you mentioned, for decades we've been relying on American pregnancy health data to inform our understanding of pregnancy outcomes in Canada. And it's not clear if that information is directly applicable to our populations given our distinct history and distinct trends in the diaspora of Black people across North America.

The US has the ability to track this information for pregnancy outcomes because it does have a systemic approach for monitoring and tracking severe maternal morbidity as well as maternal mortality. And as recently as 2023, the Centers for Disease Control in the United States reported that Black maternal mortality rates had increased from 37 to 50 deaths per 100,000 live births, meaning that Black women are three to four times as likely to die in childbirth compared to other racial groups. So clearly, these data represent a worrisome trend.

These data are brought more into focus with some of the tragic stories we hear in the news, such as the death of US athlete Tori Bowie a few years ago, as well as the severe complications that were shared personally by athlete Serena Williams during her pregnancy and birth journey. With the availability of data that is disaggregated by race, countries like the United States, like England, and other jurisdictions can analyze the causes of those maternal deaths, which can be related to pregnancy itself or sometimes to other causes. You can track then regional trends in these complications. And this creates the opportunity to introduce things like practice guidelines, quality assurance initiatives, and public policy to drive prevention and help save mothers' lives.

So where are we in Canada? Within the last five years, the Society of Obstetricians and Gynaecologists of Canada, working with many partners in the perinatal clinical care space and research in public health, as well as leaders in the Black health space, have established a series of national summit events to raise awareness and educate on maternal mortality for all Canadian mothers and birthing people with the goal of establishing a national, finally a national reporting system for maternal mortality. And we call this an obstetric surveillance system.

In the interim, we are slowly starting to learn more about the pregnancy outcomes in Black communities in Canada. Last year, for example, Professor Julia Moravac, in collaboration with myself and other members of our research team, published a scoping review on Black maternal and neonatal health in Canada. After reviewing the best available data which included six retrospective cohort studies, the conclusion was that Black race was associated with higher rates of preeclampsia, or hypertension in pregnancy as we call it, gestational diabetes, and inadequate gestational weight gain. In terms of pregnancy outcome, Black race was associated with higher rates of miscarriage, preterm birth, small-for-gestational-age infants, as well as neonatal death.

Fast forward to 2024, the Ontario Better Outcomes Registry and Network, also called BORN, reported, excuse me, on maternal mortality from a national registry dataset. And that showed that the maternal mortality rate in Ontario was 17 deaths per 100,000 live births. And although the data in this study were incomplete in terms of racial identity for mothers who passed away, the study did show that Black people were overrepresented for deaths that occurred just after as well as remote from birth.

A subanalysis of these data was reported last year looking specifically at the group of 20 Black women who died related to pregnancy over a 10-year period. And we learned that for the deaths occurring soon after birth, cardiovascular and hypertension, so high blood pressure disorders, were the most important causes. Maternal death in Black people was associated as well with material deprivation as well as the lack of a first-trimester prenatal visit. Here we have, I think, the first signals that some of these deaths are preventable and that the way forward will be through improvement in quality and cultural safety in pregnancy care as well as environmental and health system solutions.

So while the data are imperfect, they highlight the tragedy of social and structural determinants of health and the impact these have on Black birthing people. Importantly, following the publication of this Ontario-based data, our provincial registry and national organizations have committed to working with Black communities to create, analyze, and report this information in a culturally safe and respectful manner going forward.

And I would like to highlight the important work of the Black Reproductive Working Group, founded by Dr. Mubi Tundias, Dr. Carlen Wilson Mitchell, myself, and others across many disciplines who work in partnership with the Black Physicians Association of Ontario, the Black Health Alliance, and the Black Physicians of Canada, as well as community-based organizations such as Mino Care, and together we're going to find the answers to help change the outcome for Black birthing people. Thank you so much.

We're also joined today by Dr. Modupeola Aminu. Dr. Aminu is a breast surgical oncologist and general surgeon at the Scarborough Health Network and she is the current president of the Black Physicians of Ontario, the BPAO. She will shed light on the barriers Black women experience in accessing preventative care that could be behind the lower rates for breast cancer screening. Dr. Aminu, please. Thank you.

Thank you very much, Dr. Abdurrahman for having me today. Good morning to everyone and I'm really grateful for this opportunity to speak on an issue that does require urgent and sustained attention, which is the underscreening of cancer among Black women and gender-diverse individuals in Ontario, and particularly focus on cervical, breast cancer, and as we're seeing now, the rise in colorectal cancer. As Dr. Abdurrahman has said, my name is Dr. Modupeola Aminu and my focus is in surgical oncology and I work in Scarborough.

So we can say that Ontario organizes publicly funded screening programs for breast, cervical, and colorectal cancer. So on paper, this does reflect our commitment to one of the great ideals of Canada, of universal health care. But we know that universal coverage doesn't necessarily mean equitable access and it doesn't mean that you're going to have equitable outcomes. When we examine Ontario's own cancer screening performance reports, we see clearly that there are inequalities. Participation in breast and cervical cancer screening is lower among people living in neighbourhoods with higher deprivation of income and also having higher ethnic concentrations, areas where new immigrants come, and many of these areas include Black and racialized communities. These communities also have a lower rate of follow-up after abnormal screening results. And this tells us something that's really important, that this gap is not just something we see in papers or theoretical. It is something that is measurable.

So the importance of screening is that we want to catch cancer that is preventable. For example, cervical cancer is one of the most preventable cancers. With regular HPV testing, with vaccinations, and appropriate follow-up, we can detect precancerous changes long before they become life-threatening. Similar for breast cancer rates, survival rates are significantly higher when the disease is detected at what we call atypia or stage zero, so pre-invasive cancer. And often these are detected with screening mammograms. We have data extrapolated from the US and the UK and it shows that Black, Latine, and Asian people have more aggressive disease and are diagnosed at least 8 years earlier before their white peers, and our screening intervals do not reflect these differences that we see.

We know that when screening is delayed or missed, it means diagnosis at a later stage, which leads to more aggressive treatment that maybe doesn't necessarily affect your mortality but does have significant morbidity associated with it. It increases physical and financial burden. One of the common questions patients ask me when I say, "Okay, this is the treatment you're going to need, chemotherapy is going to be part of your treatment," one of their first questions is, "How am I going to pay the mortgage?" And that's not something that I have an answer for. And so this is something that we also have to keep in mind when we're talking about why screening matters. And also we know that it can potentially mean poor long-term survival.

Ontario's colorectal screening program, for example, recommends colonoscopy within about 8 weeks from what we call an abnormal FIT test, which is just a test that detects precancerous lesions using stool samples. But delays that are beyond recommended timelines can lead to missed opportunities for early intervention. And we know that early detection saves lives, but only if access is timely and consistent. Oftentimes for something like the Ontario screening program, you need a family doctor to be able to give you the screening test. We know that 2.5 million Ontarians do not have a family physician. And this is higher in neighbourhoods with higher concentrations of new immigrants, Black, and racialized communities.

So in terms of screening rates, we know that breast and cervical screening participation declined during the CO 19 pandemic and has now partially recovered. But we know cervical cancer rates had already been trending downwards even before the pandemic started. And people in neighbourhoods with higher ethnic concentrations had a lower screening participation and lower follow-up rates. It's important that we know that Ontario's screening database does not routinely collect race-based data, which means we don't actually have comprehensive provincial-level information specifically for Black women and gender-diverse individuals.

However, we do have some community evidence that fills in part of the gap at Taibu Community Health Centre, which is in Scarborough, Malvern, a center that serves predominantly Black, uninsured, Francophone, and immigrant communities. They noted that their baseline screening rates in 2012 were far below the provincial average. Their breast screening was about 17%, colorectal 18%, and cervical screening was about 54%. So they were able to create culturally tailored quality improvement initiatives using an Afrocentric approach, which included providers doing audits, patient outreach through peers, education, and community engagement, and those numbers increased dramatically. Their breast screening offered rose to 70%. Cervical screening ran to 70% as well. So this tells us something powerful: that disparity in screening is not inevitable. It is responsive when we have the right intervention.

I laid out some of the reasons why we have disparities. One of the main ones is access to primary care. Your ability to screen is strongly linked to having a regular primary care provider. People who are consistently not attached to care are significantly less likely to be screened on time. We also have structural barriers to screening, like transportation. I work in Scarborough. A majority of my patients rely on public transit. Our public transit is continually being changed and decimated in these neighbourhoods. And so if you have to take three different buses to get to a screening, that becomes a barrier for you to actually want to do the screening. Childcare is also an issue. We have, you know, the $10-a-day daycare program, but for some families that is still quite a lot of money to be able to have adequate childcare. Then there's an inflexible work schedule. Many people are working hourly jobs. And so for them to take half a day off work unpaid is quite a lot. And also just navigating the referral system that for us physicians we also find daunting, but imagine what it is like for the people that we care for. So knowing that we have a free healthcare system and free screening doesn't mean that it's frictionless or that it's accessible.

We can't also leave out the systemic racism in healthcare. We have to acknowledge the impact of systemic racism. Often, Black patients will discuss experiences of dismissal, poor communication, bias, and all this discrimination erodes trust in the healthcare system. Screening is a preventative measure, but it requires people to engage when they feel well and when they feel safe. If the trust is low, the engagement drops. Lower participation and lower follow-up in neighbourhoods with higher ethnic concentrations are a signal that there are deep structural inequalities.

As Dr. Maxwell also mentioned, without consistent race-based data collection, disparities remain partially obscured. We can't fix what we don't measure. So, what can we do to help close the gap? The first one, something that the OMA has been advocating for, is to improve primary care attachment, ensuring that everyone who is born has consistent access to a provider. This will dramatically increase screening rates as they're getting older. Expand what culturally safe community anchor programs are, such as the one at Taibu, where that experience shows that an Afrocentric approach and culturally tailored interventions do work. We also have to make sure that screening has to include timely follow-up after abnormal results. And we need to collect and use race-based data so we can use equity for our measurements, and then we also need to just extend our practical solutions, so extending hours that patients can have screenings, that patients can see providers. Cancer underscreening amongst Black people in Ontario is not about individual choice alone. It reflects how the systems are structured and how trust is built or can be broken. Ontario has strong screening programs, but strength has to also include equity. What I would like to leave is, when we have culturally responsive care and it's implemented, participation improves significantly, which means that we can close the gap and by closing this, we end up saving lives. Thank you.

Thank you so much, Dr. Aminu. At this point, we're going to open up to questions from the media. I encourage any of the journalists who are joining us today to please put your questions into the chat box and then I believe Mirina will be navigating us through the questions today. So over to you, Mirina.

Hi everyone, my name is Mirina Troleach. I'm with the OMA media relations team and our first question can go out to all the panellists, and we'll start with you, Dr. Abdurrahman. So the question is: Do you have any examples from your patients you can share that shed light on the challenges facing Black women with accessing specialist care, maternal and neonatal care, and cancer screening? Thank you.

Um, this is a great question and I do have examples, you know, in terms of the barriers, and I think this goes to what Dr. Aminu was talking about where unfortunately we see a disproportionate amount of those who identify as Black or otherwise racialized having a harder time accessing primary care, a family doctor, and so not being able to access the screening. You know, as an allergist, you know, I am working in a very small area of medicine, but I recall, especially post-pandemic, I was seeing a lot of different patients again in the office in person, and I remember one of the patients I saw and she said, "Is there any chance you could actually provide me with a pap? Because I don't have a family doctor, it's been so difficult, and I know that I need to be screened." And she was worried and she was concerned that she was missing out on her screening, which was true.

And unfortunately, you know, I'm not the right doctor to provide that service, but you know, she felt safe. She said, "You know, I just can't find someone." And you know, she was this Black woman. I said to her, I'm like, "Okay, you know what? Let's, let me give you some of the resources we have." Thankfully, the BPAO also has some resources in terms of physicians and other physicians we had in the area to help link her. But it was that moment where, you know, she said, "I just, I feel comfortable. This is a safe space." She wanted to ask because she knew she was missing the service. And so, we worked together, helped connect her with a family doctor so that she can get her screening. And you know, she just said to me, "I just, I feel that you understand why I'm asking you even though this isn't your area, but I just wanted to ask just in case that you do do this, because I know that I'm in need of this."

And I, you know, that sticks with me because it's that moment where you're in a safe space and you just want to ask, and that's why I ask everyone, you know, if you're in these relationships with a family doctor, to ask these questions. And I said to her, "Let's get you linked up." And that was, you know, how I could help. But you know, in that moment, someone really just chooses to reach out and when they feel safe, they will ask. And it's important for us to create these safe spaces because that's one of the biggest challenges, is to have the space where you can ask, "Should I be getting this screening? Where can I get this? Can you send me to the appropriate place?" So having those situations and having these areas is so important. I'll pass it over to Dr. Aminu.

And then, so you know, I definitely have stories of my patients in terms of accessing screening, but I actually want to share my story of the issues and the medical anti-Black racism and fatphobia I faced when I was having my child in 2020. I definitely felt that, and this, it was interesting because I had been very terrified of giving birth because of Serena Williams' story, and there was somebody else in the States just maybe about a year before. And so I was very scared of, you know, what could happen when I'm going to give birth. So the joke was my birth doula was my cousin who was an OB/GYN resident, and so she was there with me also, and the whole entire time my pain wasn't managed properly. I ended up having to have three epidurals before I was able to find any sort of relief. I was not being progressed, and I actually heard a comment very early on—I was induced—that, "Well, you know, she's not going to be able to push anyways, so she's going to be a C-section. So what's the point of increasing her Pitocin?" And I heard that, my cousin heard that, and we both looked at each other like, "What?" And you know, she and I actually understood what it's like. At that moment, I was not a doctor when I was giving birth, I was a patient. I felt very vulnerable, and I was grateful to have Abigail there with me, and she was the one who was advocating for me.

And you know, for me, when I reflect on it, part of that was there was the presumption that, you know, I'm over 40, I exist in a heavier body, I'm a Black woman, and that these were the things that were going to happen. And, you know, I felt proud that I did not go to a C-section. I was able to deliver him, and I pushed him out in about 30 minutes. So, I felt very proud of that. But during the process, I really got to witness firsthand just how, like, the anti-Blackness and how insidious it can be. And oftentimes people are like, "Well, how do you know it's because that you're Black or because you're fat?" I'm like, "Well, I've been both of those things for a majority of my life, one of them for all of my life. And you know when someone is treating you differently based on those things." And definitely, you know, when speaking to my OB/GYN who did come in to deliver me, you know, she had been getting messages about, you know, "She should just go to C-section." She's like, "Why? She's doing fine. Baby's doing fine." And so for me, that actually really galvanized my advocacy when it came to making sure that people who look like me, people who come from underrepresented communities, who are lower income, that they also have advocates when they're going through health challenges or just delivering a baby, which is not a challenge. Dr. Maxwell, do you also want to comment?

Thank you for sharing, Dr. Aminu. Yes, absolutely. I'm just acknowledging what you've just shared and how powerful that is, and I'm sorry for all that you experienced and hopefully together we can change that for others, right? I have all sorts of stories and experiences in the birthing space. A couple that stand out, I think, touch on some of the recurrent themes I think you hear across sort of the pregnancy as well as the cancer screening issues around cultural safety and culturally appropriate care. I do remember a patient who came in after giving birth who had a cesarean birth and had a clear and obvious wound infection. And you know, for those of us with melanated skin, sometimes detecting a wound infection is perhaps not as easy or not as readily recognizable. And so we had a look. Clearly, it was an infection. Needed some antibiotics so she could get back to her newborn and carry on with recovery from giving birth. What was interesting, though, in the conversation with her was that she said, "I spoke up repeatedly. You know, I told people at the hospital, I told, you know, healthcare givers that I think something is wrong with this incision." And folks looked at it, they said, "Oh, it looks okay. It's not an infection." Um, so this is a person who clearly tried to advocate for themselves, did speak up, and was repeatedly not listened to. So the diminishing of Black voices, not being heard, not being listened to.

And then also, I think for the healthcare workforce, having the knowledge and understanding of how to make a diagnosis when, you know, all of your education for recognition of skin infections was probably in people who didn't have melanated skin. And so, you know, you may not have that training or that experience. And so it is also on the educational system to ensure that our medical learners and physicians and other healthcare givers in the future will have that education, that experience, to provide that specific kind of care.

Another story, I think, that speaks to some of the issues around the severe outcomes, so the maternal morbidity and mortality, is a story that was shared with me by a midwifery colleague and professor who spoke of a Canadian woman who had given birth prematurely. So prematurity, I mean, it was something that occurs disproportionately in our Black communities. And she was visiting her preterm baby in the neonatal intensive care unit and started complaining of pain, so sort of upper abdominal chest pain, and told the clinical staff around her that, you know, she was having these experiences. And so this individual went on to die of a thromboembolism, so a blood clot that went to their lung, and this was in, you know, in hospital, in a care setting. And so, so very tragic.

It does recall those stories we hear in the media, particularly from the United States, the athlete Tori as mentioned, who had some complications related to pregnancy that may have been a factor in her passing. So the themes of, you know, dismissing Black voices, not being taken seriously, gaslighting I think is another term sometimes we use in this space, these are really factors that contribute to these kinds of outcomes. They come through in these stories, and I think they come out through the data that we've been discussing today.

Great. Thank you so much, Dr. Maxwell. We have another question for you. This one is asking: What impact does the lack of race-based health data in Canada have on public health?

I think as we've said a few times already, you know, what we don't measure, we can't really change or we can't really address. I'm struck by the linkage between some of what Dr. Aminu discussed and what I think about in the perinatal space. You know, what I didn't mention, by the way, is that in the Ontario data for Black mothers who die in and around pregnancy and giving birth, for those who die more remote from the birth, one of the major causes is cancer. So young, you know, young birthing people who've just given birth and then within a year of that birth, they pass away from cancer. And so some of this must be related to screening and diagnosis. We have a publicly funded healthcare system, and yet access continues to be an issue. So whether that is identifying a clinician who can provide the care to you, accessing the care, and then it's not culturally appropriate for you or you're not heard, or the education has not been such that certain features of your clinical presentation can be identified.

So the lack of this race-based data holds us back. It puts us behind other countries, for sure. And we are not able to identify those regional trends, those health trends that exacerbate certain conditions and allow early recognition of situations that can progress to severe morbidity and in some cases mortality for our Black birthing people. And so the data that we need will really inform not only the healthcare system, but it'll inform our policymakers about the structural and social determinants as well that we have to—I can call that racism. Those are the issues that we have to work on at a systems level, and we can't do that without the actual data. We can't rely on data from other countries. We must inform our work by data on Black Canadians.

Thank you, Dr. Maxwell. This next question is for Dr. Aminu. Can we really say Canada has universal healthcare given the issues you spoke about on cancer underscreening among Black women?

So, I would say Canada, Ontario, we're universal in the sense that if you need hospital care, core physician care, that is publicly funded. And Ontario has organized screening programs that exist province-wide. But universal coverage does not equal universal access. I'm someone who grew up in the small town of Wingham, Ontario, 3,000 people. And for many people in rural communities, more rural than that, access to screening is very challenging. It requires transportation to come to get screening. We know that for cervical, breast, colorectal access, screening access still depends on having a regular primary care provider, getting timely follow-ups, navigating a referral system, and you know, sometimes you become very Toronto-focused. But outside, when you're in a rural area, what we've done in terms of specialty care is that we've siloed them, that you know, this region, this hospital is what's going to be focused on XYZ. How does that affect those who have to travel four or five hours to get their rectal cancer removed? That becomes a bigger problem.

And so, you know, we talk about navigating referrals, transportation, time off work, and also just feeling safe and trusted in a clinical setting. All of this can be unevenly distributed. Our analysis notes that Black and immigrant populations are underrepresented in regular screening despite the fact that we have publicly funded care. So this points out that this persistent gap in race-based data collection makes it harder for us to understand how these inequalities are playing out and how to fix them.

Thank you, Dr. Aminu. This next question is for Dr. Abdurrahman. You mentioned there was a discrepancy in disease outcomes for Black people and people of colour during the CO 19 pandemic. How would race-based data collection during this time have helped to close those gaps?

Thank you. The way that this would have actually helped close the gaps would have been by sounding the alarm earlier. Many of us who are working in the healthcare field were raising the alarm saying we're seeing disproportionately more Black people, more people of colour, more people who identify as being Indigenous in terms of being sick and actually dying from COVID, but it wasn't being collected. So it was hard when we were trying to advocate to the government to help direct the resources to the populations with the greatest need in terms of vaccines, in terms of education as to why the vaccine was important and what it would help with. So that would have moved us faster if that data was there versus us having to just continually raise the alarm. It would have been picked up even on the side of the screening looking at the trends.

Because we were often challenged when we raised this: "Well, where are you seeing this? How are you seeing this?" And we'd say, "You know, it sounds anecdotal to you, but that's just because it's not being specifically marked down in the demographics from the hospitals." But as the physicians who are seeing the patients in hospital, who are seeing those who are dying, we were seeing these disproportionate numbers in terms of who was affected. This would have led to faster changes in terms of health policy and faster movement in terms of moving vaccines to the populations who really needed it to be at the forefront of getting them. So it would have just changed the trajectory and we would have lost much less of our populations who identify as Black, Indigenous, and people of colour, and it would have led to fewer deaths in these groups.

Thank you, Dr. Abdurrahman. This next question, we got another one for Dr. Maxwell. How does healthcare provider bias, whether it's conscious or unconscious, impact Black women and their infants?

It's a really important question. I think that there are so many examples in the medical literature that demonstrate this issue around unconscious versus conscious bias, and Dr. Aminu alluded to this as well in her story around unrecognized or under-recognized pain. So when Black folks are discussing their symptoms and describing pain, it's not taken seriously, and these are, I think, related to historical tropes that somehow Black bodies experience pain in a lesser manner than others. We know in cancer screening as already mentioned, in cardiovascular care—heart care for heart disease—that even with well-established and internationally recognized guidelines, those guidelines for care are not always applied appropriately in the setting of Black people.

And so overcoming bias is not easy. You know, part of it is certainly education. But I think that when we also establish the research that drives changes and innovation in our care, I think it's really important that Black health leaders and members of the Black community, people with lived experience, are active participants in this research. And I mean, I am happy to say that this is changing and we are seeing improvements in engagement with Black communities in research, particularly in nationally funded areas.

And I would like to highlight two that are related to Black maternal health and safety. One of them is led by Dr. Isabelle Malham out of Quebec, and it is a CIHR-funded hub grant. So the Canadian Institutes of Health Research has a number of hub or network grants to support women's health, and the study that she leads and that I collaborate with her on is really around knowledge mobilization to address pregnancy-related near-miss events and deaths, and to directly address some of the issues that we've talked about today. And I think what's important is that there has been deep and early engagement with Black communities with Black health experts to co-develop this work.

Another example is led by a midwifery professor colleague, Dr. Sarah Vedam, from British Columbia, and in her work, which is also supported by one of these network hub grants, it looks at justice and equity in perinatal services. And again, there is this deliberate and intentional co-creation with members of the Black community, with individuals who have lived experience in these areas. And I think the quality of the data that we will have around Black perinatal health will improve and will be relevant to our communities and actionable as we go forward.

Thank you, Dr. Maxwell. This next question could probably be posed best to Dr. Maxwell since your research is around this, but anyone can weigh in on this in terms of their specialties. But the question is: Why aren't we collecting race-based health data?

Okay, I'll start, but I think others will have some thoughts about this. Reflecting on that question, you know, I think historically in Canada, there maybe has been a sense that we don't have racism or that somehow it doesn't exist to the same extent as it may in other areas. And you know, we know that's not true, and it's just better to recognize it, name it, and then start to address it. I think that the notion that racism somehow doesn't exist or didn't exist can lead decision-makers to say, "Well, why do we need to collect data that is disaggregated by race if we don't actually think we have racism?" So I think that there are some historical roots there that explain part of this—resources, the will to collect this data. It's more work. It requires more resources and it's not easy to do because it has to be informed by the community. Nothing about us without us. You know, Black people need to be at the table when decisions about what to collect, what data to collect, how to collect it, how to analyze it, how to report it, and how to share it back to the community are made. This all requires deliberate effort and additional resources to be successful at. So those are my thoughts and maybe we can hear what others think.

Go ahead, Dr. Aminu.

I think I would probably echo exactly what Dr. Maxwell said. Not sure what else to add to it is that there's a reluctancy from a province-wide or Canada-wide level to do it, but we have systems to collect it. Like, you know, we use Epic in Scarborough, and on it, it asks your language, asks your background. And I do think that part of it is becoming more comfortable to say that, like for me, I am Nigerian, you know, to say, "I am Chinese." Like, we're comfortable asking people what language they speak, but people will be trying to describe someone and I'm just like, "Oh my god, are they Black, are they white, like what are we talking about here?" And so I do think there's a hesitancy, that people don't want to say those things, not realizing that noticing someone is different is actually a positive because it means that you know that they might have a different outcome. We should not treat all people the same. We should treat them according to what could be a risk factor or what outcomes they can possibly have.

Thank you. I think a lot of it has been said, but I would say that for anyone who's ever said, "I don't see race," that that is actually some of the most dangerous statements for people who are racialized. You know, there's this thought that in Canada we don't see race, everyone is treated the same, but it's not. And race is not a determinant of health, but racism is. And the system and the structures that be do have that built within it, unfortunately, and so people who are racialized are having different experiences. So the way we look at other risk factors, we have to look at that and we have to talk about it. And that's really uncomfortable for people, but we need to sit with our discomfort and do what's best for our patients. And that's why it's important to collect race-based data. And that's why people are uncomfortable about talking about it. But just because it's uncomfortable doesn't mean that you walk away from something.

I think currently we're probably going to—did you have another question, Mirina, before—

No. Yeah, I was just going to throw it to you to wrap this up, please.

Thank you so much. I wanted to say thank you, Dr. Aminu. Thank you, Dr. Maxwell. Thank you for sharing what you've seen. Thank you for your personal story, Dr. Aminu. Honestly, you know, we each have stories. We are doctors, but we're also patients in the system. We see patients. We see the importance of this. And we see the importance for people to also address things that can be uncomfortable. And this is important for the future of our healthcare system. We're so happy that you joined us today to talk about this. We hope that this leads to further conversations and to further changes in health policy. If you wish to ask us any further questions that we didn't get to, please reach out through our media team through the OMA. We're also happy to take anything further. Thank you so much for joining us today and thank you to our speakers today. Thank you so much. Thank you so much for having us.

Today we are releasing new data on the ongoing family doctor shortage in Ontario. The findings paint a picture of what lies ahead without urgent action. More than 2.5 million Ontarians do not have access to a family doctor, and a family doctor is someone that we all rely on for timely diagnosis, chronic disease management, and avoiding unnecessary trips to crowded emergency departments. 

Our new survey of Ontario family doctors provides a snapshot of the current shortage. We found that 52% of family doctors are considering retirement or plan to retire in the next five years. Just one year ago, the figure was only 39%. This shows that the number of family doctors planning to retire continues to grow, and without enough new physicians entering family medicine, the shortage will only continue. 

At the same time, the number of new family doctors coming into the system is not enough to fill this gap. A new survey with the Ontario Medical Students Association shows only 42% of medical students are considering family medicine as a career, and just 50% report an interest in comprehensive family medicine, which is that cradle-to-grave care that we talk about that is the cornerstone of our healthcare system. 

When we put all of this together, it becomes clear: the ability for patients to find a family doctor will only become more challenging in the years ahead. More physicians are planning to retire, and fewer students are choosing family medicine as a specialty. The math is not mathing—it does not add up, and the result is many more patients without access to care. This will not improve without significant changes on how we support and sustain family doctors. The Auditor General found that Ontario's plan to expand family medicine training has also fallen behind, as the government did not properly assess whether there were enough teaching sites. 

When patients cannot access a family doctor, minor issues escalate into serious conditions, and emergency departments become the default entry point into the system. Chronic diseases go untreated, and preventable complications grow more and more common. This is not sustainable for patients, physicians, or the healthcare system. The data we're releasing today reinforces what physicians across Ontario have been saying for years: primary care is the backbone of our healthcare system, and if we do not stabilize and strengthen family medicine, every other part of the system will continue to feel the strain. 

The Ontario Medical Association is committed to working with the government to address the family doctor shortage, and we have clear recommendations on how to move forward. We need to focus on attaching more patients to family doctors through team-based care, which wraps around the needs of patients and their ability to access care. These teams are designed to provide care and make it easier for patients to access the services that they need when they need them. Our recommendation is clear: build patient core teams around family doctors that help them care for more patients. Patient core teams enable family doctors to work together with registered nurses, physician assistants, and support staff to provide that comprehensive longitudinal care. This gives family doctors the resources they need to do what they do best: provide routine and acute care, manage chronic conditions, deliver preventative services, and coordinate referrals when patients need other physician specialists. The goal is simple: help doctors attach more patients with timely access to care. 

Right now, too many family doctors are drowning in administrative burden—the hours they spend on paperwork instead of spending these hours seeing patients. With the right team support, doctors can extend their capacity and serve the patients who desperately need them. Every family doctor should have access to the support that fits their practice, whether they work in a small clinic or a larger team-based setting. These teams will stabilize family medicine, reduce wait times, and keep patients out of emergency departments. 

We're very encouraged by the new Family Health Organization Plus model (FHO+). It offers a practical way to keep more family doctors in practice by giving them the support they need to focus on patients rather than paperwork. It recognizes the full work of family doctors and gives them the tools to spend more time with patients. We look forward to seeing this take effect in April because it will make a real difference in helping Ontarians get attached to a family doctor. We look forward to working collaboratively with the government on this and other solutions to strengthen primary care in Ontario. 

Today I'm joined by my colleagues who will help expand on these findings and share their perspectives on the front lines of family medicine and medical education. First, I'd like to introduce Dr. David Barber. He's a family doctor in Kingston and the chair of the OMA Section on General and Family Practice. He will speak about the growing family medicine shortage, as well as the increase in physicians planning to retire, and what he is hearing from our members across the province. Dr. Barber? 

You are muted, David. Go ahead. 

Thank you for that. These numbers presented today are really quite disturbing to me, and they should be to all people living in Ontario and Canada. The reality is that family doctors provide about 92% of all primary care in Ontario and in Canada, and I think we forget that number. It's a really, really important number—that's family docs providing the vast majority of primary care. On top of that, family doctors are also really the foundation of the healthcare system; family doctors provide about 50% of all medical care on top of this. So when you see the foundation of medical care crumbling, then we know that the whole healthcare system is in trouble. 

These new numbers that we're seeing today are especially disturbing because it's really at both ends of the age spectrum. In the younger generation, we are just not seeing the appeal of family medicine. I always say that family medicine should be, and it is, a great profession and very rewarding, but there are certain things in our system that are preventing the younger generation from seeing that. So we need to work on making the system more appealing. At the older end, to see 50% possibly retiring within five years—again, we know the problems, we know why people are leaving. My own family doctor is just retiring, and I trained him. The reason that he's leaving is simply the paperwork and having to run a small business. We forget that family doctors are small business owners, and when they see costs go up and revenue stay the same, it makes it very, very difficult. In regards to paperwork, the College of Family Physicians of Canada has said that family doctors filling out the Disability Tax Credit alone prevents 1 million visits a year to a family doctor, which is just incredible. So we know what the issues are; really, it is around what family doctors are doing every day in their office and what they don't like doing, which is the paperwork. Every family doctor wants to see patients; that's the bottom line. 

Then I think as far as stabilization for the small business owners who are family doctors, other solutions exist. If we look at what BC has done, BC changed their model, and that brought in a thousand new family doctors providing comprehensive or what we call cradle-to-grave care, and 10,000 family doctors in BC—that's a million new patients with coverage who have a family doctor, which is about 17% of their population. So there are things that can be done; we just need to really work with the government in order to find these solutions. We have been working really closely with Jane Philpott and the Primary Care Action Team. We're supporting what she's doing, which is great. I think there's a lot of other things that we could be working on with this government, and I hope we have better collaboration and communication with the government because there are many, many things that just aren't going well right now. So thanks very much, I'll pass it back to you, Dr. Abdurrahman. 

Thank you. We're also joined today by Ria Sei, who is the Vice President of Education for the Ontario Medical Students Association, and Gabrielle Taped, who's the Vice President of Advocacy for the Ontario Medical Students Association. They will speak about the medical student survey that I mentioned earlier, as well as speak to what students are experiencing and what changes they believe are necessary to encourage more students to choose family medicine. Over to you. 

Thank you so much, Dr. Abdurrahman, for the introduction, and good afternoon, everyone. As mentioned, Ria and I are both here on behalf of the Ontario Medical Students Association, which represents over 4,000 medical students across now seven medical schools. Ria and I are both medical students ourselves: myself in third year at the University of Toronto, and Ria in her second year at Queen's University. 

Today we'd like to share with you the results of a survey that we conducted to understand how medical students in Ontario view family medicine. Ultimately, as Dr. Abdurrahman mentioned, we wanted to better understand the beliefs of our future healthcare professionals and how they shape the landscape of healthcare for patients across the province. We conducted a survey from mid-February to mid-April of this past year and captured almost 12% of all medical students at the time. We were able to capture a pretty even distribution across all schools and medical students across all years of training as well. 

So what did we ask them, and what did we find? First and foremost, we asked students, "How likely are you to pursue family medicine?" It's a very simple question. Approximately 42% of respondents expressed that they were likely or very likely to pursue the specialty, which is a promising number, but we also would like to draw your attention to this 22% of participants who are neutral. Those are students who at this point report that they're quite undecided regarding their career, and I think this is a critical mass of students that have the potential to be swayed towards or away from family medicine depending on policy changes and the landscape of the specialty. 

When we asked students, "What do you like about family medicine?", they told us, "We like the long-term patient relationships, we like the shorter duration of residency—two years compared to four or five or more years for many other programs—and we like that there's flexible work hours." So students are saying that there are things about family medicine that are fundamentally, at its core, attractive. But on the flip side, we're also seeing that students are perceiving deterrents, and that is influencing the number of students that are choosing to go into family medicine. The top-ranked concerns are, by far, insufficient remuneration and administrative burden, which align with some of the concerns that we're hearing from doctors in practice about the specialty. 

Now, what is important to acknowledge is that the survey was conducted last spring, and we expect that new models like FHO+ are likely to remedy some of these challenges as they directly target the barriers that students identify to family medicine. Our focus in the future will be on information dissemination to our students about these models. 

But I think one number that has been highlighted, and that we want to really focus on, is this piece about comprehensive family medicine. When we ask students about their interest in family medicine, we're learning that when students express interest, it doesn't mean the same thing for all students. We asked them hypothetically, "If you were to go into family medicine, what would your career look like?" Only 50% of respondents said that they were interested in comprehensive family medicine. That's that cradle-to-grave model of care—the traditional full-scope practice where family physicians provide care across the life spectrum, from newborn care and pediatrics to chronic disease management and adult medicine. We're seeing that, instead, students are expressing a lot of interest in other, more narrow forms of practice. This includes enhanced skills (Plus One) training, which allows them to engage in slightly more training in order to practice in more focused areas, such as emergency medicine or low-risk obstetrics. We're finding that on the ground, when we speak to students, they find that there is less administrative burden and already built-in team-based environments in a lot of these forms of practice, which is really, really attractive to them. The reason I and many folks find this concerning is that the students who do pursue family medicine might not become the comprehensive family doctors that patients actually need to address this crisis. 

Building on the student perspective, we found that 39% of respondents agreed with the view that family medicine is a backup specialty. For many students, applying to family medicine is not an active choice, but rather seen as a safety net to ensure that they match to a residency program. From a systems perspective, again, this is very concerning, as adequate match rates may mask the reality that not all trainees intend to actually build a career in family medicine, and thus may not translate into long-term retention. 

We were also interested in understanding what helps inform the locations students are eventually interested in practicing in. Unsurprisingly, the top reasons included proximity to loved ones and available remuneration models. When asked which provinces they would consider practicing in regardless of training location, we were thrilled to see many students are considering staying in Ontario. However, it is also interesting to note that nearly half of the surveyed students demonstrate an interest in British Columbia at a time when the province was leading the country in making headlines for their innovative remuneration models. This suggests students are dialed into policy changes and respond to meaningful improvements in practice conditions, and this can play an especially important role in early stages when students are weighing all their options and envisioning their future practice. 

In terms of student perspectives, those are primarily being shaped on the ground, with 83% of students citing it's their experiences during electives and clerkship that have informed their view of family medicine, and 82% indicating that it's through conversations with current family physicians. Anecdotal evidence from med students across the province has suggested having strong preceptors is crucial in encouraging med students to pursue family medicine. Unfortunately, however, we are losing family physician preceptors across the province, with physicians stretched to their limits and unable to engage with teaching. Given the province's commitment to building two new medical schools, preceptors are now needed more than ever. 

In terms of future directions, students view systemic changes as a positive influence on pursuing comprehensive family medicine, with 71% indicating a positive change in response to loan relief programs or retroactive medical tuition refunds, and 72% with the expansion of team-based primary care—both areas that the province has made some recent developments in, which is very exciting to see. More strikingly, though, 93% of students reported that a decrease in administrative burden, and 92% reported that a change to the current remuneration model, would make them more likely to pursue comprehensive family medicine, demonstrating that it is those long-term systemic changes that we need to really bring students back in. 

Thus, our survey essentially found that medical students remain interested in family medicine, but they see that there are some deterrents to the specialty. Remuneration and administrative burden are the greatest concerns for med students, and of students that do plan on entering family medicine, many are more interested in Plus One enhanced skill training rather than comprehensive cradle-to-grave family medicine. So as we move forward, we need to think not only about attracting students to family medicine, but making comprehensive family medicine an attractive, viable career option. Thank you. 

Thank you so much. At this point, I'm going to open up for questions from the media, and I will turn it over to Adam Miller from the OMA to moderate these questions. Over to you, Adam. 

Great, thank you so much. You'll see at the bottom of the Zoom link on the screen there's a Q&A box; you can add your questions there, and we'll make sure to pass them on to our panellists. 

Okay, we have one question already in, and it's for Dr. Abdurrahman: "What solutions do you think will help connect more patients to family doctors in Ontario?" 

Thank you for that question. As I mentioned earlier, we're really trying to promote the model of having patient core teams. This is going to be essential to helping connect more patients to family doctors in Ontario, namely because it's going to allow family doctors to practice with a team working with them to help deal with some of the different issues we brought up—some of the administrative burden, and also to help them so they can spend more time seeing patients. They'll have more capacity to do so, and it's also going to encourage more of our medical students to choose family medicine to then be family doctors in the system. So this kind of model that addresses all the different issues that have been systemic and long-lasting will help address some of these issues to help connect more patients to family doctors in Ontario. Thank you. 

Great, thank you. Our next question is for Dr. Barber: "How concerned are you about the growing number of family doctors retiring, and are you seeing more family doctors leave family medicine earlier?" 

Yeah, no, this is really concerning. Those numbers suggest 50% retiring within the next five years, and remembering that every family doctor looks after about a thousand patients, when you add the numbers up, that's potentially disastrous and would leave even more people without a family doctor. Certainly I'm seeing this; I mentioned that my own family doctor is leaving family medicine to go work in the government. That's really because of the issues that we've raised around administration and running a small business. So that's the sort of thing that's happening on the ground. When the job gets so stressful and there are other options, then people are going to make changes. So it's up to all of us to try and remedy this. Thanks very much. 

Great, thanks. We have one more question for you, Dr. Barber: "Can you speak more to the demographics of the doctors who are considering or planning to retire, and is this about a glut of doctors reaching retirement age, or about younger doctors choosing to leave the profession altogether?" 

I think it's the latter—it's more about the family doctors that are closer to retirement age opting to leave the system. That's especially problematic. The older generation of doctors tended to take on larger roster sizes as well, so that just compounds all of the problems. I do think that the issue with younger doctors not choosing cradle-to-grave family medicine is especially problematic. 15 years ago, 80% of family doctors practicing did cradle-to-grave care, and that number keeps dropping. Recent numbers showing 50%—this is not sustainable, and so that definitely needs to be addressed. We need to figure out how to get the younger generation of doctors practicing cradle-to-grave care. 

Thank you. This next question is for Gabrielle and Ria: "Why do you think 39% of medical students consider applying for family medicine residency a backup option?" You can both speak to this if you feel comfortable. 

Maybe I can start. Thank you for the question. I think the answer to this is multifaceted. The piece about administrative burden is a really relevant one. Medical students want to practice medicine; medical students want to care for their patients. We don't want to run a business, and I think a lot of students are seeing the weight of the administrative burden that family physicians take on as a major deterrent to pursuing the specialty. In comparison, whether there are other practice spaces—whether that's other specialties or going through family medicine and doing enhanced Plus One training—they're able to find practice opportunities where they don't have to take on such a level of administrative burden. So I think that that's one piece that's a big deterrent. 

The other piece is education. We are seeing that there are fewer and fewer learning opportunities for students in family medicine. We have more students entering the system, but a finite amount of teachers who are willing, able, and have the time to teach. I'll give you an anecdotal example: at McMaster University, they have a program called the Family Medicine Longitudinal Experience. It's a program that exists within the first two years of medical school—it's actually similar across most medical schools; the University of Toronto has a program—and essentially it gives students the opportunity to be exposed to family medicine during their first two years of training. They get to go in the clinic, shadow a doctor, and do a bit of clinical practice before they get to their real clerkship clinical year. It's a very foundational experience for a lot of students; I know for myself it was influential, and I think it's the case for many other students. At McMaster, because of their number of students but the fewer number of preceptors who are willing and able to take this on, they've actually made this learning experience optional rather than mandatory. Part of that is due to inadequate preceptor compensation, but also just the number of physicians that are out there that have the ability and the capacity to teach. So we really believe that education is a very foundational piece to how students feel about family medicine, and if we're adding additional students to the system, we need to make sure that the education they receive about family medicine is robust enough to make us feel interested, supported, and wanting to go into the specialty. 

Great, thank you. Ria, did you have anything else you wanted to add, or did that cover it? 

I think Gabby got the main points. It really comes down to the fact that students can, through something like Plus One enhanced training, just do an additional year, and they're able to cut down on their administrative burden, work in a team-based environment, and also increase their earning potential, which I think is a big concern for many students. Similarly, on the education piece, from my own experiences at Queen's, we do a week of rural family medicine at the end of our first year, and most of the family doctors that we were placed with had all done some sort of additional training and had what they called their "side gig." They said that that's really what kept them going in the specialty, and I think that speaks to what students are seeing from current family doctors: that they're burnt out, that they're not able to do family medicine full-time, and that they need those other supports in place. 

Thank you. Our next question is for Dr. Abdurrahman: "You talked about team-based care. How do you think team-based care can help family doctors see more patients and improve patient access across Ontario?" 

Thank you, Adam. What we've talked about a lot here is that administrative burden and all the work that takes away from patient care. Recent studies show up to 19 hours per week is spent on administrative burden, so by having a patient core team with others who are supporting the family doctor—such as registered nurses, physician assistants, and other support staff—they can actually take on some of those aspects, whether that's helping with inbox management, triage, or all the other aspects, freeing up the physician to actually spend time with direct patient care. So much time is spent on indirect patient care that you can't offer more direct care for patients. 

In addition, this is also important because cutting away some of this work allows people to consider building more teaching into their practice as well. This is important because, as you've heard, if we're not seeing modelling where people are able to see longitudinal family practice—where physicians can do the direct patient care work they want and have the time to share the joy of their practice—then we're not seeing our future students choose this. So team-based care supports this in multiple ways: first, to see more patients, but second, to build our future workforce by showing the feasibility, sustainability, and frankly, the joy in family medicine. 

Thank you. We have another question that I think could be answered by everyone: "The government is pouring money into primary care, and the OMA has a new deal that should make family medicine more lucrative. Why do we think this isn't enough to convince doctors to stay in the profession or for students to choose it?" 

Maybe I'll start, and then others may choose to jump in. Firstly, we have to recognize that how we got here is from several years, if not decades, of not investing in or supporting this system. So we have to recognize that this has been a systemic issue. Yes, there has been funding, as we've talked about with FHO+; we're hopeful that this will encourage more people to choose it. Similarly, with funding put into models such as the Primary Care Action Team with Dr. Jane Philpott, we're hopeful this will help build more supports. But we have to recognize that there are also limitations. We want the funding to go to all of the family doctors who are currently in practice, but currently that's not the case. We're hopeful that more funding can be directed to all family doctors in the province to allow for this. These changes give us hope, but it's not going to be one thing that changes everything overnight; it requires a continued commitment and ongoing investment into family medicine moving forward. I'll pass it over to David Barber for further comments. 

Yeah, thanks very much. There is certainly a lag time here that explains part of it. The money that Dr. Philpott is working to distribute hasn't fully flowed yet, so it's going to take a while to have an impact. Looking at everything, I get the impression that there's a lot of bureaucracy within the government that prevents those monies from being distributed quickly. There are barriers such that family doctors can't receive the money directly—it has to go through different channels—and to me, that is problematic. The bottom line is that we haven't seen the impact from that yet. We're hopeful and working closely with Dr. Philpott and her team to make sure it does have an impact. 

The same thing applies to FHO+. In general, it's a good model, but that doesn't roll out until April 1st. Frankly, there are a lot of unknowns around the FHO+ model regarding what the impact is going to be. People need to realize that was part of a negotiation, and the government forced some issues. One of the things they wanted to see was family doctors having more patient visits per day, which actually goes against the whole team-based model. They pushed an issue that does the exact opposite of what we should be doing; they want us to see more patients per day, yet it actually makes more sense for team members to see those patients or for me to spend more time with a patient to address all of their issues at once. There is also potentially some negative impact in rural hospitals and rural areas. So we don't actually know, and there's still a lot of concern amongst family doctors about what the impact will be. Overall, I think it's going to be positive, but there are a lot of unknowns, so we just don't have the full impacts yet. 

Just adding the student piece: until these programs are actually in operation, those question marks exist for students as well. As students, we look to our instructors, preceptors, and mentors—who are current family physicians—to give us advice. Until those folks feel that these models are working, students won't trust in them and start choosing family medicine. So we really need to see what they will look like on the ground. 

I might just add something on the teaching clinics piece. I work at Queen's as an academic family doctor. We have 50 medical students per year entering the residency program, for a total of well over 100 residents. The reality is our program hasn't had an increase in funding for our academic work in about eight years, which is unsustainable. We actually can't hire or find family doctors to work in our academic center, and that's part of the reason. We are supposed to be paying preceptors out in the community to help us train residents, and that's problematic as well. It's just not getting the attention it deserves. One of our buildings at Queen's has been shut down, and we need to find a new space. You would think it would be easy to find funding for a Department of Family Medicine at Queen's, and we see a lot of money thrown into hospitals, but family medicine is being sidelined. If the government was serious about family medicine education, that would not be an issue—the money would show up, and we'd have a modern building where we could train more residents. But that's simply not the case. 

Great, thanks everyone. This is a question for Ria and Gabrielle: "We know that this survey came out in the spring, and since then there have been some changes, like FHO+ and solutions like AI scribes. Do you think these things are helping to make the practice more attractive to medical students, and do you think we may see more positive interest in family medicine going forward?" 

I think that's a really good question, and the honest answer is it's quite hard to say at this time. With a lot of the announcements slowly trickling out and not all of them being enacted as of yet, it's hard to say how students are going to react. We definitely think that there is potential for a strong positive impact, but like Ria mentioned, students need to see things in practice and see how their preceptors respond. If they see in clinical practice that there is a positive effect on their preceptors' work-life balance and administrative burden, I think that will be super influential. There is value in us reassessing how students perceive the specialty in a couple of months once FHO+ has rolled out. But it's also important to acknowledge that a lot of the challenges regarding education haven't really changed. 

Anecdotally, a lot of students receive very little formal education on practice models. I'm in my third year and currently in my family medicine block in clerkship right now, which means I'm in a family medicine clinic every day. This is the last time in my training I will receive formal education on family medicine for the rest of my medical school training. At no point during my education has anyone sat me down and talked about FHO+ or other practice models available to us. So there's a big piece here about information dissemination. Students respond to things they hear in the press or from preceptors, but these are complex models that students need to understand to comprehend how they shape their future practice and administrative burden. The level of instruction students get about FHO+ is likely to be a big determinant as to whether the program affects their perception of the specialty or not. 

Great, thanks. Ria, did you have anything else to add? 

Okay, we had one last question for Dr. Abdurrahman: "What changes do you think would help family doctors focus more on patient care, and are you hopeful about FHO+ taking effect in April to achieve that?" 

I think that some of the changes in FHO+ will be helpful to support family doctors to see more patients. What we also need to provide is similar support—in terms of administrative burden reduction and wraparound care with core teams—to other models of family medicine across Ontario, because longitudinal family medicine is practiced in many different models. So we want to ensure these supports are across all of family medicine so that regardless of where you are, you can access them. 

I'm cautiously optimistic in terms of the changes taking place in April. We need to see how translation goes when physicians move over to the FHO+ model and ensure it values their time spent on both direct and indirect patient care. I'm looking forward to seeing that and hoping it translates into doctors spending more time with patients. We also hope to see further changes in funding for academic work so family doctors can do more teaching. I have some cautious optimism moving forward, but I do see a lot of other areas where there can be infusions of funding, support, and infrastructure. Medicine was started off as an apprenticeship, and we need to build that back into all of these models so we can continue that integral work for future generations. 

With that, that was our last question. I want to say thank you to everyone who joined today, and thank you to Dr. Barber, Gabrielle, and Ria for coming on. It's really important to hear from all of the different viewpoints—from the OMA, from the Chair of Family Medicine, and from the future of medicine. I hope this gives a better, comprehensive idea of what is needed. For those making decisions—especially regarding funding in the Ministry of Health and ministries funding education—we will continue to propose solutions in hopes of connecting every Ontarian with a family doctor across the province. Thank you for joining us. 

Good morning and thank you for joining us on our latest media briefing. I'm Dr. Zainab Abdurrahman and I am an allergist and clinical immunologist in the Mississauga area and president of the Ontario Medical Association. We represent over 47,000 doctors. As doctors, we're not just fighting for our patients' healthcare anymore. We're also fighting to get funded for providing the care that our Ontarians need. Whether it's treating a newborn without a valid health card or someone experiencing homelessness, physicians are always there to care for our patients. The system, though, it's not always there for us.

This passion tax is taking a toll. Doctors are working tirelessly for our patients, often without compensation, and we're buried in administrative burden and fighting to just get claims paid for the services already rendered. It's one of the reasons that physicians are experiencing burnout and, in some cases, just leaving the profession altogether much earlier than they had planned. As a resident of Ontario, your tax dollars fund OHIP to ensure that healthcare is provided and is available to you when you need it. Unfortunately, physicians can't rely on OHIP to properly fund the care that they provide regardless. And this is leading to cases of just outright denials and putting your healthcare at risk.

Personally, having worked especially with newborns in my first few years of my career, I can think of many times where I spent most of the better part of a night taking care of a sickly newborn who may not have made it, and then later having that billing rejected because, unfortunately, the family did not go further to ServiceOntario to register that baby. I can tell you that no doctor is calling that family to do that. But having to put that on and telling us that that's what we need to do, that is extremely unfair, and I don't wish for anyone to go through that experience.

A recent OMA survey of over 2,500 physicians showed that 90% of them had experienced OHIP claims rejections in 2024. Amongst those, over half of them said they are less willing to perform certain procedures because they've seen so many rejections. Over 65% said that this led to more administrative time dealing with the rejected billings, and that unfortunately then reduced time to spend treating patients. Based on the survey data, we estimate that there's an additional 5,700 patients that could have been seen if physicians weren't spending that time actually following all those rejected billings. So, the more time doctors spend chasing OHIP billings, the fewer patients they can see. There's only so many hours in the day.

The Ontario government has committed to providing accessible healthcare for all Ontarians, but these funding issues are standing in the way of that commitment being fulfilled. We're calling on the government to establish an ombudsperson, an office where people have clinical experience and expertise to help resolve these funding disputes, ensure that there are reasonable, realistic timelines for the appeal of rejected claims, and to give physicians an appropriate amount of time to appeal their case, and to ensure the process is transparent.

Doctors don't turn people away. It goes against every instinct and value we have. But when we care for patients who don't have valid OHIP cards, we often do that work for free. Across the province, physicians are treating people every day who, for some reason or the other, don't have a valid health card. They could be a newborn baby whose health card is expired because the parents could not complete the health work—the health paperwork—in time. But it could be also those who are struggling with mental health issues or who are experiencing homelessness. And these are some of our most vulnerable patients, and they deserve care.

In every one of those cases, a doctor will provide them that care that they deserve, but the system refuses to recognize it. When we're seeing this failure in policy, it's punishing doctors for doing the right thing. No one should have to choose between following their duty to patients and being paid for the work that they provide.

The Ontario Medical Association is asking the government to bring back the good faith billing. It's a simple, fair policy that allows doctors to bill for medically necessary care to provide a patient when their coverage can't be verified even though they're eligible for it. For newborns, we're asking the Ministry of Health to allow OHIP claims for a pre-assigned healthcare number to stay valid for 90 days instead of expiring within 30. For Ontario residents who are eligible but can't provide documentation due to homelessness or poverty, doctors should be able to bill in good faith.

Your tax dollars are meant to fund healthcare, but right now they stop short. And for someone who can't show or prove that they're covered, even if they are, good faith billing is about restoring fairness to physicians and providing the best care for our patients. Doctors are asking for one simple thing: to be treated in good faith when acting in good faith.

Today, I'm joined by some colleagues that you've seen behind me. We have Dr. Jane Healey, Dr. Ken Milne, and Dr. Tanya Tajarian, and they're also going to speak to some of these OHIP billing issues that they encounter in their practices and how it impacts their patients. We'll start with Dr. Jane Healey, who is a pediatrician at Trillium Health Partners. Please.

Thank you, Dr. Abdurrahman. As our OMA president mentioned, rejections for new OHIP health cards is a very big strain on my colleagues in pediatrics. You may hear that a very small proportion of OHIP claims is rejected on the order of 0.58%. However, what's important to recognize is that certain specialties are affected more profoundly by these rejections. The system that we have in place for registering newborns for their valid health card is flawed. It depends on multiple very outdated systems that involve a paper form making its way to the OHIP office to be registered, and there are multiple failure points that can get in the way of that process happening.

And not only is it unfair to physicians that are providing that care in good faith, it's also unfair and burdensome to families with a new baby at home. Because in order to properly register that newborn, they then have to suffer the inconvenience of going to a ServiceOntario office with their new baby to obtain a brand new health card. They need to field calls from multiple healthcare providers that they may have been in contact with during their baby's hospital admission to provide that new number. All of this is unfair. It's administratively burdensome—not just for physicians, but also for families. And I would call on the government to consider revamping the system, to consider good faith payments as they were before, and to make sure that this is a fair process for our very youngest Ontarians, our newborn babies. Thank you.

Thank you, Dr. Healey. I'm excited to also call up Dr. Tanya Tajarian. She is the chief health information officer and chief of hospital medicine division at CAMH. Thank you.

Thank you so much. So, I'm a primary care hospitalist and I've been for the past two decades taking care of patients with severe mental illness at CAMH. I think it's very important to know that team-based medicine and team-based care is how modern medicine works. OHIP's virtual care rules need to catch up, recognizing that continuity belongs to a team and not just for a physician. Right now, if a patient, for example, needs to see their physician and the physician is away, they have to come in in person to see another member of the team. There's, again, access for care—for virtual care for the most vulnerable—is very important. Thinking about the barriers to reduce them, it's going to be very critical. So, thank you for this opportunity.

Thank you. And last, but definitely not least, Dr. Kevin Milne. He is a rural emergency physician from the Strathroy region of Ontario. Please.

Thank you very much. I'm really pleased to have the opportunity here to advocate for rural healthcare and for access to rural healthcare. And I know that my colleagues have talked about funding, and funding is really, really important. But we also talked about good faith care, and that's because it starts with patient care and it ends with patient care, and funding of that care is only to facilitate that care.

I don't know if you've heard, but there's a shortage of rural physicians, and we have emergency departments closing—and some have closed at night. They say they're temporary, but they've been permanent in one case since 2019. And we need proper funding for rural areas. And one of my colleagues mentioned, what was it, about 0.5? Wow. You know, it's sort of like being pregnant. You're not 0.5 pregnant. You either are pregnant or you're not pregnant. And so, you either got paid for the service or you didn't get paid for the service.

And if physicians—and especially rural physicians where there's a severe shortage and you could be one doctor away from that community not having any care or being a healthcare desert—we need to ensure that they are being funded properly and fairly and in good faith, because I don't think anybody wants to lose access to their family physician. Thank you very much.

Thank you so much. We'll now take some questions from the media.

Thanks, Ed. I think Dr. Milne touched on this a bit. I was wondering if it would be possible to sort of get an update on how things stand with the physician shortage. We've heard from the government they've cut the Ontario Healthcare Connect waitlist in half. You guys seeing a difference? Where are things at?

Thank you. So, as you know, as you mentioned, the Healthcare Connect announcement did come up. We do know that we have many unattached patients across Ontario. As you know, it was closer—it's closer to 2 to 2.5 million, and the waitlist on Healthcare Connect was not 2 million. So, we know that there's many patients who are also not on that list. So, it's also difficult to fully quantify that. There is movement forward, but we still know that we need more physicians also on the ground to be able to properly connect. But we also need funding for all the different models of care across family medicine to allow for them to continue with increased attachment, and that's why we continue to push on ensuring that every Ontarian has access to a family doctor. I don't know if anybody else also wished to comment.

Yeah, if you don't mind. Thank you for the question, because it was something that I raised, and so I appreciate that very much. But there's a difference between being connected to a physician or a primary care team and access. And you said access, and that's what we're really talking about. We don't want people just to have a primary care physician in name only. In name only. They still have to see in a timely manner that physician or that physician's team. And so, it's really, really important.

And if you've cut down on the list, great. You've cut down on the list. But the real metric is: can that patient see their physician? Not if they have a physician in name—they're connected to a physician. And I'm an emergency physician. I have not seen a change. Now, it may be too early, but I have not seen a change yet for access to care. And that was the key word you brought up. Yes, access. So, you don't want just a physician or a physician team in name. You want to be able to call up your doctor and not say, "Yeah, well, the next available appointment is 6 weeks. Go to the emergency department." Primary care should be delivered in a primary care setting.

Thank you. Any other questions?

Okay. Thank you so much for joining us today. We're excited to be here. We're here all day and we're going to be meeting with various MPPs, and we're going to continue to discuss this issue as well as all the other issues on our fall advocacy push, which still includes discussion of the OHIP billings as well as ensuring that patients have access to a family doctor and also access to all our community-based specialty physicians, as well as discussing from here—which, you know, we've talked about burnout in terms of the OHIP billings—really talking about physician wellness as well. Because as much as we have physicians in the system, we also need to make sure the system is going to be able to allow them to stay healthy and stay in practice for as long as they have planned to be. Once again, thank you so much for joining us today.

Good morning and thank you for joining us for our latest media briefing on back-to-school health and safety checkup for students and families.

I'm Dr. Abdurrahman, and I am an allergist and clinical immunologist in Mississauga, and I'm the president of the Ontario Medical Association, which represents more than 43,000 doctors.

The return to school is a time of excitement and also a time to remember to put all safety checks in place for a safe and happy school year. The two top areas I think about in my practice are vaccines and food allergies.

Ontario has had the highest number of measles cases in Canada this year, with more than 2,300 cases reported as of August 16th. Shockingly, the province was also the measles center of the entire Western Hemisphere back in June, and we may see more outbreaks as kids return to school. Almost three-quarters of the cases have been in unvaccinated children, underscoring the need for parents to ensure their children are up to date on vaccinations ahead of the school year.

With students being back in such close contact in classrooms, it's also a good time to consider other important immunizations. This includes the updated COVID-19 vaccine and the annual flu shot in the fall.

For my food allergy kids, every student deserves a full and safe school experience. From field trips to eating with friends at lunchtime, kids just want to fit in with their peers. And for kids with allergies, these activities can be particularly challenging for them to participate in safely. That's why it's so important for their parents to send them to school with a plan and proper documentation.

All children with food allergies should be heading into the school year with an anaphylaxis action plan. For older kids with food allergies, now is a good time to remind them about their plan, but also review how to use their EpiPen.

There are currently more than 3 million Canadians affected by food allergies, one of the leading causes of life-threatening anaphylactic reactions. Because there's no way of predicting how severe an allergic reaction may be and no known cure, avoiding the food you're allergic to is a crucial step in prevention and keeping everyone safe.

And now I'd like to introduce today's panellists, who will also be speaking about the trends they see in their specialties and provide more details about what families and students should do to stay healthy and safe going back to school.

We have Dr. Daniela Lobo. She is an addiction psychiatrist and the medical head of problem gambling and technology services at the Centre for Addiction and Mental Health. She will speak about addiction trends among youth, such as online gambling and the high levels of vaping and nicotine pouch use in Ontario, as well as mental health support for students.

We have also Dr. Steve Lynn, who is an emergency physician, a trauma team leader, and the interim chief of emergency medicine at St. Michael's Hospital. He'll be focused on road safety for parents and kids going back to school and his personal experience on what types of road safety injuries he's seeing in the emergency room.

We're going to start with Dr. Lobo, who'll tell us about her experience as a psychiatrist and what issues parents should be looking out for with addictions and mental health ahead of the new year.

Dr. Lobo, thank you so much.

It's a pleasure to be here. For youth, it's such an exciting time to be growing up, developing, and making new social connections. It's also a very vulnerable time because ages between 15 and 24 are when you have a very high rate of brain development, which also means that youth are much more vulnerable to developing mental health and addiction concerns.

Just to give people some understanding of the picture that we have in Ontario currently, there are some data from the Ontario Drug Use and Student Survey that I find very useful. This survey looks at trends in substance use and mental health in youth between grades 7 and 12 across the province.

What we see is that the most common substance used is alcohol, by about 35% of students. That doesn't mean that it's used in a harmful way, but just used overall. Non-medical use of opioid pain relievers is 22%, which is quite concerning. Cannabis is 18%, and e-cigarettes, vapes, and nicotine pouches are about 13%. Kids are using them, which is quite high.

So, how do parents deal with this? When we talk about prevention, we're talking about being able to talk to your kids about how they see substance use, what they think about it, and also look for reliable information together.

It's important to keep these conversations short. Try to get an understanding of what's the importance of these behaviours for them and what they are seeing at school. Validate their concerns about, "Oh, but it's so hard to say no when people are telling you that it's cool and you have to use it," or, "When you want to fit in, it's hard just to know what to say."

Having these short, brief conversations rather than going into a lecturing format is a lot more useful.

The other thing we have to be aware of is the use of cannabis, which has been quite high, and that has resulted in a lot more mental health concerns and hospitalizations.

In particular, Ontario has the highest number of cannabis stores in Canada. We have 1,700 cannabis stores in Ontario as opposed to, for instance, Quebec, which has 100 dispensaries. Quebec has the lowest number of health concerns related to cannabis.

So, how do you perceive the signs when youth are struggling with mental health and addictions?

Usually, the most obvious sign is when you see your child getting home intoxicated, for instance. Also, kids who start to lose sleep. Many times, these are the kids who are very tired in the morning unusually so, and you may start noticing that they are using their phone through the night. They may be using social media or gaming through the night, and it's very important to have those conversations.

Another sign is kids who are withdrawing more, staying more at home, not connecting with family, and having more conflicts with family.

Things that I would like parents to keep in mind are that it's very important how you model your own substance use and how you cope with stress. Kids are very attuned to what their parents are doing, even if they don't show it. How you use substances or avoid substances, how you cope with stress, and how you express your emotions will be important to model to your kids.

Always choose the right time and place to talk to your kids. It's no use talking to a kid when you have been worried sick at home and it's 1:00 a.m. and they have just arrived home. Be curious about what's actually happening and how they feel about it. Validate their emotions and concerns, and look for information together on trusted sites.

I always recommend the site from the Centre for Addiction and Mental Health, which is where I work. They have very valuable information on substances, mental health for youth, and how to access services.

Thank you so much, Dr. Lobo. I'd like to turn things over to Dr. Lynn to talk to us a little bit about some of the safety concerns, specifically road safety, from the emergency perspective.

Dr. Lynn?

Great. Well, thank you for having me today.

Now, as students head back to school, there's a lot of excitement: new teachers, new classes, and reconnecting with friends. But it's also one of the busiest and sometimes riskiest times on our roads and sidewalks. Safety really needs to be top of mind for students, families, educators, and our communities.

Road safety injuries and even mortality are still considered the highest, according to the WHO, for those who are ages 5 to 29. Our children, youth, and young adults are all at risk.

So really, one of the most important parts of the conversation is how children travel to and from school each day, which we should focus on.

Let's start with walking safety because many children still walk all the way or partway to school every single day. It may sound simple, but the basics are still the most important. Always use crosswalks, obey traffic signals, and remember the rule that we've always been taught: look left, right, and then left again before crossing.

Students should not assume that drivers see them. They should try to make eye contact with drivers whenever possible. While it's tempting to walk with your head down looking at your phone or listening to loud music on headphones or earphones, staying alert and being aware of your surroundings is what truly keeps people safe.

Also, walking with a buddy or a group of friends is a good habit. One, it's more fun, and it's also a great way to add an extra layer of safety for everyone.

For those who ride bicycles, e-scooters, and e-bikes, the number one rule is still this: always wear a helmet. It's not negotiable. Helmets reduce the risk of serious head injury and mortality, and they save lives. They can reduce that risk by up to 88%.

Riders should also check their equipment. Make sure their brakes work, their tires are inflated, and they have lights and reflectors in place. Once they're on the road, the same traffic laws apply to them as well. That means riding in the same direction as traffic, signalling turns, and stopping fully at red lights and stop signs.

Visibility is also key. Wearing bright clothing and reflective gear, and making sure there are front and rear lights, can really make a difference, especially as mornings and evenings become darker.

When riders get to school, it's also important to dismount and walk their bike or scooter through school zones or crowded sidewalks. These small steps can really prevent accidents and improve safety for everyone.

For students who take the school bus, there are a couple of simple rules that really make the ride much safer. Try to arrive at the bus stop a few minutes early and wait in a safe spot away from the road. When the school bus arrives, wait until it comes to a complete stop before approaching it.

If a student needs to cross the street after getting off, they should always cross in front of the bus, never behind it, and walk far enough ahead so that they are visible to the driver. Children should still look both ways before crossing any roads.

Another thing they should be aware of is stranger awareness. While the majority of people students meet are kind and safe, it's still important that they know not to accept rides, invitations, or gifts from someone they don't know. If a student feels uncomfortable or unsafe, they should go directly to a teacher, parent, or another trusted adult.

Really, having the confidence to speak up is part of their safety as well.

Safety doesn't just rest on the shoulders of students. As a community of drivers, we have a huge role to play as well. Back-to-school season means more traffic, more bicycles, more scooters, and more school buses stopping frequently. We need drivers to slow down in school zones, stay alert for students as they cross, and never pass a stopped school bus.

That extra caution, just a few seconds of patience, can really prevent tragedies.

At the heart of all of this is the simple truth that safety is a shared responsibility. Students, parents, teachers, and drivers all have a part to play. When students practice safe walking, biking, or riding habits, when parents reinforce these lessons, and when drivers stay attentive and cautious, we can create a safe environment for everyone. Thank you.

Okay, we'll get started. Thank you for joining us for our latest media briefing on important healthcare issues in the news. I'm Zainab Abdurrahman and I'm a clinical immunologist and allergist mainly practicing in Mississauga, and I'm also the president of the Ontario Medical Association which represents over 43,000 doctors.

As doctors, we know our patients care deeply about their health. And there are valid reasons why someone might want to take their care into their own hands. It could be lack of access to physician care. We know we're in a healthcare crisis, inability to take time away from their work or from taking care of other members to take care of themselves. And there could also be fear or lack of trust in the medical profession based on the previous transgressions, especially for our equity deserving populations.

When patients take health into their own hands and they actually implement some of these do-it-yourself treatments or remedies, unfortunately, there are often consequences. The treatments may not actually help alleviate the symptoms that they're looking for help on, help with the disease, or prevent a certain disease, or worse, they can cause unnecessary harms or prolong symptoms or prolong them from actually getting the care they need.

It makes sense that patients want to prevent disease and are eager to heal. However, we want to find ways that it's the best for them to navigate to do so because when they are doing it right now, they might be met with an overload of information from a range of sources for which credibility may be unknown, and it makes it harder to know what to do. Many symptoms or diseases do require specialist care, which can be unfamiliar or difficult to navigate for new patients. It's also interactions with a new physician can be overwhelming and can include a lot of new information as well.

Doctors recognize complex circumstances that make do-it-yourself treatments appealing, but reassuring patients that experts are here to help. And we wish to share our expertise to help people heal. With that, I'd like to introduce some of our panellists today who are going to speak to the do-it-yourself trends that we're seeing. They're going to speak to it as per their specialty and give you some more details about how you can actually help get care in these settings.

So, one by one, you'll start to see them. First, we have Dr. Valerie Primeau. She is a bilingual psychiatrist practicing in North Bay, Ontario. She's held various leadership positions in mental health and addictions, both inpatient and outpatient care. And she currently serves as the medical director of the department of psychiatry and head of service for community mental health and addictions at North Bay Regional Health Centre.

We'll also have Dr. Alyse Goldberg. She is an endocrinologist in Toronto. Her research in clinical practice focus on the care of patients with polycystic ovarian syndrome. Also managing hormone conditions in reproductive age women, hypothyroidism, as well as gestational endocrine and metabolic optimization.

And we also have Dr. David D'Souza, who is an associate professor and radiation oncologist at Western University and London Health Sciences Centre. He leads image-based detections and treatments for several types of cancers.

So, we're going to hear from them. And this is a great mesh of different specialties because we know most Canadians are going to be affected by cancer or have family members who are affected by cancer, endocrinology in terms of going through the realm of different hormonal issues which are constantly in the media, as well as mental health, which is a huge issue as well as one in terms of people looking for guidance here.

So with that, we're going to start with Dr. Valerie Primeau, who's going to share about her experiences as a psychiatrist with patients who have been using or perhaps influenced by some of these do-it-yourself trends in psychiatry. Dr. Primeau, thank you.

Perfect, I see my slide deck is up. So, thank you, everybody. I'm hoping to give you a quick overview about the rising trend of self-diagnosis, specifically when it comes to mental health. When I think of anecdotes of patients, some of the things that my colleagues and I have seen more in recent years is patients coming to us and saying, "My child has been diagnosed with ADHD or autism and I see myself a lot in my child, do I have this diagnosis?" or "I saw a video on TikTok that sounds like I have all the criteria, that must mean that I have this disorder."

So, there's many reasons why people now reach out and look at self-diagnosis as a way to get answers. I've put some of the most common ones for mental health here. Part of it is access. So, and also the concern around barriers to mental health care, as well as financial barriers to access certain types of tests that may confirm diagnosis.

In these slides, you will see there's multiple different clips of social media. So, it's not hard to find different either media influencers or non-healthcare providers that will give you a video and encourage you to look at yourself and see if you meet criteria for certain disorders. Some of them are healthcare providers, some of them—or many of them—were not. Next slide, please.

Can we move to the next slide, please?

My screen is frozen on my end, so I don't know if there's an issue with the slide deck.

Hello. We'll just keep going. Oh, there we go. Sorry, I don't want to lose time. So, in terms of also online testing, there's many tests that market themselves as being accurate to diagnose different disorders. These are the ones for ADHD. Some of them actually you pay for online to get a diagnosis, and some of them are free and they tell you if they think you have a certain diagnosis, ADHD being one of the most common ones. Next slide, please.

I wanted to talk a little bit about the potential risks of using these self-diagnostic tools or watching videos and diagnosing yourself based on the impression of someone providing information online. And the first concern obviously is misdiagnosis. And there's certain disorders that are high risk of misdiagnosis, specifically bipolar disorder, for example. And studies have been shown that it's not very accurate to do a self-diagnosis when it comes to that illness.

When studies have looked at videos on social media, a lot of them are overly generalized, meaning they don't target a particular disorder, even though they say they do. They may portray inaccurately certain illnesses or provide misleading information. If you think you have an illness, obviously that will increase anxiety about having that illness and you may not actually suffer from an illness. So, that can be dangerous as well.

You may be given unfiltered advice about how to manage the illness which is not likely to be evidence-based, and you may reach for self-treatment. Some patients, for example, have reported to me trying a medication from, you know, a friend, a family member, because they believe they suffered from the same illness, and it's led to side effects. So, that can be dangerous as well.

The last piece I wanted to highlight is privacy issues. If you're giving your information on the internet without proper privacy security, that can be at risk as well. Next slide, please.

There are, however, benefits of looking at videos or listening to people talk about their illness. One could be just enhancing your self-awareness that you may have an illness that needs further investigation. So, it's not all negative. There's actually some studies that have shown that in terms of internalizing disorders—so by that I mean anxiety or depression—some of these disorders can actually be accurately self-diagnosed to some degree.

Obviously, you still need confirmation by a health professional, but if you take a quiz about anxiety and depression, in the studies it's shown to be more accurate than other types of mental illnesses if you do a self-diagnostic tool, and it may bring to light that you need to reach out to a mental health professional.

So, always encourage if patients come to my office to let me know if they've done research. I think it's helpful to know what they've looked at, what they think might be going on, and why do they think that they might have that illness, right? What symptoms have they associated with it? It may encourage them to give you a better chronology or timeline of the symptoms so that you can understand better what they're suffering from.

It also provides validation and it provides a sense of community because they can meet or talk to other people who may have similar symptoms or illnesses. So, I think it's important to take it into account if a patient brings it to your office and encourage them to talk to you about it and have the conversation. I never encourage somebody to self-diagnose, but I think it can be helpful in giving us additional information for us to confirm what they might be suffering from. I'll leave it there, and I'm happy to answer questions later. I'll pass it back to Dr. Abdurrahman. Thank you.

Thank you. Next, I'll pass it over to Dr. Alyse Goldberg to give us some comments from her field in terms of do-it-yourself trends and what she's hearing from patients, and I believe there's also a slide deck for her. Thank you, Dr. Goldberg.

Apparently, my video is being disabled by the host. Is that—oh, stop my video. Okay, nice.

Thank you for having me. So, I'm an endocrinologist, as was mentioned. So, I see primarily patients with reproductive endocrine and hormonal issues while trying to get pregnant. I work alongside fertility clinics as well as diabetes and pregnancy clinics at a hospital.

So, I'm sure that you're all very familiar with the plethora of hormone-targeting discussion, particularly on social media, particularly in reproductive age women. And so, I wanted to highlight that for us as clinicians to understand the trends, it's really essential in order to rebuild the trust with our patients and reframe their targeting and use of evidence-based care.

But I also wanted to highlight what I personally, as someone who just talks about this all day with my patients, gets shown on social media. And I'm not even necessarily searching for it. So, if you go to the next slide, this was some screenshots just from what my phone listens to me talk about and then promotes to me without me following these accounts.

So, what is your body telling you and what should you be doing from a lifestyle approach, whether it's your bloating and your anxiety and your brain fog, which might be invisible signs of PCOS. Go to the next slide, please.

You get targeted in terms of what therapeutic options your physician may be giving you, but then reasons to avoid some evidence-based treatment. Go to the next slide.

And then other possibly non-medical or non-evidence-based therapies, whether it be tea, supplements. Here, this app in the third picture promises that people have lost 16 pounds in one week by following their program. You can add water to reduce your cortisol levels, or this last person uses tea to reduce her testosterone levels.

So, these all sound really wonderful, particularly in people who are having symptoms that may be linked or may not be linked to these conditions. But it may show them and kind of fracture the relationship with their physician, who have been withholding this type of recommendations from them.

And then if you go to the next slide, I don't personally do a lot of menopause care, but the perimenopause age is, I find, quite big in the media right now, especially with all of the confusion and the changes in recommendations about hormone replacement therapy. And I know that personally, just discussing even non-menopause care with my patients, I get targeted with all sorts of different advertisements for either supplements or ways that my doctor has been withholding different treatment options for me.

So, I can only imagine what people who are not feeling their best, searching their symptoms specifically, will be given, and what additional recommendations that they'll seek out, which potentially could delay, in worst cases harm their care, harm themselves, and potentially be exploited from an investment perspective.

If you go to my last slide, I apologize for the small font, but when I've been brainstorming with my colleagues who also see a lot of a similar population, these were some of the things that came out in our discussions. Whether it's just the way that people are, or the advice on the internet is framed, really taking away from what medical care does and pretending that there is some sort of perfect root cause that needs to be addressed, test, or different dietary or supplement interventions, which might simplify the condition and are not necessarily generalizable to all patients.

A lot of the recommendations are anecdotal which, although can be reassuring when they work for other people, may not be transferable to a population at whole. So, these are just some other things that we came up with. So, testing approaches, which is not necessarily evidence-based and can potentially lead to searching for conditions that don't exist because of inappropriate testing assays that were recommended to the patients, or coaching programs, which, although might give a potential degree of community, may be exploitative and misdirect people to pursue really restrictive measures.

Yeah, so that's my section.

So, thank you so much, Dr. Goldberg. Now I'm going to turn it over to Dr. D'Souza to talk about his experiences from a radiation oncologist perspective seeing patients with cancer and other vulnerable population and some of these do-it-yourself trends. Dr. D'Souza, the floor is yours.

Hello. Good morning and thank you for having me participate today. I have the privilege of looking after people who are diagnosed with cancer. They usually come to us with an established diagnosis of cancer that's usually made through another physician or another aspect in their journey of care. And I think most of us will agree that, as they often refer to it, the C-word or cancer is scary.

So, you know, when people hear this, I think often they feel very overwhelmed with their diagnosis and they are looking for hope. So, we do know that Canadian Cancer Society statistics show about 63% of patients are alive at 5 years, and for a lot of patients with localized disease, it's very good outcome. So, there are some that patients unfortunately do not do well.

So, I think when a person's diagnosed with cancer, they're often wondering where do they lie in this spectrum of outcomes and often, you know, imagine the worst. So, the first thing that they often do, if it's the patient or their family member, is they look for information. And in this day and age, looking at social media or going on the internet is the way to try to kind of find things.

I always joke with my kids about how we had to go to the library when we had to do research or look anything up. But now it's just so easy to get online and try and get information that's there. And you know, when you're looking for hope, I think some of the things that get portrayed, especially for cancer treatments that appeal to people, are things that are all-natural, the ones that treatments come with very, you know, very few or no unpleasant side effects, or they offer miraculous outcomes. And those are the kinds of things that people often will latch on to and be looking for.

So, there was a prior study done of looking at the most popular posts on social media between 2018 and 2019 with regards to cancer, and they found about a third of them had false, inaccurate, or misleading information. And you know, you might say, "Well, what's the big deal or what's the problem with it?" Well, most of them are potentially harmful.

So, to give you a few examples from my practice over the last few years, there can be delays in seeking treatment for a cancer that is potentially curable. I had a young woman diagnosed with cervix cancer, and she came to us. She was not ready to accept, you know, conventional treatment and decided she was going to pursue other remedies that she had heard about, and she came back two years later, unfortunately, with her disease having progressed and spread, in a lot of pain, and unfortunately, our ability to control her cancer and give her a long-term good outcome was severely compromised.

There were sometimes just frankly dangerous things. I had a patient who had a tube going into their kidney because it was blocked—it's called a nephrostomy tube—due to their cancer. And they actually tried to put the twine from a weed whacker in to get out the sludge that was in there. And they were asking about actually putting in a little bit of Lysol to clear it out. So, fortunately, we stopped them from doing the Lysol part.

Most recently, I've had a patient who's very well educated. She actually went and got a second opinion from Johns Hopkins, which is in Baltimore. Yet, she refused key parts of the treatment, and instead was driving two hours away from here for hyperthermia treatments where they try to heat the body, and has been taking intravenous ivermectin, which we may have heard about as treatment for parasites that became popular during COVID.

There's also patients who have done some really different things like trying to inject or put things like cannabis oil on their tumour. I treat gynecologic cancers and prostate as a lot of what I do. And you know, I sometimes ask a few questions to find out exactly how they get things in there.

So, you know, the one aspect which I kind of view myself, we look to build a relationship with our patients who come to us first. We don't know each other. It's like getting acquainted with a stranger. But what we look to do is build relationships and have trust.

And once patients are comfortable, very often they will run things by or say, "You know, a family member offered this instead," or "I was wondering about this." And rather than coming back with a judgmental tone, I embrace the fact that they are communicating. I try to put it on a level of, "Do I understand it or not?" Because as you can imagine, there are so many things out there.

If they just say, "What about treatment X as an alternative?" I will first admit I don't know necessarily about their treatment, but I'm willing to try and look it up or get some further information.

So, the other thing I think which is critical for cancer patients when they come to us being told, "You need surgery, you need this type of radiation, you need this type of drug," it doesn't necessarily give them a sense of control. So, the things that I try to encourage my patients are other aspects of their well-being. So, ask things like exercise levels, activity, the type of foods that they take in, without an emphasis on taking some type of supplement or something else that we don't have evidence to support. So, it's really about engaging them in their own health, which I think is quite helpful.

So, I think it's important, and most of us in the medical field look to engage our patients to not be hostile. I know when I started in practice many years ago, there were some physicians who would basically say, "I don't want to hear it if it's anything else." And I don't think that's been the right approach that was done in the past.

I think, you know, most of us are on social media ourselves and we do see what's out there. And being able to engage with our patients and kind of work through some of the things that they are coming up with is helpful. It often also relates to a fear or an underlying issue that they may have come up with this idea, and it gives the good opportunity to address that. Thank you very much.

Thank you so much, Dr. D'Souza. We're going to actually move into our Q&A session now. I invite all of you to write your questions in the Q&A chat box, and then I'm going to turn it over to the OMA's Jordan Kerbel, who will moderate this portion of today's briefing. Jordan, over to you.

Thank you, Dr. Abdurrahman. Hello, everyone, my name is Jordan Kerbel. Just want to take this opportunity to say thank you so much for attending today's briefing, and to remind you that in order to ask a question, simply put your question in the Q&A chat box at the bottom of your screen. If you could please include your name and your media outlet, that would be wonderful. Again, just put it in the chat room and we'll do our best to get to as many questions as we possibly can.

We're going to start off with—okay, sorry, so already, thank you. We have a question from Karen Lieberman. So, Karen's asking—and I'll let you know who we're going to throw this to—if you can speak directly to patients, what would you tell them about the dangers of self-diagnosis or turning to Dr. Google? It's a fantastic question. Dr. Abdurrahman, why don't we throw that to you first, and then we can see if any of the other panellists would like to answer the dangers of self-diagnosis.

Big dangers that we're talking about, I think each of our three speakers also mentioned this one. Sometimes some of these things are very general and they're not actually speaking to what you're specifically worried about. So, you might be getting some suggestions that are not appropriate.

There's a risk that you could also be taking on interventions that may be harmful to you because they're not necessary and they're actually causing other new issues. Or you could also have this delay where, you know, there's a lot of different issues that when they do come up, this would also be very helpful to have taken care of early.

This is what Dr. D'Souza was talking about in terms of some of the early cancer detection and addressing that early before waiting for further complications or spread. And this is the same, similar to many different issues where you can have consequent complications, whether that is even from something like waiting to diagnose and treat something like diabetes or other medical conditions.

So, it's important, and there are things that you can do that we may also recommend that are also in this realm of, "These are the supplements we do recommend in this condition." So, you can also get that kind of guidance. So, there's a lot of concerns when you choose not to and you actually choose to go in a different direction, but there's a lot of help that can be gotten if you are addressing it. And I'll also perhaps—I don't know if anybody else wants to comment.

I think Dr. D'Souza would like to also answer this question. Dr. D'Souza.

Yeah, thank you. And to that question, I think it's a great one because we know people are going online. So, in as I'm sure my fellow panellists will say, most of the time even when patients come to see us, they've tried to look up our profile online to kind of get a sense of our background and that.

So, the aspect of looking is not necessarily a problem, it's the interpretation of it. And I think the other aspect of what's at stake is our patients' body or their health.

You know, it's a little bit different if I want to look up how to fix an appliance in my house or something else and I try to Google and find a video of how somebody got something set up. I was trying to figure out an electric toothbrush how to do something the other day, and I kept looking for a video to show how to do it. Well, the worst thing is I don't get my electric toothbrush to work or there's some problem I caused to it. But the problem is if you go down the wrong path, you can cause harm.

The other aspect which I know has been mentioned, even in our field of oncology, things are changing so quickly. Information that was relevant or the way we would treat things even two years ago in some areas changes. So, the problem is, you know, sometimes some of these videos and other information may be dated. It could look like it's from 2023, it's not that old, but it may not be the correct thing.

Even the way we profile a lot of cancers these days is based on biomarkers, additional information which the patient may not even be aware of. So, the problem which I try to avoid is the perception that we somehow know more or we feel there's an air of superiority. It's not that, it's just that we can understand some more details, and I always look to explain that to the patient at a level that they understand.

Thank you, Doctor. The next question is from Elizabeth Payne with the Ottawa Citizen. "Can you quantify how big a trend this is and how quickly is this growing?" I'm going to throw this one over to Dr. Primeau.

Thank you. So, I don't have, obviously, specific research numbers, but I would say if I speak to my colleagues and what I've seen from my experience, it's probably at least a patient out of three that will bring up some form of self-diagnosis or self-management.

So, examples of like, "Oh, I've been diagnosed with ADHD." Well, not yet, but it's just because somebody hasn't made the diagnosis yet, but I know I have it, or something to that respect. And that will happen at least in one-third of the patient encounters I have.

And I think part of that, if I look over the past 12 years that I've practiced, is the rise of technology advances, right? I think it was Dr. Goldberg that was mentioning her phone is listening to her and showing her certain content related to her work, right? So, our phones now are intelligent. They listen to what—and they look at our trends, and if we talk about something that we're concerned about, they will show us videos that relate to that.

So, the answers seem more immediate and accessible, and people want that. People are looking for answers and they get that validation from that access on social media. So, I think that is why it has been rising so quickly, is availability of that kind of consumerism type of access, right? We're just looking for quick answers, and the internet is willing to try to provide those answers, if that makes sense. Dr. Abdurrahman?

Yeah, to give you some quantification, this has been increasing, and the Canadian Medical Association has actually been doing an annual survey where they're looking at health and media annual tracking, and the numbers are going up each year.

The 2025 survey had shown 62% of Canadians have encountered health information that they later found to be false or misleading, and this was increased. So, people are also realizing that, but also what was a concerning statistic was 23% reported having a negative health reaction following online health advice.

So, we are seeing this, and we also, when you break it down by generations, we're also seeing a higher uptake, especially in some of our very young populations who are still in their teens and early 20s, who are looking more at social media, and in terms of how they quantify how reliable or credible a source is versus other generations.

So, this is something that is very important that we need to continue to keep on top of.

Thank you, Dr. Abdurrahman. I'm going to throw now to Janice Golding. Janice Golding asks that there has been a lot of distrust arose during COVID regarding vaccines and other recommendations that were ever-changing, and that that has done a lot to erode public trust. "How do you suggest repairing that trust?" Dr. Abdman, I'll start with you, and then Dr. Goldberg, I'll throw it to you after that.

Especially talking about COVID vaccines particularly sits with me because I did a lot of work in this realm, just even to talk about building trust to take the COVID vaccines initially, especially looking at certain populations, thinking especially about Black populations with different experiments, Tuskegee, etc.

What happened with COVID, though, is this was, as we always say, unprecedented times. We also had a lot of changes, and I think a lot of people are used to having new recommendations come out, and then that's the status quo for quite a while, but we were actually in a changing model, and so people actually saw what it's like for us to pivot and change based on what was happening.

And so with kind of movement, some of this will continue to happen in terms of us changing recommendations based on further research. And so I think what we have to do is be able to convey that we do change strategies when we get new information. It's like when Dr. D'Souza said, some of the cancers, how we treated them earlier, with new treatments, new modalities, we are changing.

So within two years, how we treat certain cancers can really critically change, and you want a medical system that is dynamic and responding to the new information to get you the best health. So I think part of it is bringing everyone together to understand that technology is changing, research is leading to change, and we're going to continue to pivot to provide the best care. And you don't want a system that's stagnant when it comes to your health.

This is, you know, in response to providing better health, although sometimes it seemed very fast during COVID and with the COVID vaccines, but we continue to do this with all of our treatments. You may just not get quite this short period where a lot of things change quite fast, but we do have changes.

And as an allergist, I can speak to that even with how we talk about preventing food allergy. Initially, we thought maybe avoiding foods when children were very little, but we've actually seen the research and that's really made us pivot, and it's the exact opposite. Now, it's very important to introduce foods very early when they're under 11 months of age. It's a total pivot.

So, that's from research as well. So, we do have to pivot when we're seeing this. And this is about talking and explaining why, and I think that's going to be the key part of building the trust again.

Dr. Goldberg?

So again, not specific towards the vaccine world, but in my patient population, we have a lot of discussions about both less evidence-based and less research therapeutics, like in the supplement world, or very evidence-based and very experienced medications, such as the birth control pill or metformin, which will definitely get a lot of different opinions online based on people's personal experiences and their own belief system.

So, I find success in really having open conversations and really educating, both from a pathophysiology perspective to try to explain what the theory is or what has been shown in the research about why these medications are often used, why certain things are considered first-line, how certain medications can really improve or may not be the right thing for different people, and really emphasizing that we're all really in this together to try to help our patients feel better, prevent complications, and in order to have them getting through with whatever condition they have in the most successful way.

So, with that in mind, there has to be lots of open conversations because there's lots of evolving both research and evolving therapeutics in all fields.

Thank you, Doctor. Another question from Karen Lieberman: "Why is this a bigger issue now than in previous years? Is it connected to a lack of family physicians in Ontario?" I'll throw this one over to Dr. D'Souza to start, please.

We do have difficulty, of course, in our province with patients accessing primary care and seeing a family physician. I can give you my opinion, because again, I can't give you evidence to prove that it is the case, but my practical experience, often when I see I'm following a patient with cancer, okay, they've got pain and I want to know, I'm the specialist seeing them once in a few months, do I prescribe the pain medication and they live an hour and a half away, or do I ask if their primary care physician can do it, and they say, "Well," or I see on the record they don't have a primary care physician.

So, you know, sometimes aspects like that, you can see why if they had pain before they came to see me, why they might be looking to see, "Well, what can I do to just help myself?" So, that's just a practical example.

What I see the other area that would happen a lot more before is when people had a good relationship and had access to their primary care physician, if they had something like, "I got to decide whether I'm going to have my prostate removed surgically or to get some type of radiation modality," they say, "I'm going to go talk to my family doctor. You know, they've been my family doctor for the last 25 years. My kids were born and raised, you know, for the pediatric care through them, so I'm going to go back and have a chat with them and see what they tell me." And generally, that's not the case now. So, those are just two practical examples. Some of my colleagues may have some insight, too.

I'll just chime in for a moment. I would definitely agree with what Dr. D'Souza said, and the fact that not having access to a family doctor does play a role here. The crux of what Dr. D'Souza said, and I think everyone would agree here, is that it's about being able to ask these questions, it's about trust. And one of the places where you have a lot of trust because you've had a long relationship is your family doctor. And that's someone that you can feel comfortable to bounce some of these ideas by.

And so when you don't have that, you're often feeling like you're going to all these other sources and you're not able to necessarily check the credibility for these resources. So it is playing a big role, and that's why we're also very much advocating in terms of every Ontarian having access to a family doctor, because these types of conversations do need to happen, and it's got to be in a trusting situation, and that's one of the places where you have a really great trusted resource for your health.

Thank you, Dr. Abdurrahman. The next question is from Nicole Ireland with the Canadian Press. "Knowing that patients are going to look online and to social media, how do you advise them to distinguish between reputable information and mis- or disinformation?" And for this one, I'll throw it over to Dr. Primeau.

Thank you. I would say that it's probably difficult for members of the public to distinguish what would be reputable versus not. So, I would always recommend seeking help from your family physician or a professional.

But in general, like when I was talking about emerging research in mental health, for example, they showed that there was more accuracy in videos that were provided by health care providers online versus non-healthcare providers. So if you can confirm that you're hearing information from a healthcare providers, whether it's a presentation or a video, then there may be more accuracy to the information. Obviously, official sources like anything coming out of the OMA would be a good source to follow. So looking for a medical association releasing information as well would be obviously more trustworthy than something that you find on a social media platform. But I think in general it's really hard in a sea of information to tell the difference. And I always recommend just bring what you found to your primary care provider or a professional if you're able to make sure that you can tell what is appropriate and what isn't.

Thank you, doctor. We've had kind of a follow-up question. So I'm going to leave this with Dr. Primo from uh Joanna Freredic at the Hamilton Spectator. So when people do turn to the internet, where would you recommend they start? Like are there actual reliable sources they can turn to and what should they absolutely avoid? So we can start with Dr. Primo and then anyone else that wants to answer that would be wonderful.

I can answer from a mental health standpoint if that's helpful. Uh there are definitely  guides for example like major hospitals mental health hospital like CAMH for example in Toronto will provide a lot of good patient information on their website. So if I were to start somewhere I would go to the CHA website the Canadian mental health association or one of these larger research hospitals because they often provide a lot of very lay friendly information.  and then they give you uh extra steps right so if you notice that you may have some those things this is what you should do next, and that information obviously is going to be safer and more reliable than anything you would find on a social media platform. So that would re that's where I would recommend starting. And CHA also has drop in. So you could always go to your closest CHA as well to meet with a clinician to discuss some of the research that you're doing and they will give you some additional information as well. So that would be kind of for mental health where I would recommend starting.

Thank you doctor. Dr. Abdurrahman, can I throw that to you as well please?

Sure. Definitely like Dr. Primo said, there's a lot of great health organizations that can be issue specific, disease specific or kind of cover a variety. So that you can look at the medical associations, OMA, CMA in terms of larger kind of health, social health issues. But then you might also be looking at specifically to the actual disease. You can go to cancer care Ontario. There's a lot of different ones out in Canada. There's a lot of different ones depending what the issue is. 

What I would also want to say is that when you see perhaps an ad or something on social media that says this has been hiding from you this is kind of never before seen if there's any kind of wording like that do go to the kind of associate u medical association that would deal with that. if it's a whole new cancer treatment and they say this is being you know suggested by all cancer associations go to cancer cure Ontario go to check all these different websites and check for them to be actually putting that information if they are actually backing it so there's also an important fact of cross-checking by going directly to the organization and seeing if it's there because there is a lot of AI generated programming out there as as well that sometimes pulls in different names. So, it's also important to go and check the source because most organizations aren't backing any particular medication or anything like that, but we'll give you information about generally about where to get credible information.

Thank you, Dr. Durma. The next question is from Helen Bagshaw and this is for Dr. Goldberg. Is Dr. Goldberg seeing most of the misinformation? Is it related to polycystic ovary syndrome or are there other fertility issues that people are self- treating for? 

Oh, there's all sorts of things. You're getting my bias because that's the majority of my practice right now. And I think that young reproductive women are spending a lot of time on social media. So, I will get to hear what the current trends are and what, different recommendations are there. Toxicity yes and there's all sorts of fertility influencers and then there's male reproductive care. So it's obviously not just for women but I think um in a lot of the endocrine conditions there are very heterogeneous. They present differently for each individual and some of times they're made up of a lot of non-specific symptoms. So if people aren't feeling well, they will be able to look into their symptoms and they will get a whole array of conditions that potentially will make these patients feel very validated and heard and then when they're discussed, if it's not necessarily the correct syndrome that's going on, it can become very um challenging to kind of overcome that.

Thank you doctor. Uh the next question is going to be for both Dr. Primo and Dr. Duza. So we'll start with Dr. Primo. What do you say to patients when they walk into your practice and they have already self diagnosed themselves or decided what treatments they need? How do you deal with those patients? Dr. Primo, then Dr. Duza, please. 

Thank you. I think one of the biggest things is patients want to feel that they have a say in the decisions that you make with them in the appointment. So when they come with me with already some opinion about what they might be suffering from or their treatment first of all is I take the information right. So I think listening to what they found and trying to understand why they came to that conclusion and what have they tried and how they obtained the treatment whether it's a supplement or a medication and then once I have that information and done my diagnostic interview if there is a discrepancy let's say what they think they have is not what I think they have then we have an open discussions about it and I often bring information that I have in my office.

So, it really helps to actually open your book and show to the patient, this is why I think you have this illness. These are the criteria that I believe you've told me today and these are the ones that I don't think fit with you and that's what you thought you had. And most of them will realize that it actually makes sense where we're leaning towards. Often they just had misinformation and thought that they fit in the category. A big example of that is bipolar disorder versus borderline personality disorder. there's a lot of overlap in symptom between those two and patients often misdiagnose themselves with one or the latter and it just helps to actually explain to them why they fit in one category over another. So I think involving them in that kind of decision- making and that partnership is really important in building that trust.

Thank you Dr. Primo. Dr. Duza.

Yeah. So for cancer it's usually there's the confirmed diagnosis. So it's usually patients uh mapping out their own treatment. So uh one aspect even if they were to receive care or any patient receiving care to have informed consent means they understand what their options are and kind of what the outcomes or likely outcomes are from those. So if they choose uh a different treatment uh of their own choosing, I will first make sure they are in understand the disease they have and the likely uh timelines that it may progress and if it's going to change to uh a setting where they're very unlikely to be cured or they will not be cured.

So I think that's an important aspect because cancer is uncontrolled cellular growth. Some stay local, some may spread and they do them in different time frames but to understand what they are looking at if their treatment isn't effective. I do let them know what options are available uh that I would consider as appropriate for them. And if they aren't going to have treatment with me, I generally will not be involved in ongoing monitoring because uh there really probably isn't much point. But I will leave the door open and give them uh the avenue if they need to get back to see me or if they change their mind, they can do that at any point.

Thank you, doctor. I'm going to throw the next one to Dr. Abdurrahman. Dr. Abdurrahman, this is from Nicole Ireland at Canadian Press. When you advise people to bring information they found online to a primary care provider, who should they go to if they don't have a dedicated family doctor? Should they go to a walk-in clinic? Who would be the best person to speak with? 

That's a great question. Um, and it can also, it's may not be one simple answer because it might depend what it is. Um, for example, um, I think Dr. Primo kind of alluded to some of this earlier that if it's more mental health, we do have, um, the mental health associations that are kind of based in communities that you're able to actually access and talk to a clinician. And that might be one of the ways um if you are if it is something for a treatment um you can um access um a doctor in um in a walk-in clinic to have that discussion and to talk to them there as well.

Um so and you know and sometimes when it comes to specific things too for example um when we were talking about a lot of times with even um you know measles right now because that's still top of mind and talking about that when you don't have access uh we did have um obviously with the government they have access for patients to be able to contact through there to get um linked in to get vaccines or to talk about the vaccines as well. So definitely there's a lot of avenues to also still reach doctors to talk about this if you don't have a regular doctor. Um so whichever of the avenues kind of works best for you. Um please do kind of utilize it makes as long as something that you can easily access and that you know will be reliable for yourself um and based on your community as well. So I think that um utilizing any of those would be very helpful.

Thank you. Uh Dr. Abduran, uh follow up to that question. Uh this one I'm going to throw over to Dr. Primo. Um do you see the internet and social media as a valuable place to turn for people to get pure support?

Thank you. I would say that in general, yes. Although obviously it depends on the composition of the group and who would be running any type of peer support. But for example, I'll give an anecdote from my practice. Um I do a lot of addiction psychiatry and one of my pe mentioned that one of the um strengths that they found was there was a Reddit group uh where they were fostering abstinence and they were getting together and talking about not drinking and that was really helpful for that particular individual. They felt not shamed. They felt accepted. There was no judgment and it was a good cohesive group. So in that case that was a very positive experience.

Now, I've also had on the flip side some patients that have told me that they've been stigmatized or shamed online for disclosing. So, I think um obviously there's caution to peer support online, especially if it's not regulated. What I would encourage is using online tools to access peer support that is regulated to some degree. And by that I mean if there is a professional moderating uh which there's different groups that do that. Um for example in addiction there are um a peer support group where there is a moderator but it is all peers otherwise that start the discussion but it's just to make sure that the environment is not judgmental. So that would be a way to ensure that it's safe but also very helpful. So maybe just being cautious about which type of peer support you seek online because there's all kinds of stuff right.

Thank you doctor. We've had a question from Mike Pearson at Metroland Media. Speaking of DIY treatments, can you speak to the Mc uh McMigraine Tik Tok and social media trend uh which people believe that McDonald's fries and a Coke can relieve migraine symptoms? Um if not that one in particular, you know, can we just talk about uh the trend of of Tik Tok videos and having more younger people watching Tik Tok and turning to that for I guess their potential treatments. So um Dr. Dr. Primo, I can start with you because I noticed you nodding and then I can throw it to whomever else.

No, I'll throw it over to Dr. Dorman. I don't know anything about it. I just think if it was true, that would be a great reason to eat this amazing fast food. That's all.

Dr. Dorman, the prevalence of of Tik Tok videos for for any number of these ailments.

Yeah. Um, you know, there's always like that need to want looking for um some solutions, right? That's kind of why we're here. And so we do see a rise in a lot of different Tik Tok videos. Um, and what I would say is that there are a lot of different ways to address a lot of different u medical issues that may not require specifically um medications. You know, um I'll speak a little bit to migraines, not fully to just the Tik Tok video, but for example, sometimes people come to me and they say, I read that um all these foods affect migraines. this must be an allergy and they come to talk to me.

And one of the things I do talk a lot about in my office is that okay, let's talk about the root problem. You're worried about how foods are affecting your body and how they're affecting your migraines. Foods do affect bodies in a lot of different ways. And we know that when people have migraines, we can have cheeses trigger their migraines. And for some people, caffeine can be a trigger. And for some people, in some of the treatments for u migraines, sometimes caffeine is used. So, it's also a trigger. It's also um can be part of the solution for some people.

So, I can understand why they're perhaps talking about fries and a coke in that kind of context. But the thing is you want to actually have the conversation. Um so, whoever is treating your migraines, if you're talking to your family doctor, you're talking to your headache specialist, your neurologist, say, "Can we talk about how foods play a role here and which foods um maybe I should avoid or which foods can be helpful if I am having a migraine?" because there are a lots and I think each of us would talk about them in a lot of different um issues in terms of how foods can be helpful but sometimes if you're in a crisis mode some of the foods that you eat all the time could bother you.

So you know these are big important things to think about and migraine is a big one because migraines really it's a balance in terms of your neurotransmitters and a lot of different foods can play a role in that. Chocolate m can place play issues with migraines, caffeine, as well as strong cheeses. They're not an allergy, but they can definitely play a role here. So, I think it's worth having that discussion and talking with your specialist um to see which ones are playing a role for you and what to do because each person is different.

So, it's not an easy one to say everyone take this diet with a headache because this that meal that was described is also um a trigger for many people because it can contain things like cheese and caffeine and salt. So, which can play a role there too. So, this is where it needs to be individualized to you.

Thank you, Dr. Burman. To the to all the journalists online, we're going to do our best to get to the questions in the next five minutes. So, I'm going to ask the uh participants if we can go fast.

Uh Dr. Primo, as mentioned in this presentation, ADHD seems to be a particular focus of social media self diagnosis right now. Why do you think this is happening with ADHD? And what specific messages do you want to get around the self diagnosis of ADHD?

I will try to be brief. Um, but if I ask everybody online today, have you ever been distracted or had trouble with organization or answering all your emails? I think most people are going to say yes. And this is why I think there is a rising trend to self diagnose with it is because we recognize ourselves in the videos that are played about ADHD because in general society is struggling with inattentions. Uh and that would be a whole talk aside so we don't have time for that today although happy to do that later if the or wants but essentially ADHD is a neurodevelopmental illness and I think people forget that.

So you technically have to have it in childhood before a certain age and that is not portrayed in social media. So when I talk to patients is I make sure to confirm the childhood history whether it was documented in school or not. We still need to make sure that there was a history talk to the parents and that's the piece that's missing in the portrayals online and that's why people get confused because we have an attention in general as a society right now. So, it's just something that resonates a lot with us and I think that's why um

the final question, thank you Dr. Prima. The final question, I'm going to open it up uh to the floor if we can give quick answers, but but uh to all the panellists, why do you feel that that now is the important time to warn people about DYI healthcare? Why now? Um Dr. Primo, you've got your mic open. Why don't we start with you?

And sorry, can you just repeat the question really quickly?

Why now? Why why is it so important that right now we we forewarn people about the dangers of DIY?

Because it's happening more right now and I foresee it continuing to happen more and more especially with AI technology getting more and more available and more and more sophisticated. I have patients now that talk to ChatGPT um to get advice and have a conversation. So I foresee that we will continue having this issue and if we don't address it now and help people navigate this they will struggle. We have challenges with access. That's not likely to go away, right? It's a national problem. So, we need to address how patients navigate these issues on the day-to-day. So, I just think it's very relevant and will continue to be an issue going forward.

Dr. Duza, can I throw that over to you as well? Same question.

Yeah, I think it's a problem that's, you know, been identified before, but we, you know, it's been more established. I think particularly after COVID the pandemic with the people more and more going online pretty much everybody including my patients who are in their 80s have a smartphone and look at these things. So I think it's important that we address this. Now you know the last anecdote I'll gave as a patient came to me asking if he should wait to have his cancer uh that was diagnosed treated in a few years because he believes that AI will customize cancer treatments for patients and I had to convince him why he should have treatment now.

Thank you Dr. Duza. Dr. Goldberg

I think uh two things comes to mind. So firstly is the AI aspect and I know that a colleague of mine from Europe was doing a study on misinformations and reproductive endocrine and AI and giving out surveys to different physicians and how they would rate um the answers that were provided and all of them had partial truths and partial misinformation and that could lead to increased like more confusion because there's a little bit of truths in a lot of what the AI is saying. And the second I think is with so many people building online businesses and the proprietary aspect of social media. So we really have to be mindful about who is trying to make money off of us and use our um our symptoms and our um medical experiences in order to self-promote themselves.

Thank you Dr. Goldberg. Dr. Abdurrahman.

Thank you. I agree with all the points that are brought up. The other issue that we have to remember is it's increasing and it is going to younger and younger generations. So we're having lots of um our teenagers and pre-teens also looking at this and trying some of these for what they perceive may be issues affecting them. So we want to ensure that we are talking about this. We are addressing this because it is an important issue and we're going to have more and more people seeing this because social media is so pervasive in our day-to-day lives. So, we want to come and address and talk about this and talk about how to get credible information because we know misinformation um and disinformation is something that as a society we are managing and healthcare is not immune to this.

With that. Oh, Jordan, did you want to say

Thank you, Dr. Durman, to the reporters, if we didn't get to your questions in the uh the media advisory you were sent was uh was uh was Julia's email address, the OMA media, please just send the questions to you and we'll do our best to get them answered. Dr. Gurman, back to you.

I just want to say thank you to everyone for attending today's briefing and for all your thoughtful questions. If we didn't catch any questions, u media team will follow up with you if you if you want. You can also email mediama.org with requests for interviews or information. I'm sure from hearing from um these three great doctors, you might actually want to have further discussions with them um especially pertinent to their um specialties um as well as perhaps in the communities where um they are.

And a recording of this session will be available on the OMA's YouTube channel immediately following this briefing as well. Thank you again to our three physicians. I really appreciated hearing all your different thoughts and hearing um about the importance especially in your different fields and sharing the stories because that's really the important of why we're here. It's because of our patients and what they're sharing with us and we want to make sure that we're providing them with the best care.  So once again, thank you so much.

Good morning everyone, and thank you for joining us for our latest Ontario Medical Association briefing on important healthcare issues in the news. My name is Dr. Andrew Park, and I'm the president of the OMA, which represents more than 43,000 doctors. Far too many Ontarians, a staggering 2.3 million people, are already without a family doctor, and that number is expected to nearly double in just two years. The OMA is concerned about the declining number of medical students choosing family medicine. Today, we will hear from a few medical school leaders across the province about the situation in their communities and what solutions are needed.

Each year, medical school graduates decide what type of medicine they want to specialize in. The Canadian Residency Matching Service, or CaRMS, matches graduates with residency placements at medical schools in two rounds. Following the first round of this year's match, there were 108 unfilled family medicine spots out of a total of 560 in Ontario, up from 100 unclaimed spots last year. That's a sharp rise from 61 in 2022, 52 in 2021, and 30 in 2020. The second round of matching will be this Thursday, and Ontario's doctors are watching very closely what the results will be.

Medical students must see family medicine as a desirable and rewarding career choice, or they will choose another specialty. Students are aware of the funding issues and the administrative work associated with practicing comprehensive family medicine and don't want to enter practice in a broken system. We must address these problems and promote family medicine as a rewarding and impactful career choice. It is clear we need to act now to ensure there is a future for family medicine in Ontario.

We have to ensure that funding for doctors keeps pace with the rising cost of inflation and is reflective of their ability to operate their practice. In the past 10 years, inflation has grown by 25.4%, while average billings have grown by only 6.1%. Another reason medical students may not be choosing family medicine is that they hear about the crushing administrative burden that exists. No one goes to medical school to fill out forms. Doctors want to care for their patients, but the administrative work that has crept into medicine makes the field less about caring for people and more about paperwork. This has to change.

What does this all mean for patients? It means that there will be fewer family doctors practicing family medicine, which means less access to care. Family doctors are the foundation of the healthcare system and are the vital link to specialist care. They help patients stay healthy, prevent disease by identifying risk factors, manage chronic disease, and get their patients access to diagnostics and many other healthcare services. Lack of access to a family doctor can negatively impact health outcomes. According to the College of Family Physicians of Canada, patients with a family doctor have better health outcomes, including fewer preventable hospitalizations and improved outcomes for chronic conditions. The result of the family doctor shortage is that people will be left with unattended healthcare concerns that lead to poor outcomes.

I'd now like to introduce my physician colleagues, who are all leaders at medical schools across the province. Dr. Cathy Risdon is a family doctor and the chair of the Department of Family Medicine at McMaster University. Dr. Gina Politi is the associate dean of undergraduate medical education at Queen's University. Dr. Azadeh Moaveni is a family doctor and director of undergraduate medical education in the Department of Family and Community Medicine at the University of Toronto. And Dr. Jobin Varughese is a family doctor and interim assistant dean of primary care education at Toronto Metropolitan University. I'd now like to hand things over to Dr. Cathy Risdon, chair of the Department of Family Medicine at McMaster University.

Thank you very much, Dr. Park, and thanks to all my co-panellists and also members of the media who've gathered this morning to really highlight a very urgent issue for all Ontarians. Dr. Park, you did a nice job outlining the importance of family physicians to our patients. I also just want to highlight that family physicians are a resource to the entire healthcare system, and the anchoring of our healthcare system really lies in primary care and family medicine. Without a significant investment in the family medicine ecosystem, the healthcare of all Ontarians, both in and out of the hospital, is going to be impacted. So this is a critical problem for all of us to turn our minds to.

I want to spend a few more minutes thinking about that family medicine ecosystem. We are talking a lot today about why medical students aren't choosing comprehensive family medicine. My colleagues will bring some really important points to that. But I want to highlight a piece of the investment in future family physicians that is also very critical, and I think somewhat hidden and perhaps poorly understood, and that's the fact that medical students who want to become family doctors train in family doctors' offices. So we have a medical workforce that is also a teaching workforce, and they are absolutely critical to our future.

If you think of a family doc who takes students over their career, they've trained hundreds of students to be future family physicians. Those students will see thousands and thousands of patients over their lives. So every single medical teacher that we lose is actually the loss of a significant future, and potentially the loss of the capacity to train the family physicians that we are being told to train in Ontario. So, it's been very exciting to have several new medical schools announced. That's a fabulous contribution to our future. It is exciting to have some expanded residency positions announced for all the schools in Ontario. But we're actually losing our family medicine teachers, and that really relates to the issues that we'll explore in this panel.

The working conditions for family physicians right now are extremely challenging. We are losing many to retirement and to a switch from comprehensive practice to more focused practice, and we're losing our teachers. So an immediate investment in the teaching workforce of family medicine is sort of, I would say, one of the most urgent priorities. Without that workforce, all of the efforts our schools and our policymakers are doing to explain to medical students how fabulous a family medicine career is will fall short because we won't have a place to train them.

So, investments in the direct costs of teaching are really important. Our preceptors haven't had a raise for over 20 years. That's simply unacceptable. We need an investment in the ecosystems that allow for successful education all over Ontario within cities, within small towns, and within rural placements. There's so much thought and creativity being put into training environments, but those training environments are shrinking because family docs are under such strain and pressure.

I will leave it to my colleagues to describe in more detail what we're hearing from students. In the ideal world, we get a motivated student who gets inspired by a family physician—that was certainly my experience—and the magic happens. But we really have to protect those environments where our physicians are practicing so they can be our teachers of the future. Back to you, Dr. Park.

Thank you, Dr. Risdon. I think all of us, certainly on this panel, can identify with having that preceptor, that supervisor, or that family medicine teacher that inspired us into a career of where we are in our lives. I'd like to hand things over to Dr. Gina Piliotis, the associate dean of undergraduate medical education at Queen's University. Dr. Piliotis.

Thank you very much, Dr. Park, and thank you for inviting me to this panel. This is an extremely important discussion, and I'm quite happy to be invited to be part of it with my colleagues as well. I do think that this is a very multi-system problem. There's no question that our young medical students listen to the news, hear all of the stresses, look at a career in family medicine, and say to themselves that it seems really, really hard. So there's no question that is part of the problem as far as our students choosing family medicine as a career.

But there are multiple layers that we have to address as well. One of them is the actual medical school training that they undertake. Most of our schools are still very much specialty-based with respect to our clinical training and our pre-clinical teaching. We don't have enough family doctors in front of our students at an early stage of their education to be modelling careers and the profession. So that's definitely part of what we're trying to address.

At Queen's, we have developed a new campus in Oshawa in partnership with Lakeridge Health. This is a program that is dedicated to students who have chosen a career in family medicine from the get-go. They enter the program, and the program is designed to deliver all of medical school through the lens of a family physician. So that's multifaceted. One is actually teaching from a generalist perspective, which is not an easy thing to do and something that a lot of our schools want to try to do. Hopefully, we'll learn from this and adapt that to our main campus as well. But also having community family physicians doing the teaching and in front of our students from day one, as well as integrating clinical experiences longitudinally at a very early phase.

We just started—it just opened in September of 2023. So, we're really excited to see how it goes. But this is for 20 students that we've managed to craft this for, and it's reproducible. I'm very excited and hopeful about its success, but it is depending on community family docs coming in to teach. The support of family physicians teaching in classrooms is not even on the radar. Clinical teaching is hard to have. There's not enough support for our clinical teachers in the community, let alone having them come in and actually do in-classroom teaching and leaving their very busy, tight offices to do so. There's no support for our community physicians to do that.

So, I have to continue to stress and really take on, after Dr. Risdon's conversation, that if we don't support our family docs being part of medical education—both in in-person teaching and in clinical teaching—it's impossible for our students to be able to see family medicine as important as it is and be able to think of themselves in that career. I think that's one thing that we're trying to change, but we need the support of our community family docs to support us in that endeavour.

Thank you, Dr. Piliotis. We're all watching with a lot of attention on that partnership with Lakeridge. It is innovative, and we're excited to see how that progresses. I'd now like to turn things over to Dr. Azadeh Moaveni, a family doctor as well as director of undergraduate medical education in the Department of Family and Community Medicine at the University of Toronto.

Thanks, everyone. I just want to echo what Dr. Risdon and Dr. Piliotis have said, but I'm going to focus a little bit on something else, which is the voice of the student. For the last nine years, I've been the undergrad director of my department, and so my primary mandate is to deliver the best family medicine programming from the first day of med school all the way to the day of graduation. Our goal is to have the highest numbers of U of T medical students choosing family medicine as their career of choice.

We emphasize early exposure by hosting and sponsoring mentor events, socials, career exploration workshops, and summer programs. We do early clinical exposure for our second-year medical students, where they work with community family physicians. They all then go on to their third-year family medicine clerkship, which is a six-week program. In their fourth year, they can elect to spend time with family physicians in all the areas they work. So they work in comprehensive family medicine, palliative care, emergency medicine, sports medicine, and like me, 18 years of rural obstetrics. There are so many different kinds of medicine that they can explore with a family physician.

Yesterday morning, I oriented 46 medical students to their six-week, third-year rotation. I told them about this press conference, and I asked them to lend me their voices. I asked them three main questions, and I asked them to write them on strips of paper so that they could be anonymous, frank, and honest in their answers. I asked them three questions:

If you're interested in family medicine, tell me why. 

If you're not interested in family medicine, tell me why. 

If you're unsure and considering family medicine, what would make you choose it? 

I'm just going to share some of their answers with you, focusing on this last question. This group of students is attracted to family medicine because of the longitudinal relationships and the ability to affect the health of a community for the better. They seek the variety and diversity of a generalist practice, from the first day of life to the last day of life, and the unique focus on prevention and the managing of complex and chronic disease—stuff I do every day.

However, these quotes are from the students' papers: "I doubt my choice to pursue family medicine because of the lack of support and recognition regarding financial compensation, administrative burden, and the uncertainty of being able to work in teams where I could be supported to take care of patients." This student also added—putting a little smiley face—"Please change family medicine for future medical students."

Another student said, "I'm undecided, but would choose family medicine if there was less overhead burden, I had more respect for the work that I would do, and there was fair compensation given the amount of work."

This student at the bottom said, "Unfortunately, I haven't been working with many very happy family doctors recently."

The comments are all very similar. They are interested, but also very worried, and they are uncertain about how they will thrive and work in this current system. Twenty years ago, when I chose family medicine, I had these same hopes and interests. This is what I wanted to do. I had many choices, but I chose family medicine first. But I didn't have the same worries. I didn't worry about these things. I worried about where I would live and where I would set up a practice. I did not worry about administrative burden and spending my hours doing unpaid work.

As educators, all four of us want to be part of the solution, and Kathy, Gina, and I have talked about things that could help. But we want to urge the urgency. This is urgent. We need to do something now so that students will pick family medicine as their career of choice. Thank you.

Thank you, Dr. Moaveni, for bringing the student voice into this conversation. I think that is very powerful. I'd like to turn things over to Dr. Jobin Varughese, a family doctor and the interim assistant dean of primary care education at Toronto Metropolitan University. Dr. Varughese, thanks so much.

As some might know, the Toronto Metropolitan University School of Medicine will open in September of 2025 in Brampton. Our medical school is going to be founded on building a community-driven, intentionally inclusive primary care model. As part of that commitment, they created my role as assistant dean of primary care education to develop a comprehensive primary care education strategy and advance that commitment towards family medicine.

Over time, patient complexity has increased, and we've heard already multiple times about the increased burden, the difficulty in managing care, and serving in atypical roles. This has actually led to burnout, and students have heard this. They've noted that when they work with a family physician who doesn't have access to team-based care, they usually have a more negative opinion of what's happening.

I personally love my job, but I recognize I am in team-based care within a Family Health Team, and I get to experience interprofessional care every single day. But students sometimes see the alternative, and then they do not choose family medicine as a specialty, as we heard from those CaRMS numbers mentioned earlier.

Communities that are medically underserved, like Brampton, are significantly impacted by fewer students choosing family medicine, similar to the cascade that Dr. Risdon spoke about. Not only is Brampton one of the most culturally diverse cities in Canada, it's also the ninth-largest city and the second fastest-growing city in Canada, with a projected growth of 30.2% by 2041. However, access to primary care is decreasing.

Because Brampton and its surrounding areas have high pre-chronic and complex care needs, TMU intentionally selected this region based on 70 letters of interest from community leaders to bring a medical school to Brampton and provide that much-needed, high-quality healthcare capacity to the community.

Our School of Medicine is working to encourage more medical students to choose family medicine in a few different ways. We aim to allocate 60% of our residency seats to family medicine stream residencies, and we're finding innovative ways to streamline primary care delivery—like lightening the administrative burden we've heard so much about by having systemic text innovation, including interprofessional care and technology-enabled care.

We also want to train learners to feel ready and able to develop thriving family medicine practices by allowing them to embrace uncertainty early in their training. We'll expose medical students to family medicine as they participate in the primary care longitudinal experience in their first year of medical school. We'll also provide them with exposure to multiple aspects of healthcare in primary care settings.

All these different areas will allow a clear ability for our learners to experience the benefits and the joy of family medicine and decrease those burdens you've heard so much about. The only way we're going to be able to work through this is through a multifaceted approach, as Dr. Piliotis spoke about. It's going to be critical to work on both the education perspective and the systemic portions that are involved. The more we can work together on this, the better chance we'll have. Thank you, Dr. Park. Back to you.

Thank you, and thank you to all of our panellists for sharing your firsthand stories. We are now going to open up our Q&A session. The OMA's Emily English will moderate this portion of today's briefing. Please put your questions in the Q&A chat. If we don't get to them, the media team will follow up with you. You can also email media@oma.org with requests for interviews or information. Emily.

Thanks very much, Dr. Park, and thank you to all the panellists for participating today and sharing your expertise and experiences with us. The first question is from reporter Len Gillis, who's with Sudbury.com. I'll have Dr. Andrew Park, OMA president, answer this one. "There has been some talk of financial incentives to inspire more interest in family medicine. Could that work, and would the government be willing to bear the cost?" Dr. Park.

Yeah, as I mentioned in my opening remarks, there's no question that additional financial incentive is needed for family medicine. I think there are two components here. There's financial assistance required, but also a systemic issue that we need to tackle. My co-panellists have talked about that as it pertains to the financial piece. When inflation is 25% over 10 years with a fee increase of 6%, and overhead is 40% plus at times, this creates an unsustainable model of practice. This is especially true when combined with the systemic issues of practicing family medicine, where each task becomes that much harder and more complex. You know, we definitely need financial incentives as well as support to actually do the job, or else this will be a failing model.

Thank you very much. A question for Dr. Azadeh Moaveni: "Can you tell us, as a practicing family physician, more about the administrative burden facing family doctors?"

Oh, sure. Well, I'm talking to you today instead of monitoring my inbox, I shall say. My inbox is, I think, inversely proportional to my perceived self-worth. The bigger it gets, the worse I feel about myself because every single message is about a patient who needs something. I've had the same practice since I was a resident, and I will tell you that administrative burden has skyrocketed.

In terms of what I have to do for patients, I have to fill out forms from insurance companies. I have to sign off because they want to take a rehab course because they've had a recent fall. I have to get the same message about an X-ray six times, or because they go to the hospital, the integration of my EMR and their EMR is not the same, so I'm looking at it two, three, four times sometimes. I have messages from patients, prescription notifications of renewals, and pharmacists emailing me to say they've done a meds check for a patient where nothing needs to be done—which, by the way, I hate those.

There are just so many. By the time I leave you today, I'll probably have 40 to 60 messages in my box, which will take me two or three hours. We all know if you look at the average, it's about 19 hours of unpaid work a week, depending on how many patients you see. The more patients you take care of, the more work you have to do.

I do that on weekends and Saturday mornings while my daughter is at soccer. I'm always the one with my laptop at soccer games, and people wonder what I'm doing. I'm checking my labs and my messages. That's what we're talking about. Students see that; they sit with me and say, "What are you doing?" "Oh, I am going through all of my inbox." I want to make sure my patients are taken care of; I can't ignore these. That is what you see with physicians being on their computers or in their offices at all hours of the day and night working through that inbox.

Thank you very much. We have another question now from reporter Len Gillis. I'll direct this one to Dr. Cathy Risdon from McMaster University, and perhaps Dr. Piliotis from Queen's may also like to weigh in on this. "Is there any way to fast-track or modify the medical education process so that medical schools might be able to answer the call for more family physicians by shaving off a bit of time, or would that be seen as too radical?" Dr. Risdon, I'll start with you.

Thanks. It's a great question because we're always looking for creative solutions to get people into the workforce. I think what this call is demonstrating is that the practice environment and the educational environment are inseparable—they are one and the same. So every educational intervention we could ever imagine is always going to fall far short of what's needed to expand, retain, and promote a family medicine practice for the long haul.

It's possible to imagine a really supportive practice container that allows different educational pathways—the one Queen's is pioneering is really interesting to look at regarding impact. But we can't separate the practice environment. The other challenge is that recent studies demonstrate that the most complex medical specialty is family medicine because of the vast number of patients we see and our uncanny ability to manage a lot of problems simultaneously as expert generalists.

McMaster can train a medical student in three years with a two-year family medicine residency, which is the shortest time to get someone out. Even then, our graduates tell us that they would love to be part of a team and a supportive environment so their clinical confidence and expertise grow in their first few years of practice. With supportive practice environments, we could probably grow really strong, confident family docs who stay for the long haul, but again, we have to address the practice environment.

Thank you very much. Dr. Piliotis, could you also weigh in on whether there's any way to fast-track or modify the medical education process?

Yeah, happy to. Certainly, when we built our program in Oshawa, we ultimately hoped to design a truly integrated undergrad/postgrad residency program. For those of us on the call, the fourth year of medical school in undergraduate medicine is sort of cannibalized by the CaRMS process. By removing that for students in this program, we get a lot of time to integrate with our postgrad or residency colleagues to develop a much more integrated and transitional educational program. So I do think it's possible.

The problem is regulatory. We couldn't do it in time to launch this program by any stretch because there are so many regulatory authorities—from the College of Family Physicians, the medical school accrediting body, to our university senate. There are so many places we'd have to navigate to have a truly integrated program. We could very easily shave off time—not because there's less to do in family medicine, but because there is wasted time in MD programs that we could recapture. So I think that's something we're thinking about, but it's in its early phases. We're focusing on getting our program up and running first, and then that's the next part we hope to tackle.

Thank you very much. A question now from Sana Patel, a reporter with The Trillium. I'll direct this one to OMA President Dr. Andrew Park. "Dr. Park, could you speak to how the proposed changes to the capital gains tax at the federal level play into this issue, both in terms of impact on those currently practicing or those looking to get into family medicine?"

Yeah, for sure. With the capital gains inclusion rate going from 50% to 66%—which is a 33% increase—this impacts physicians in a couple of ways. Number one, by incorporating, physicians have a vehicle to save for their retirement. As they sell off those assets in retirement, they're going to be included at a higher tax rate, meaning they will be taxed more heavily.

All that sounds technical, but the bottom line is this: if you're saving for retirement or a pension and a portion of that (5% to 10% based on calculations) is clawed back, that has significant implications. Either you have to work longer, change your scope, or look at other alternatives.

When we talk about 25% inflation with a 6% fee increase and 45% overhead, and now you look at the length of your career based on what you can store away in your corporation to help you later on, it means you're going to try to reduce overhead by looking at alternatives. That depletes the workforce in comprehensive family medicine, or it means working longer in a system that isn't geared toward letting you do the patient care you want to do.

For those nearing retirement, that's a hard sell. For those looking at entering, they don't need another reason not to do family medicine. For those thinking of switching, if you're close enough, this gives you the push you need. It is the responsibility of our governments to work collaboratively to create an environment where family medicine is sustainable. This is just another knock against family doctors in particular, as well as our other generalists working in office-based practices, and it's not helpful.

The last thing I'll say is that the way medical corporations are set up doesn't really allow for exemptions like the Lifetime Capital Gains Exemption or the Canadian Entrepreneurs' Incentive, and we don't have access to a $250,000 personal exemption. Every single dollar of assets sold from a corporation, for the most part, is going to be taxed at that higher inclusion rate. So this is one of those things doctors are looking at from a financial perspective and making hard decisions about where they're going to be in the next few years.

Thank you very much. We have a question from reporter Megan Ogilvie with the Kingston Whig-Standard, directed to Dr. Piliotis from Queen's University: "How important is Queen's University and the healthcare infrastructure in Kingston in nurturing the province's future family physicians? Also, do we see students specializing in family medicine and leaving the province to practice?"

Happy to speak to The Whig. This is an important problem that I'm sure all of our schools face. When you look at Kingston and the family physicians in the region, we are certainly one of the areas with a significant deficit in family physicians. We have an academic Department of Family Medicine that supports residency training and medical students, but it's pretty small. When we want to go into our pool of really phenomenal family physicians in the community who aren't academic, there are few, they're stressed, and we don't have a good way of supporting them.

I know many community docs want to be part of the solution and do things for free to support medical students so they can be in front of students and support that future choice. That's not an appropriate setup; it's not okay not to support our family docs in the community. We have so many who want to be part of our training, but we just don't have the proper resources to support them, which is part of the problem we're all facing in both undergrad and postgrad.

As far as students choosing family medicine and leaving, other provinces are making changes. If they set up practice environments that are much more conducive to family docs doing their job best in a healthier approach for both patients and their own self-worth, physicians will leave. We can learn from other provinces that have made changes and really start pushing the issue provincially.

Thank you very much. We have a question now from reporter Megan Ogilvie with the Toronto Star. I'll start with Dr. Jobin Varughese on this one, and perhaps a few more panellists may like to weigh in. "The Ontario government has expanded medical seats, invested in family health teams, and is funding new medical schools. What is your specific ask to help address the practice environment, and is this being addressed in negotiations on the 2024 Physician Services Agreement?" Dr. Varughese, I'll start with you, and then perhaps Dr. Park can weigh in on system-level solutions and negotiations.

Sure. From a medical education perspective, one of the clear systemic needs is built into the community doctors doing the teaching. Currently, a family doc providing community clinical education is asked to take on learners in their space—where they may or may not have extra rooms—and the compensation basically comes out to about $25 per half day. It ends up being an ask of goodwill and altruism. Similar to what Dr. Risdon was talking about regarding health human resources for our future, it's going to be a "both/and" situation of improving the systemic options available.

Teams are being introduced, which is lovely and really important, but that needs to be expanded further so every Ontarian has access to a family doctor who has access to team-based care. That's a big ask that will take time, but we achieve it by creating systemic changes.

Other areas that could be hugely helpful include improving patient access to their own electronic medical records, and shifting from individual referral systems to one centralized referral system, which would make an immense difference. Additionally, improving the money available per doctor when they take on learners ensures that teaching doesn't come at the cost of being a viable family doctor.

Dr. Park?

Yeah, thank you for that. Dr. Varughese neatly outlined a lot of our asks. Team-based care for all Ontarians when and where they need it is crucial. What we're talking to the government about is centralized intake and referral systems. Currently, it's very haphazard and difficult to track referrals, wait times, waitlists, and patient preferences.

We're looking at a streamlining of forms, elimination of sick notes, and the use of technologies like AI scribes. These are major system asks we're discussing with the government.

As far as negotiations go for the Physician Services Agreement, I won't comment too much other than to say that our responsibility to our members, and the government's responsibility to constituents, is to utilize every lever we have to ensure every Ontarian gets access to a family doctor. Outcomes get worse without one. But we must ensure it's a sustainable model. Too many forms are either unnecessary, extraordinarily cumbersome, or varied across every insurance company, employer, university, and sports association. These forms need to be eliminated, shortened, or revised, and all of those options should be on the table.

Dr. Risdon?

Thank you. There are solutions easily lifted from other healthcare systems around the world. Systems that cost less than Canada's and achieve better outcomes invest more in primary care. A benchmark for high-performing systems is 8% to 10% of the healthcare budget spent on primary care, whereas Ontario is currently around 5%.

What would we do with that extra 3%? Absolutely invest in our children and future, which means thriving environments for teaching and practice. Just as you can't train a surgeon without an OR, we need to invest in settings where we can train family physicians. That means well-functioning teams and physicians with high morale.

Another hidden cost to invest in is great data that allows us to understand how our entire system performs as patients move from family medicine to hospital care and back. We currently have no way of knowing how that journey goes or where to improve outcomes. If we had a great way of measuring how the team of medicine works together, family medicine would be thrilled to step up. Investing earlier in primary care saves significant costs down the road.

The government has made a great start, but it falls short of what's needed to attach those 2.3 million—and growing to 4.4 million—unattached Ontarians. We need to think about strong educational foundations, team-based care, and integrated care informed by outcomes and data.

Thank you very much. We have another question from Megan Ogilvie with the Toronto Star, directed to Dr. Andrew Park: "The Ontario government has told me that it's working with the OMA through the bilateral Burnout Task Force to help simplify government forms, and that it has a Patients Before Paperwork initiative to tackle administrative burden. Can you please provide details on these two initiatives?"

Yeah, absolutely. We have had both the bilateral Burnout Task Force and the Patients Before Paperwork initiative over the past couple of years, and you know, we're at the table with both the ministry as well as our government partners, and have had very productive conversations where we're starting to see the momentum.

Having said that, what we need to do is ensure that momentum doesn't stale date and that we're still pushing forward because while we have, you know, that initial portion, our family doctors on the ground need to see that there's continued momentum in these areas, and they need to feel that that's making a real impact to their daily working lives. And I think as we continue to grow that momentum, that will make a really big impact.

You know, we've seen some initiatives in Nova Scotia where they've been very tactical about their approach to reducing the administrative burden to their physicians, and we're looking at various models across the country to see how we can help support our family physicians that are spending over 19 hours of a week on these administrative tasks. Again, which does detract from either their personal lives or their ability to provide the excellent patient care that they want to. So, all those options are available to us, and we're looking at every one of those to ensure that we can support our members.

Thank you very much. And a reminder to journalists that you can put questions in the Q&A portion of the chat. We do have a few minutes left and happy to answer any questions that you may have. As Dr. Park said in his opening remarks, "We know 2.3 million people in Ontario don't have a family doctor." And we've talked today about how family medicine is the foundation of our healthcare system. So, I'd like to ask the family doctors on the panel if you could tell us about what you find rewarding about practicing family medicine. Dr. Moaveni, can we start with you?

I mean, sure. Yesterday, when I oriented those medical students, I said, "Hey guys, I would still pick family medicine. I would still pick it, even if all the struggles I have. At the end of the day, I go home being happy being a family doctor because I truly make a difference in people's lives."

The rewarding parts of family medicine—I mean, some of the babies I delivered in the last 18 years went to university this year. I got to see them off and fill out their forms, Andrew, as they went off to university. But, you know, I have pronounced people in the home that I've known for 20 years. There's nothing like it in terms of practicing medicine.

I have worked in urban settings, and I have worked in very rural and remote settings. I just got back from a trip from Wawa, where I staffed the emergency room and took care of critically ill patients. I also delivered a baby there—wasn't a planned one, but I did—and I took care of patients who were unattached and hadn't had a family doctor for three years. And, you know, they were still very grateful for my take of that visit with them, and I did the best I could for them in that very short period of time I had with them. But it's the patients that you—that's why we do it.

The other reason, my other hat, is why do I still love family medicine? I love the medical student who comes to my office who says, "Wow, I've never done that before," or "I've never seen that before." And teaching them is truly a joy, and hoping to, you know, be that person that might convince them that this is the job for them is something I strive for every day, right? So, being a mentor and a teacher and a family physician, and the model that I want—I want to model what it is to be a physician. So, I still find those things rewarding.

Do we have our challenges? Yes. And I think Dr. Risdon and Dr. Varughese and Dr. Piliotis have said some of the systems changes that need to change so that we can continue to provide the kind of healthcare that we want to provide to all Canadians. And I think if we make those changes, that hopefully students will choose family medicine like I did.

Thank you very much, and what a great answer and so nice to hear. Dr. Varughese, could you also tell us what you find rewarding about practicing family medicine?

Yeah, Dr. Moaveni covered it really well, but I think it is that idea of being able to really connect with our patients. Spending time directly eye-to-eye with them is really what I love the most—being able to build in all their successes, share in their losses, and really provide that comforting voice or arm where needed.

I think the other thing is also, like was mentioned, really bringing on those medical students. One of the best comments I ever received in an evaluation was from a student that said, "And whenever you get to the intersection between art and science of family medicine, art and science of medicine, that's where you're going to find family medicine." Because it really is this ability to bring together all the communication, all the collaboration, all the things you learn, and then bring it together with all the complexities and all the difficulties that you have with certain patients.

And so I think about the idea of, you know, some of the uncertainty that comes in, and some of the things of you don't know what you're going to get on a daily basis. I could spend a day walking into my clinic and get a whole day of, "Oh well, cough and cold. This is actually quite easy." And then you get another day where you get a lot of heavy psychosocial and a lot of different things that come through, including one time we delivered a baby in our office unexpectedly as well. So these are all things that you actually gain the uncertainty, the ability to really build in that expertise. And I think that is such a rewarding experience both to have and to share.

Thank you very much. And Dr. Risdon, can you tell us what you find rewarding about practicing family medicine?

Oh, I'm so glad you let me answer this question, too. It's such a delicious one. The phrase I use, Dr. Varughese, is "the biology meets biography." And I do love walking in a room, whether I've known a patient for a long time or just meeting them, and thinking to myself, "Okay, at the end of this visit, I want you to feel seen and heard as a patient. I want you to feel that your life choices have been factored in to whatever it is we need to do next."

And actually, that's powerful even if it is a cough and cold, because usually something else might be going on. And it's very powerful when we encounter all of the uncertainties, the pivotal life milestones, the losses, the grief, the joys. Every moment's a chance to invest in a person's sense of well-being, a sense of hope for their future, a sense of being able to move on through all of the challenges in their life. And to be an amplifier and a company to that journey is really—there's nothing like it in medicine. And being able to sustain that and offer the glimpse of that to students, and the possibility of them having that life, is really endlessly rewarding.

Thank you very much. And we want to speak more about the impact of the family doctor shortage. We know 2.3 million people in Ontario don't have a family doctor, so we want to hear more about some of the impacts of that on a patient level. So, Dr. Jobin Varughese, could you start us off and tell us about the impacts of patients not having access to a family doctor?

100%. Yeah, one of the problems it does come down to: when Ontarians don't have a family doctor, it increases the likelihood that their complexities and the necessities that they need for their health actually get worse, and they present to specialists, to ERs, far more at a far more advanced stage. It makes it more likely that something that was treatable very quickly in an office setting requires fairly intensive and very expensive care.

There's also a strong amount of difficulty with coordinating care, and I think specialists would agree as well that there's difficulty in knowing what to do with certain results and certain aspects that normally a family doctor does every day. So I think that when Ontarians are left without a family physician, it leads to a lot of problems that are very preventable, and it affects their everyday life.

Thank you very much. And Dr. Piliotis, do you also weigh in on the impact that you see of 2.3 million people not having access to a family doctor in Ontario?

Yeah, certainly, happy to. Full disclosure, I'm a specialist, so I'm a cancer specialist, and I can tell you the dramatic effects because I see patients coming in who have been unattached and haven't had a family doctor for years. And they're coming in with not only their cancer conditions coming in at a later stage, but also coming in with just untreated hypertension, untreated diabetes—just things that haven't been able to have properly monitored.

And, you know, I'm a really bad family doctor. So when we try and help and say, "Sure, I can do X, Y, and Z," it's completely subpar to what they need. And, you know, you're always feeling so torn and so challenged because they ask me for a family doctor, and I say, "Oh my goodness, I wish I had one for you." And that's just—it's really quite a sad situation, and one that has been quite sucked in, and certainly in the Kingston area.

But I can also say as a specialist, I do have many conditions that are actually chronic cancers, and so I follow patients for a really long time. And the best outcome is when I myself and the family doctor work as a team and follow these patients together. And it's magic when you have that wonderful relationship. And so I can't underestimate that partnership in longitudinal care of patients.

Thank you very much, and thank you to all the panellists today for your work on this panel and sharing your expertise and your experiences. And Dr. Cathy Risdon, I think you have some extra thoughts on the impact of the family doctor shortage.

Actually, it was a—I just wanted to redirect people's attention to a really landmark Canadian report that was done with the leadership of some folks at the University of Toronto. It's called the Our CAREs report, and it's the most comprehensive conversation with Canadians about what they want from their primary care family medicine teams that's ever been done. So if we start with that patient voice, it will guide us in all the directions we need to go.

So the first is that all citizens of Ontario deserve access to primary care and a family physician. So 100% attachment is the goal of family medicine leadership in Ontario. And we're calling it 100+, because that plus refers to some of the critical elements of the quality of family medicine primary care. So we've talked about team-based care, talked about investments in education. Dr. Varughese is offering huge leadership in Brampton to the importance of culturally safe, cultural humility care—care that is rooted in truth and reconciliation. There's so many populations that deserve excellent primary care that we haven't had a chance to talk about today.

So Canadians are telling us what they need and want, and it's an investment in a family doc primary care team for everybody, and the Our CAREs report can really help guide us there. So that's another place to look. The system solutions have been named for us by our patients as well.

Thank you very much and excellent points. And now I'll hand it over to OMA President Dr. Andrew Park for some closing remarks.

Yeah, I just want to thank all of our panellists as well as the media for today's briefing, and for your thoughtful questions, and for the impassioned voices that you heard from both the educators, the community facilitators or supervisors, as well as the students and our patients. So thank you for that.

We will have a recording of this session available later this afternoon. Ontario's doctors want what's best for their patients. Lack of access to a family doctor can negatively impact health outcomes. We really need to build a more sustainable system that allows us to recruit physicians to want to work in family medicine.

In the OMA's Prescription for Ontario doctor solution for immediate action, we have called for solutions that tackle the crisis in primary care. We hope to work with the government to ensure that there's a future for family medicine in Ontario. Everyone in Ontario deserves access to a family doctor. 2.3 million people in Ontario are currently without. We hope bringing attention to this issue today makes a difference. Thank you very much and enjoy the rest of your day. Bye now.

Good morning and thank you for joining us for our latest Ontario Medical Association briefing on important healthcare issues in the news. My name is Dr. Andrew Park and I'm the president of the OMA, which represents more than 43,000 doctors across the province. Today we are out with a warning that family physicians are increasingly considering leaving their practices due to systemic challenges. We will hear from physicians about why this is happening and what solutions are needed. As part of our panel, two family physicians will share firsthand accounts about making the difficult decision to leave full-time family medicine practices because of unsustainable pressures. Both are now working in other parts of medicine. We will also discuss urgently needed solutions and the impact that a lack of family doctors is having on the health care system overall. 

Far too many Ontarians, a staggering 2.3 million people, are already without a family doctor, and that number is expected to nearly double in only two years. The OMA recently asked family physicians who might be considering changing practice models a very simple question: What is the one thing you want the public to know? There were two major themes that emerged: financial pressures due to funding not keeping up with inflation, and the burden of administrative work. 

I want to read some excerpts of what we have heard. One family doctor said, "Increasing inflation makes it impossible to maintain my clinic." Another said, "The administrative burden is crushing me. I am so tired of spending hours every day doing paperwork." These sentiments were echoed over and over by family doctors across the province. 

With every role there are administrative duties which are reasonable. We are not talking about completing patient charts. Rather, what we're talking about are lengthy and repetitive insurance forms and bureaucratic and unnecessarily long forms that have to be completed by a doctor. No one went to medical school to fill out forms. We want to care for patients, but the administrative work that has crept into medicine makes it feel less about caring for people and more about paperwork. It's ridiculous and it has to change. 

This much is clear: We need to act now to ensure there's a future for family medicine in Ontario. Data is showing us that the proportion of Ontario family physicians practicing comprehensive family medicine is declining. A survey by the Ontario College of Family Physicians found that two-thirds of its members plan to change their practice model, reduce hours, or retire in the next five years. And the number of medical school graduates choosing family medicine is the lowest it's been in 15 years, according to the Canadian Residency Matching Service. 

So what does this mean for patients? It means that there will be fewer family doctors practicing family medicine, which means less access to care and worse health outcomes. Family doctors are the foundation of the health care system and are the vital link to specialist care. They help patients stay healthy, prevent disease by identifying risk factors, manage chronic disease, and get patients access to diagnostics and many other health care services. The result of the family doctor shortage is that all of our health is at stake. Evidence shows that fewer family physicians in our communities is associated with poor quality of life and shorter life expectancy. 

I'd now like to introduce my physician colleagues. Dr. David Barber is chair of the OMA section of general and family practice and a family doctor in Kingston. Dr. Natalie Lehey is a family physician and is now practicing as a general practitioner in oncology with the Durham Regional Cancer Centre. And Dr. Danica Switzer is a rural generalist in Northern Ontario. I'd now like to hand things over to Dr. Barber, who will talk about the pressures of practicing family medicine in Ontario and what solutions are needed. Dr. Barber, can you expand more on the challenges currently facing family doctors, and how can the system be improved to make practicing family medicine more sustainable? 

Great, thanks Dr. Park. Certainly, the pressures on family medicine are many, and they're really compounding each other as well, which is making everything worse on the ground for family doctors. The three things that I would point out are paperwork, the financial piece, and then just burnout. 

To start with the paperwork, that paperwork is taking up 20 hours of a family doctor's work week. That's more than two days of full-time work just doing paperwork. The paperwork is mostly insurance forms, requests for certain drugs, sick notes, and it continues to get worse and take up more of our time. The reality is that family doctors didn't go into medicine to do paperwork; we want to see patients and help our patients, and that certainly takes away from it. 

The second piece would be financial. The reality is that family doctors are business people, and right now they're in a failing or failed business model. Over the last 20 years, there's been a 20% cut in the funding that goes to a family doctor to run that business. When doctors look at the numbers, that's why they're looking to get out. 

The third one would be burnout and I think general demoralization. Family doctors are having to work harder, patients are more complex these days, and things are just compounding. One of the things around the demoralization is that I don't think the government has really sent any signals to these family doctors on the ground that they know what's happening. Some of the recent announcements have been for new spots, but the crisis really needs to be solved by the doctors we already have. That's where the focus needs to be. When doctors aren't hearing from the government that they've got their backs, then family doctors are just giving up, and that's why we're seeing so many leaving. 

There are solutions, and I would point out that the solutions need to be brought forward and worked on by government with family doctors, not in isolation on either side. We're keen to work and find these solutions, and they do exist. We talk about team-based care; the reality is that family doctors need people working around them, and they need those people to help remove the administrative burden and see these more complex patients, so the government needs to work that out. 

The other thing I would say would just be some type of stabilization funding for doctors on the ground. When you're in a failed business model, they need to see that, otherwise they're going to keep leaving. We have a lot of solutions and want to work with the government on it, but as it stands, the direction we're heading and the number of patients that are going to lose family doctors is just untenable. Thanks very much. 

Thank you, Dr. Barber. Now I'd like to hand things over to Dr. Natalie Lehey, who will tell us about the difficult decision she made to close her family practice in Oshawa in September. Dr. Lehey, what reasons contributed to this decision, and what more needs to be done to retain physicians to continue to work in family medicine? 

Thanks, Dr. Park, and thanks everybody for listening to me today. My name is Natalie Lehey. I went to medical school at McMaster and completed my residency training in Toronto at Sunnybrook and Women's College Hospitals. I finished my training in 2006. My husband and I decided to move to Whitby shortly after that to raise our family, and I opened my practice in Oshawa in 2007. At that time, Oshawa was considered an underserviced area. 

When I closed my practice in September, I had just under 1,200 patients. I had many patients that had been with me since the beginning—some two-generation, even some three-generation families in my practice. It was a big decision for me to close, and I can tell you there were a lot of tears shared amongst my patients and myself in those months leading up to my final day as I was saying goodbye to people that I had cared for for many years. 

My reasons for leaving were essentially similar to what Dr. Barber alluded to earlier. The first thing certainly is the economics of it. Right now in Ontario, family medicine is a failed business model. Our ability to bill OHIP—the amount we're able to bill—has not kept up near inflation the last 10 years. Certainly in the last decade, I've seen billings capped, cut, or at most increased by 1% a year. Since COVID, my expenses had reached upwards of a 10% a year increase with inflation, and my income was not keeping up with that. As a small business owner, I have to pay my overhead, my expenses, and my staff before I pay myself, and the numbers just were not adding up. I had even gone to the point of taking on an extra job eight years ago; I've been working once a week doing on-call work in a hospital overnight to try to make ends meet, and even that was not sufficient. 

Certainly over the years, if I've had to take time off for mat leave, when I had to get my knee reconstructed, or even vacation, I'm still responsible for those expenses even when I'm not bringing in any income. I worked as a preceptor with Queen's University for a decade, so I had family medicine residents rotating through my clinic, teaching them and mentoring them. Initially, a couple of them did end up joining our clinic and starting practices, but over the last six or seven years, I noticed a trend where my residents, when they were finished, were not choosing to set up practice. These are young, smart, motivated people, but they were coming with significant debt from their schooling and it just didn't make sense for them to set up practice when they knew that it would be a failed model from the beginning economically speaking. That was difficult for me to witness. 

The second reason was the administrative burden and the lack of support in dealing with that. By the time I left practice, I was spending on average 3 hours a day on paperwork. I'm not talking about patient charting; I'm talking about forms, prescription renewals, and referrals. The volume and requests for that type of information has been exponentially increasing. For example, the CRA disability tax credit form went from a 6-page form to a 16-page form in the last couple of years. With the advent of electronic medical records, on the one hand they've been very helpful, but on the other hand it's increased the volume of information coming into my inbox. Where before I would get maybe 30 to 40 messages to review a day, by the time I left I was getting on average 100, and that wasn't directly related to patient care—that was just FYI information that I was having to sift through. 

Additionally, we don't have a centralized referral system in this province for referring to specialists. I was spending an inordinate amount of time trying to become the patient navigator and figure out which specialists were taking on new patients. It was not unusual for me to have to try three or four different specialists and multiple referrals before I found someone that would see my patient for a specialty need. That was taking up a lot of time. As Dr. Barber mentioned, I actually had to reduce my clinical hours in order to accommodate all of the administrative tasks that I was dealing with. I liked working with my patients; I enjoyed the clinical work. 

The administrative tasks led to the third issue, which was burnout. I had experienced a fairly significant episode of burnout in 2014 and I had put measures in place to protect myself going forward—better self-care, more boundaries at work, etc. Then COVID happened, and all of a sudden I was faced with an unprecedented pandemic as we all were. I remained on the front lines seeing patients in person in urgent care, working at COVID assessment centers, and working at vaccine clinics. I was putting in a lot of work during this scary and uncertain time. 

During the course of the pandemic, I also was dealing with a couple of ill family members. My father was diagnosed with metastatic cancer and my eldest child was dealing with a significant medical issue. Towards the end of 2022 and leading into 2023, when my father needed more care, as did my eldest child, I did have to take about 6 weeks off to help care for my loved ones and ultimately deal with bereavement (my father passed away a year ago). I was not able to find somebody to look after my practice during that time. Another issue leading to burnout amongst family doctors is that we simply don't have replacements available when we need them. Similar to substitute teachers, we don't have substitute doctors to fill in when needed. So at a time when I should have been caring for my family, I was still responsible for my office expenses, those hundred messages a day in my inbox, all the paperwork, etc. It was towards the end of that leave when I was coming back to work that I decided I had to make a change for my own well-being and the well-being of my family. Ultimately, my final decision was to leave family medicine. 

Thank you, Dr. Lehey, for that personal account. I'd like to turn things over to Dr. Danica Switzer, who works as a rural generalist in Northern Ontario. You left your full-time position with the Wawa Family Health Team at the end of last year. What went into that decision, and from your perspective, what system solutions are needed? 

Hi, thank you Dr. Park. My name is Danica Switzer. I'm from Wawa—born and raised here—and I came back to work. I did my medical school in Thunder Bay and residency in Saskatchewan knowing that I would come back to the north to practice. I returned in 2017 and took on a full-time practice in Wawa in 2019, which continued until the end of August of 2023. I was doing full-scope general practice: office work, seeing inpatients in the hospital, doing 24-hour emergency department shifts, making home visits, doing palliative care, small procedures, teaching learners, as well as doing the primary care memory clinic. 

When I started, we were seven doctors filling the government-assigned quota of six, so we had internal coverage, there were lots of us, and the work was a reasonable load. In 2021, we lost two colleagues and went down to four doctors filling the role of six, then lost another colleague, putting us down to three. We maintained four doctors in town for two and a half years until we lost a third colleague in June of 2023, facing being only three doctors in town. Also, last summer, the government assessed how much work we were doing and thought we should be seven doctors. So you're going to be three physicians doing the work of seven. 

We had multiple rounds of discussion with our Ministry of Health contacts, and they repeatedly refused to provide meaningful long-term support to the vacant practices for the missing doctors who don't exist in our town. The contract that we work under—which is from 1996 and has not been meaningfully updated since then (I was in elementary school at that time)—simply falls to whichever doctors remain in town to do all the work, and that is an untenable expectation. In addition to all the clinical work, there are administrative and leadership roles that doctors in small towns fulfill. 

I made a very difficult decision to close my practice, abandoning my patients and my colleagues. It's not that I'm not working now; I continue to work. I was back in Wawa for five weeks as a locum through November and December, and I've been working at other places as well. My job now is part-time, where I choose when, how much, and where I work. 

If we're going to change things in the north, particularly in small towns where a small group of rural family doctors are doing everything, we need both immediate measures to retain practicing rural physicians who have so much experience, as well as long-term plans. We have decades showing that short-term solutions based on the political cycle are not working, so it's time for much longer-term plans for the North. We cannot recruit our way out of a retention problem. 

Thank you, Dr. Switzer, and thank you to all of our panellists for sharing their stories firsthand. We are now going to open up our Q&A session. The OMA's Emily English will moderate this portion of today's briefing to the media. Please put your questions in the Q&A chat. If we don't get to your questions, our media team will follow up with you. You can also email media@oma.org with requests for interviews or information. 

Thank you very much, Dr. Park, and thank you to the panellists. Dr. Park, I want to start with you. What kind of impact does this crisis in family medicine have on a patient level? 

So much. Patients rely on their family physicians for so many things, but the bottom line is they rely on them for their health. As Dr. Lehey alluded to, when you get sick, your family physician acts as your navigator and quarterback through the system. As frustrating or challenging as that is, that is the role family doctors want to provide. When that doesn't exist or isn't there, patients don't get the care they need from the beginning of an illness process to the end. That can leave patients feeling alone, or feeling like there's no one there to walk them through that journey during a very vulnerable time. It's incredibly impactful, and that's only speaking about the illness journey, not prevention or keeping a person healthy. That is the purview of the family physician, so it cannot be understated how big this is. 

Thank you very much. We have a question from Len Gillis with Sudbury.com. I'll start with Dr. Barber, chair of the OMA section on general and family practice. What could be done immediately in the short term to turn things around and convince physicians to hang in and continue working? 

One of the most important things would be some type of stabilization funding. The inflationary pressures on doctors just can't continue, and doctors need to hear from the government that they are supported. Some type of stabilization funding to help with overhead would be really important. I also think a signal from the government that they know this is an issue and want to help is needed. Right now, they want to give family doctors a 0% increase in pay this year, and when family doctors hear that, it gives them the sense that nothing is going to change, which is why they are giving up. 

Dr. Switzer, could you weigh in from a northern perspective on what can keep doctors working in the short term? 

For sure. In small towns where family doctors provide all the medicine, we need immediate locum support for vacant practices. Small towns like Wawa that have a quota of seven doctors currently have three working, leaving four missing doctors and four vacant practices. There needs to be full locum support for this—sending in 20 doctor days per month per missing doctor (which is how much a regular doctor would work), as well as a block of overhead funding. When you go down to three or two doctors, you're still trying to operate a business, and overhead is being split into much larger pieces with fewer physicians. Those two things would support missing doctors so that the doctors remaining on the ground have a reasonable workload. A second thing specifically for the north is the continuation of emergency department funding, which is set to expire on March 31st. This is required to keep emergency departments open, not only on the backs of local doctors, but by attracting locums. Without locum support for full-time, hardworking rural physicians, they're going to continue to leave. We need retention measures, not recruitment. 

Dr. Lehey, could you speak to what could be done immediately in the short term? 

I would echo the sentiments of Dr. Switzer and Dr. Barber in terms of funding. That's probably the number one thing right now. In order for doctors to keep their businesses up and running, pay staff, and pay expenses, they need funding. Without that, people cannot keep their businesses running. Additionally, if we had a centralized referral system, that would save a lot of time for family doctors trying to arrange specialist referrals. Looking at the volume of information coming in from electronic medical records—especially hospitals—there is a way to streamline that so only essential information reaches our inboxes. Those three things could help right away. 

Thank you very much. Another question from reporter Marcia Young: Ontario has become the fifth province to make a deal with the federal government for more funding. Is that hopeful? Dr. Park? 

That federal government deal was for $3 billion over three years. While that's hopeful, and the focus being on primary care is a good thing, we still have a long way to go in terms of federal funding reaching that 35% mark of total healthcare funding. At this point, we're still far behind the mark, so while we're hopeful and think good use can be made of that money, we're still quite a ways behind in terms of the funding needed for a stable, sustainable system. 

Another question from reporter Elizabeth Payne with the Ottawa Citizen: Is the exodus of family physicians speeding up in Ontario, and are we revising estimates about how many patients could be without a family doctor in the coming years? Dr. Park? 

Yes is the short answer. Where we saw unattachment rates a couple of years ago, that number has gone up and will continue to rise because of an unsustainable model, as well as our aging demographics—both from a physician workforce standpoint and our population. We are heading into a perfect storm. It's very important to realize that up to 60% to 70% of our workforce is looking at reducing attachment through comprehensive family medicine for one reason or another. 

Dr. Barber, over to you on the growing number of patients who might be left without a family doctor. 

The current number is 2.2 million, and the Ontario College of Family Physicians projects that will be 4.4 million by 2026. 4.4 million is one in four—25% of the population in Ontario without a family doctor. That means no access to our health care system. Regarding the federal funding mentioned, while it seems like a big number, I didn't hear where that funding would go to doctors on the ground. They mentioned training 600 new family doctors, but that only covers 600,000 patients. When looking at 4.4 million without a family doctor, that's just not enough, so there have to be different solutions. 

We have a question from Kyle Darbyson with the Soo Greyhounds/SooToday. Dr. Park, what was your reaction to the Group Health Centre in Sault Ste. Marie de-rostering 10,000 patients, and what are solutions for recruitment in Northern Ontario? 

I was devastated. For those 10,000 people to lose their family doctor is enormous. Having talked to some of that group, these are not decisions family doctors want to make; they struggle with them immensely because they understand the patient impact. Projecting up to one-third of that city being without a family doctor is going to create a potentially catastrophic impact on the community. In terms of solutions, we need to look at the model province-wide and ask what makes this job unsustainable—whether it's infrastructure support, bridge funding, or support for centralized referrals. It can't be this inefficient and burdensome to practice medicine in this province. 

Dr. Switzer, your reaction to the situation in Sault Ste. Marie and the recruitment/retention challenges there? 

It's disappointing, but not surprising given the landscape. What do family doctors want? You want to be with a team, have support staff, and have other providers seeing patients with you to amplify the reach of a single physician. There's an appetite for alternative funding models beyond fee-for-service. Look at BC's new longitudinal family physician payment model. Whether it's Sault Ste. Marie, Thunder Bay, or dozens of small communities, we need a long-term strategy for Northern Ontario healthcare rather than stopgap measures. The auditor general's report from December 2023 highlighted many shortcomings, so we need to move towards a multi-decade strategy. 

A question from Megan Ogilvie with the Toronto Star: What are the top practical ways to reduce administrative burden for family doctors, and who is responsible? Dr. Barber? 

First would be reducing the amount coming in, which government can do by eliminating the requirement for sick notes. Nova Scotia doesn't require them anymore. Also, more regulation around insurance companies and the amount of data they require from us. Secondly, spreading the administrative work among a multidisciplinary team. There's no margin in family medicine to hire people to do this without funding, which is a shame because technology exists that could help us. The government has a huge role to play. 

Dr. Lehey, could you weigh in? 

In addition to a centralized referral system, standardized forms would help. Every hospital and imaging center currently has its own form. If we had a single Ontario form for diagnostic imaging like we do for lab work, or standardized insurance/employer forms, that would be a huge reduction in time spent filling out paperwork. 

Dr. Park, can you speak more on why a centralized referral system is so badly needed? 

Currently, when a family doctor fills out a referral form for a specialist or test, they don't know the specialist's wait times or specific procedures. If a referral gets rejected, it bounces back, introducing delays of days or weeks. Family doctors end up navigating a "Yellow Pages" type system using local contacts. A centralized referral system like major companies use would streamline navigation and eliminate massive inefficiencies. 

Question from Tim Kelly: Are AI tools available to help with paperwork, and are there other ways to reduce administrative load? Dr. Switzer? 

Non-technology ways involve having teams. Many forms don't require a physician; adequate support staff, social workers, or pharmacists could complete large portions of them. 

Dr. Lehey? 

A team-based model reduces administrative burden significantly. Regarding AI, I've seen AI scribes used for patient charting, but that requires financial investment when doctors are already struggling. AI hasn't been widely implemented for filling out complex administrative forms yet. 

Question from Jacqueline Labelle with Global News: What would you say to anyone concerned that this could pave the way toward privatized healthcare? Dr. Park? 

We share that concern. Primary care is the foundation of our system, and every Ontarian deserves access to a family doctor. Blocking access or creating bottlenecks is something we have no interest in, and any erosion of public access is something we will not stand for. 

Dr. Barber? 

People don't realize this is happening already. I had a patient pay over $2,000 in Montreal for a test because wait times in Ontario were months long. Nurse practitioner clinics charging $500 for access, or pharmacies charging for injections—that is privatization. Underfunding is pushing us toward an American model, which weakens the system overall. 

Question from Ian Adams with Simcoe.com: Are some areas more susceptible to the doctor shortage than others, and are municipalities competing against each other for doctors? Dr. Lehey? 

Rural areas are feeling the pinch more. In urban or suburban areas, walk-in clinics try to fill the gap, but municipalities like Whitby are resorting to financial incentives to recruit doctors because provincial support is lacking. 

Dr. Switzer? 

In the North, we don't have walk-in clinics—the ER is staffed by the few local family doctors. Instead of competing, recruiters in northern towns often collaborate, sharing locum contacts across sites. A northern healthcare strategy could establish regional recruiters or salaried locum pools to support communities systematically. 

Question from Megan Ogilvie: As of February 2024, where do discussions with the Ontario government stand? Dr. Park? 

We've gone to the government with these concerns and are having conversations, but we need to stress the extreme urgency of the situation and the need for immediate, actionable changes to make the system sustainable. 

Question from Natalie Van Rooy with CTV News Ottawa: A family doctor near Ottawa is closing a practice of 1,500 patients amid a city-wide shortage of 171 doctors. Is this scenario becoming common across the province? Dr. Barber? 

Yes, Dr. Ramsay Hijazi's departure is happening across Ontario. Last summer in Kingston, six physicians retired, leaving 7,000 patients unattached. Without rapid stabilization funding or innovative temporary models like team-based unattachment clinics, more patients will fall through the cracks. 

Question from Shannon Proudfoot with the Globe and Mail on team-based care: How does a team model help reduce administrative burden? Dr. Park? 

Teams allow doctors to focus on being doctors rather than spending hours on non-clinical paperwork. Surrounding the physician with nurses, nurse practitioners, pharmacists, social workers, dietitians, and physiotherapists creates a wraparound model where the doctor doesn't have to be all things to all people. 

Dr. Barber? 

If a physiotherapist on the team can assess joint or back pain patients in collaboration with the doctor, it opens up doctor appointments, allowing family doctors to roster more patients. If every family doctor in Ontario could roster 240 new patients with team support, the unattachment problem would be solved. 

Dr. Lehey? 

I currently work in a team-based model in oncology alongside pharmacists, social workers, dietitians, and clerical support. It works extremely well for patient outcomes, and implementing this in family medicine with proper funding would transform primary care. 

Dr. Switzer? 

Working in a team in a small town allowed my diabetes and hypertension patients to receive great care from nurses and educators. However, when physician vacancies occur, the workload on remaining doctors becomes unsustainable even within a team model if vacant practices aren't supported. 

Final thoughts from panellists for the public: 

Dr. Barber: The public needs to know they are at risk of losing their family doctor. If 25% of Ontarians are without a doctor by 2026, access to healthcare is severely compromised. Contact your elected officials and demand action. 

Dr. Lehey: Primary care is the bedrock of healthcare. Investments in primary care save dollars down the line. The system is beyond crisis levels, and the health of our province depends on getting this right now. 

Dr. Switzer: Family doctors care deeply about their patients, but we cannot continue to prioritize patients' health over our own physical and mental well-being. We need immediate government support to make family practice sustainable. 

Dr. Park (Closing Remarks): Thank you to our panellists and the media. Everyone in Ontario deserves access to a family doctor, yet 2.3 million currently do not have one. We hope bringing attention to this issue drives immediate government action to build a sustainable primary care system. Have a good day. 

Good morning, everyone, and thank you for joining us for our latest Ontario Medical Association briefing on important healthcare issues in the news. My name is Dr. Andrew Park, and I'm the president of the Ontario Medical Association, which represents more than 43,000 doctors across the province. January is Alzheimer's Awareness Month in Canada. Today, we have assembled an expert panel of physicians to discuss the current state of dementia care in the province and how we can better prepare for the future. 

New analysis of OHIP billing data being released today by the Ontario Medical Association shows that there has been a 48% increase in patients with dementia since 2010. The actual incidence of dementia is likely even higher, as some patients may be treated for other things or have not yet received a diagnosis. As our population ages, the number of people living with Alzheimer's disease and other forms of dementia is expected to continue to grow rapidly. 

A study by the Alzheimer Society of Canada predicts that the number of people in Canada living with dementia will triple over the next 30 years. With an already strained healthcare system and fewer than 300 dementia care specialists across Canada, we are not prepared to meet their needs. This is an issue that needs urgent attention from all levels of government so people can get the care they deserve and our healthcare system can withstand rising pressures. 

Dementia is an umbrella term for several diseases that affect memory and cognitive ability and that interfere significantly with a person's ability to maintain daily living activities. Alzheimer's disease is the most common form of dementia and represents 60 to 70% of cases. Dementia is the seventh leading cause of death globally and a major cause of disability and dependency amongst older adults. This not only impacts the individuals who have dementia, but also their caregivers, family, and communities. 

Currently, dementia care in Ontario happens mainly in institutional settings, for example, hospitals and long-term care. We need to change this. Most people living with dementia prefer to remain at home and out of long-term care homes for as long as possible; this helps preserve their quality of life. In the OMA's Prescription for Ontario: Doctor-Led Solutions for Immediate Action, we have called on the government to increase community capacity, which would also help tackle hospital overcrowding. Far too many Ontarians are languishing in a hospital bed when they could be better discharged and served and cared for elsewhere. 

One significant cause of hospital crowding is a lack of access to home care, long-term care, and palliative care. For example, a patient with dementia requiring supportive care may end up living in a hospital due to a lack of available resources in the most appropriate setting. These patients are given the label ALC, or alternate level of care, and have existed in Ontario for many years with root causes remaining unresolved. The pandemic made a bad situation even worse, and now the consequences of inaction are more urgent than ever. 

We are urging the government to appropriately fund home care. Home care support can include assistance for regular activities that support dignity, such as eating and bathing. In 2020, there were 82,000 home care visits to Ontarians living with dementia, but according to an expert analysis by the Alzheimer Society of Ontario, 2.5 million annual home visits were needed to provide adequate support. That's a significant gap in capacity versus demand. 

Ontario's doctors know that it is important that we act now to shape the future of dementia care in Ontario. Our panel will provide important insights into the state of dementia care today and what needs to change. We will also hear about new, exciting breakthroughs that could soon be approved in Canada that would have major impacts on people's lives. 

I'd now like to introduce my physician colleagues: 

• Dr. Alexandria Peele, a geriatrician and chair of Senior Care at the Gateway Centre for Excellence in Rural Health in Goderich. 

• Dr. Carmela Tartaglia, a cognitive neurologist and co-director of the Memory Clinic at Toronto Western Hospital. 

• Dr. Linda Lee, a family physician with a concentration in the care of the elderly, and the executive director of the MINT Memory Clinic—a non-profit organization helping to establish memory clinics in primary care nationally. 

I'd now like to hand things over to Dr. Peele, who will talk about the current state of dementia care in Ontario. Dr. Peele, as a geriatrician, what gaps do you see in care for dementia patients in Ontario, and what should the province be doing to bolster care available for patients who need it?

Thank you very much, Dr. Park, for your kind introduction. 

One in three people in Ontario have a close connection to someone with dementia. So, let's describe the experience of dementia for many people living in Ontario and talk about how we can do things differently in 2024 and beyond. 

Your loved one is forgetting conversations more easily, misplacing items, and having more difficulty organizing documents for their taxes this year. Your family doctor advises that the wait time for any kind of specialist memory assessment could be months or years. Scattered specialist care teams established over 15 years ago cannot meet the current demand. In Canada, the number of children is the same as the number of older adults, but there are 10 times more pediatricians taking care of children than there are geriatricians taking care of older adults. 

A referral is sent, and the wait begins. 12 months later, your loved one sees a specialist, and investigations are ordered. The wait time for an MRI head is 12 months more. Now, over two years from their initial visit to the family doctor, a diagnosis of probable Alzheimer's dementia is confirmed. Throughout this time, your loved one is declining; they're a shadow of their former self. 

One night, they fall, and you bring them to the emergency department. After a 16-hour wait, they're disoriented and delirious. They receive pain medication for a broken rib, and they cannot go home. After sleeping overnight in the hallway of the emergency department, they're so disoriented that they strike a nurse who's trying to take them to the toilet. After a week in the hospital trying to control their pain, they're so deconditioned that they cannot go home. You have no choice but to put them on the list for long-term care, but no beds are available. After a seven-month wait in the hospital as an ALC (alternate level of care) patient—the title used to describe people who don't require acute hospital care but have no options for care at home—they finally move to long-term care. 

This journey is too common, and it can be different. Currently, there's no centralized responsibility for dementia and frailty care in Ontario. Dementia and frailty care falls under multiple provincial ministries, most notably Ontario Health and Ontario Health Teams, as well as the Ministry of Long-Term Care, the Ministry of Municipal Affairs and Housing, and the Ministry for Seniors and Accessibility. Within these departments, there are a myriad of agencies that are not always coordinating to deliver efficient and effective dementia and frailty care. This stands in sharp contrast to other diseases, like cancer or cardiac care, that are coordinated provincially. 

With the introduction of Bill 121, Improving Dementia Care in Ontario Act, 2023, dementia experts are calling for one coordinated body that would provide strategic direction for dementia and frailty care in Ontario. That coordinated body would need control of funding and deliverables, provide clinical expertise, and have participation from all ministries. Experts are also recommending implementing a dementia strategy for Ontario that builds on the 2019 National Canadian Dementia Strategy. 

Doctors want all Ontarians with dementia and their caregivers to have the best possible health care. Key components to a dementia strategy would include: 

• Streamlined and timely access to diagnosis, ideally within three months. 

• Timely access to required testing and treatments. 

• Specialized interdisciplinary dementia care support and education, as well as long-term follow-up throughout the dementia journey. 

• Access to flexible home and community care support services to meet their care needs at home. 

As Dr. Park mentioned, 91% of older adults want to live at home as long as possible. But the reality is, the system needs to change to meet current and future demands for care in the home. Best practice dictates interdisciplinary team-based care for people with dementia and frailty. In my practice area, there are five different specialized healthcare services that provide dementia and frailty care, managed by five different organizations. We have five different medical record systems; I don't know when my patient has visited another provider. Each service reports to different managers, so as the physician, I cannot delegate care tasks to other team members. We lack secure communication tools, like text messaging and email, that would help us coordinate your care. These inefficiencies affect your care and mean wait times continue to grow. 

Another important part of staying at home as long as possible for people with dementia is home care—for things like nursing care, physical therapy, and help with dressing or a bath—and community support services for things like transportation, meal support, and respite care for caregivers. These types of services are also very cost-effective for the province. In 2020, the province estimated that the cost to provide home care was $13 per day. This is in comparison to $212 per day to provide care in long-term care, and $730 a day to provide care in a hospital. 

As the OMA has shown, the number of persons with dementia is increasing. Estimates indicate that community support service budgets would need to grow by 25% to meet the current demands of older adults living in the community, and budgets would need to continue to grow each year as the population continues to age and the number of people with dementia and frailty continues to increase. But remember, this will always come at a fraction of the cost of hospital and long-term care. 

In addition to a funding and resource crisis, recruiting providers in home care is a challenge because of pay gaps. For example, personal support workers (PSWs) make 19% less on average working in home care compared to their peers who work in hospitals. Furthermore, provincial policy dictates that PSWs who work in the community are only paid full wages for direct care, but not during travel between homes. This puts rural and remote Ontarians at further disadvantages, where travel distances are long and weather often compounds the time between homes. 

Current data from the Alzheimer Society of Ontario shows that for every three people with dementia who connect to their local Alzheimer Society, one emergency department visit is prevented. Once older adults are hospitalized, those who spend the night in the emergency room hallway are more likely to die in the hospital and experience adverse complications compared to those who are admitted directly to a hospital ward. People with dementia stay two times as long in the hospital compared to their peers, and they're six times more likely to go to long-term care when assessed in the hospital compared to when assessed from home. 

Dementia and frailty care is at the root of hallway healthcare and the alternate level of care crisis. Dementia and frailty care affects us all; we need to transform and modernize how we provide care for older people. Thank you.

Dr. Andrew Park: Thank you, Dr. Peele. I'd like to hand things over to Dr. Linda Lee, who will focus on an innovative model of care for patients with dementia in the community. Dr. Lee, what are MINT Memory Clinics, and how can these clinics provide better dementia care within primary care? And lastly, how can these clinics relieve pressure on the healthcare system overall? 

Dr. Linda Lee: Well, thank you very much, Dr. Park. More than 500,000 people in Canada live with dementia, and that number is expected to triple by 2050 to 1.7 million. Our current healthcare system is not set up to support the growing number of individuals living with dementia or their family care partners, and there are real system-related challenges, as Dr. Park described, that prevent people from accessing a timely diagnosis and accessing the services and supports that they need to live in the community with the best quality of life for as long as possible. Our system is reactive, it is crisis-driven, and programs that help solve these problems, such as MINT Memory Clinics, are underfunded. We need to leverage Canada's strong infrastructure of primary care and enable them to deliver high-quality, accessible dementia care no matter where people live. 

MINT Memory Clinics is a non-profit organization dedicated to improving dementia care in primary care through standardized, nationally accredited training. It's complete, compassionate care that's full-service, multidisciplinary, and provided throughout a person's journey. It's one-stop, located where people live in their own communities. The MINT clinics take a preventative approach, aiming to avoid those crisis situations, as Dr. Peele described, that result in much added suffering and costly use of healthcare system resources, such as emergency department visits, hospitalizations, and transitions into long-term care. 

What's important is that MINT clinic care has been shown to help people living with dementia stay in their own homes longer, and out of the hospital and out of long-term care for as long as possible. The MINT clinic teams work in partnership with the patient's own family physician or nurse practitioner, in collaboration with specialists, Alzheimer Society team members, and with our training, the need for referrals to specialists is reduced by 90%. What that means is that people can get everything they need throughout the journey from their local MINT Memory Clinic without long waits and without needing to travel to see specialists. 

The MINT clinics have been proven to provide high-quality care. Specialists are linked to each MINT clinic and accessed virtually when needed for the most complex conditions. What's also most important is that patient and family satisfaction with MINT clinics is very high. Studies have shown that 96% of patients and family caregivers would recommend the service to others. There is a need for sustainable provincial funding to enable the spread and scale of MINT clinics so that every person can have access to this kind of service and support. 

The MINT Memory Clinic model has been extensively evaluated, and a recent cost-effectiveness analysis conducted by a health economics expert demonstrated $51,500 net cost savings for every patient seen in MINT clinics, along with improved quality of life. Other studies commissioned by the ministry have shown that, compared to usual care, MINT clinic care is associated with a 50% reduction in emergency department costs, a 50% reduction in hospitalization costs, and delayed transition into long-term care. 

What that means is that with MINT clinics, people living with dementia can remain living in their own homes for longer, with the best quality of life, at a much lower cost to the healthcare system. Again, that $51,500 net cost savings is inclusive of the cost of training and the staffing costs for these MINT clinics. 

Our health-care system needs to evolve to better meet the needs of the growing numbers of people affected by dementia. There's a need for investment in proven solutions, such as MINT Memory Clinics, that offer better care at a lower cost and allow more equitable access to this type of care no matter where people live. As a non-profit initiative, we could prioritize standardized, nationally accredited training for teams to allow rapid spread and scale of the MINT clinic program, ensuring widespread access to high-quality care at substantial healthcare system savings. There are now over 100 MINT clinics in Ontario and 20 MINT clinics in five other provinces, and there needs to be more. This is urgently needed and will help us deliver the kind of care that older adults need and deserve. Thank you. 

Dr. Andrew Park: Thank you, Dr. Lee. Now I'd like to turn things over to Dr. Carmela Tartaglia, who will tell us about some of the new treatments on the horizon for dementia. Dr. Tartaglia, what new medications could be available in the future, and how will this shape dementia care in Ontario moving forward? 

Dr. Carmela Tartaglia: Yeah, I think to answer this question, we really have to start backwards. Up until now, we've been talking about dementia, but actually, there are no disease-modifying treatments for people who have moderate or severe dementia. The disease-modifying treatments are only for people with mild cognitive impairment and early, early, early, early stages of dementia, where there may not even be dementia yet. 

I think it's really important for people to realize that these staggering numbers we're talking about are actually a huge underestimate. The vast majority of our patients who have a neurodegenerative disease in the brain—meaning something like Alzheimer's, Parkinson's, or something else—aren't even accounted for, because those people aren't getting diagnosed. Those people are sometimes erroneously told that they're just aging, or that they have depression, anxiety, or even a midlife crisis. 

The thing to remember is, although the vast majority of patients are older—over the age of 65, which is actually not that old when you think of our lifespan—there are millions of people with young-onset dementias where they could be in their 40s, 50s, or early 60s, and these people also have a neurodegenerative disease. 

So, I think the landscape has completely changed now. Think of cancer: when do you diagnose cancer? You don't wait until people have late-stage disease to make a diagnosis; you need to get in there early. That's the only time you will be able to disease-modify—meaning actually change the course of the illness. 

There are currently three FDA-approved treatments in the United States that have evidence that they can modify the course of Alzheimer's disease (not the other neurodegenerative diseases yet). Recent results show that these treatments are only beneficial when patients take them at very early stages. But those patients, for the most part, are not even getting a diagnosis—they're being told that they don't even have a disease. Up until now, it was perfectly acceptable to misdiagnose or not diagnose, but now you will actually be missing out on a treatment that could change the course of your illness. 

So, as physicians and as people, we are going to have to change our outlook. This disease does not start when you have dementia, and people should not be dying with just a "dementia" diagnosis. That's like saying you died of a cough; you would hopefully know that your cough was caused by cancer, asthma, or tuberculosis. Well, the same thing goes for dementia: you need to know what the cause of it is. 

We need access to diagnostics and proper assessments. Proper assessments in neurodegenerative disease take time. People have to be compensated for taking the time to listen to their patients. When your brain changes due to a neurodegenerative disease, you change, and in the beginning, most of our patients are the ones who notice the change first. They go to their physicians, nurse practitioners, and healthcare providers and say, "Something is different," and oftentimes they're told, "No, things are okay," without any assessments, just because they sound okay. But think about it—in cancer, would we do that? We would not. 

Our perspective on these diseases has to change because there are dramatic shifts happening; there are disease-modifying treatments. One of them is actually under Health Canada review right now, and we will get a decision soon. That means you have to be able to diagnose people to be able to access it. 

It's important to remember that young people get these diseases, and you shouldn't discount when somebody in their 50s tells you, "Something is not right. I feel that my memory is not good, I can't speak as well as I used to, or I can't coordinate things as well." That's important. It means something is changing, and we need to get a diagnosis of what that is.

It's also important to remember that there are no physicians untouched by this disease, and I am certain there are very few people untouched by these diseases. We have a lot of older adults taking care of children, so even pediatrics should be thinking about these conditions. Our patients need accurate diagnoses just like in any other condition—as Dr. Peele alluded to, cardiac care and cancer care have coordinated precision and personalized medicine. Well, we need that personalized medicine in neurodegenerative diseases. Thank you. 

Dr. Andrew Park: Thank you so much, Dr. Tartaglia, and thank you to all of our panellists for sharing their expertise. We are now going to open up our Q&A session. The OMA's Emily English will moderate this portion of today's briefing. As always, please put your questions in the Q&A chat. If we don't get to your questions, our media team will follow up with you. You can also email media@oma.org with requests for interviews or information. Emily? 

Emily English: Thank you very much, Dr. Park, and thank you to all our panellists for sharing your expertise today. To the journalists in the room, thank you for attending. Please feel free to put questions in the Q&A chat. 

• Emily English: We have our first question from reporter Len Gillis with Sudbury.com. I'm going to direct this one to Dr. Peele. Dr. Peele, are there enough resources in smaller and rural communities like Northern Ontario where patients with dementia can get access to care and services? What should be done to bolster that? 

• Dr. Alexandria Peele: What a great question, Len. That is really close to my heart and my practice, because as I alluded to before, I'm one of the very few geriatricians in Ontario who practices rurally. Certainly, it doesn't matter where you live in the province of Ontario, you qualify the same for services. But the issues I alluded to—where we have a resource shortage and a shortage of workers able to do that work—are certainly compounded in rural areas. 

In terms of pieces we could change to help with that going forward: some of my work through Gateway has been looking at strategies to try to increase health worker recruitment in rural areas. One program gives high school students jobs in healthcare so they can grow their experience and hopefully pursue a job in healthcare later on. Having more healthcare workers in your rural or remote area in general has been shown to be quite helpful. Another initiative we've been working on is training PSWs locally, with the hope that they will then return to work there. In rural areas, we have some of the best care, but we have to be creative to increase our healthcare worker base. 

• Emily English: Thank you very much for that answer. I have a question now for Dr. Linda Lee: If somebody is showing signs of dementia, when should they go to their family doctor to have that discussion? 

• Dr. Linda Lee: That's a really important question. If a person is experiencing memory symptoms, or if people are worried about someone they care about, they should seek medical attention. Not all memory loss is dementia; sometimes there are treatable conditions, and the only way you'll know is by seeking help from your family doctor or nurse practitioner to get investigations started. As Dr. Tartaglia said, if you're noticing any changes in your memory or other people are noticing changes, that's the time to seek help. 

• Emily English: Thank you very much. We have a question from Andy Pinsent with CFRA in Ottawa. I'll direct this one to Dr. Park, who is an emergency physician as well as OMA president. Dr. Park, can you tell us if police and paramedic services need to be consulted as stakeholders? I'm aware they end up responding to situations involving dementia patients, and it adds to the complexity. 

• Dr. Andrew Park: Yeah, for sure. Thank you for your question. I think the new wave of healthcare, as we're conceptualizing what service looks like for patients, has to be more collaborative. It has to look at what stakeholders are involved with what patients at what points in their journey. As Dr. Lee said, we are often in crisis mode; how do we get ahead of this so we're providing the education that both police and paramedic services need so they are able to manage these patients with compassion, as opposed to relying only on the tools they currently have? It's really important to ask how we engage with external stakeholders—beyond what we might have conventionally thought of—to better care for patients, because ultimately, patients are citizens in Ontario and this affects all of us. Absolutely. 

• Emily English: Thank you very much. We have a question now from Ananya Dougal with The Trillium. I'll direct this one to Dr. Tartaglia. There's been discussion about how people are given a probable diagnosis and the need for diagnostic testing. Could you speak to some of the specific tests needed to help in diagnosing that aren't necessarily covered by OHIP, and how that ultimately impacts patients? 

• Dr. Carmela Tartaglia: Yeah, I think that's a great question. We need to have access to diagnostics. Diagnostics in Alzheimer's disease have been around for four decades; there is no reason that people in Ontario don't have access to them. We had access to lumbar punctures for cerebrospinal fluid analysis until March 2019, when it was actually removed. Now we have a very small program where some patients are given access to PET amyloid scans to make a diagnosis, but it's a very restricted program. We can't keep going like that; we need accurate diagnoses. 

This is costing the system a lot of money, because patients aren't coming to a doctor just because they have nothing better to do—they have something real going on with them. As Dr. Lee alluded to, there are some things that are reversible, and there are medications now available that change the course of the disease. We can argue whether they do it enough—nobody thinks the miracle cure has arrived yet—but they have evidence that they're changing the course, and you need an accurate diagnosis for that. There are blood tests being worked on that will hopefully be in our clinics in the near future, but until then, we still need access to existing diagnostics in Ontario. We're in 2024; this is the time for people to get a diagnosis of what is causing a profound change in their ability to interact with others and do the things they used to be able to do.  

• Emily English: Thank you very much for that answer. We have a question from The Toronto Star: Can you speak to what we know about the impact of COVID on the increase of patients with dementia, and the progression of the disease in existing patients? 

• Dr. Carmela Tartaglia: That's a great question. As I've already alluded to, this disease starts decades—sometimes two decades—before you actually show signs of disease. You might think, "How is it that this disease is in your brain, but you aren't showing any signs?" That's because you can compensate for disease in the brain. But then you have to think about things that could decompensate you, and COVID happens to be one of those things. 

A COVID infection in some people causes significant changes in cognitive function; they develop anxiety, depression, and headaches. Those symptoms can exacerbate underlying disease in terms of exposing it. You may have been able to compensate until then. It's similar to when people have an underlying condition and get a concussion—they feel much worse and think, "Oh no, this started the disease," but actually, that event just exposed the underlying disease. We've had patients sent to my COVID clinic only to find out they have Alzheimer's disease. The same is true for concussions. It's not that COVID causes a degenerative disease (we don't have evidence for that), but that it exacerbates and exposes it. 

There is also data coming out showing that older people who have had COVID have worse cognitive function than those who haven't. That data is more difficult to interpret because nowadays almost everyone has had COVID, even if asymptomatic. That will be a work in progress over the next few years, but definitely, COVID exposes people who already had a neurodegenerative disease that was previously well-compensated. 

• Dr. Andrew Park: I'm happy to weigh in as well. The other thing you're hearing from the panellists, particularly around dementia, is the importance of continuity of care, preventative care, and upfront relationships with longitudinal, comprehensive physicians and practitioners who know you in a team-based model. All of that was disrupted during COVID, so as a society, we lost a large opportunity to continue our relationships with patients. That may have exacerbated findings around patients slipping through the cracks early on when we shut down society. It's important to recognize that COVID acted like gasoline on the fire for many chronic conditions in our healthcare system. As you're hearing today, this is a real opportunity to highlight system deficiencies and talk about how we can bolster systems around primary care to rebuild those relationships, intervene early (for example, with MINT Memory Clinics), or refer to specialist colleagues. 

• Emily English: Thank you very much. I have a question directed to Dr. Tartaglia from Dilshan Burman, a reporter with CityNews: Are there any specific treatments or therapies being worked on that look promising? 

• Dr. Carmela Tartaglia: Yes, actually! There are three that have FDA approval, sharing a similar mechanism of action: they try to remove amyloid from the brain in Alzheimer's disease. In Alzheimer's, there are two bad proteins in the brain: amyloid and tau. We now have three agents approved by the FDA in the U.S. that can change the course of the illness. 

As you might have heard in the news, these aren't miracle cures. They aren't bringing you back to a pre-disease state or bringing back cells that are already gone, but there is evidence showing they can keep people in a milder stage of disease for maybe six months longer. When people are in the mild cognitive impairment range, they're not demented yet—they have a cognitive problem or change, but they are completely independent. When you become dependent on somebody else for activities you used to do on your own, that is when you enter the dementia stage. These medications can keep you in the mild cognitive impairment range for a longer period of time, and I think most of us would say that is a worthy goal. There are other mechanisms of action also being investigated, so our landscape is completely changing. We have every reason to be optimistic that disease-modifying treatments are coming to neurodegenerative diseases, just like they exist in cancer and other conditions.  

• Emily English: Thank you very much. We have a question from The Toronto Star reporter Maria Iqbal. I'll direct this one to OMA President Dr. Andrew Park: Can you elaborate on how unusual the 48% increase in patients with dementia since 2010 is, and how the number of patients is being measured in 2010 versus now? 

• Dr. Andrew Park: Thank you, Maria. This is OHIP billing data. We have to recognize a couple of things: while there's been a demonstrable increase in that billing data since 2010, it probably under-captures the number of patients who actually have dementia. As Dr. Tartaglia has said, this is a disease decades in the making. There are patients who are under-recognized by this crude measure, have yet to receive a diagnosis, or are being treated for a different condition while having underlying dementia. 

The purpose of highlighting this data is twofold: first, to show that numbers are on the rise as our population ages—affecting individuals, families, and society—and second, to open up the discussion about how we prepare for that future, what it looks like, and what foundational system supports we need to put in place to better support our aging population.  

• Emily English: Thank you very much. We have another question from Ananya Dougal with The Trillium. I'll direct this to Dr. Linda Lee: While the goal is keeping people living with dementia at home, for those who need to be in long-term care, do you think staff working in long-term care or retirement homes are adequately equipped to deal with dementia, including behavioural issues? Is more training needed specifically on dementia, and should that be mandated province-wide? 

• Dr. Linda Lee: I work in several long-term care facilities and help care for many people with advanced dementia. First, I will say that the people working in long-term care are doing the best they can. There are so many challenges associated with long-term care, and the staff are really trying their best. Having said that, while the goal is to help people stay in their own homes for as long as possible, as dementia advances, many will need to transition into the supports available in long-term care. 

Dementia doesn't affect everyone the same way; it's very individualized. That's why specialized training is needed to manage the effects of advancing dementia. I agree that more specialized training on individualized, person-centered approaches, medication optimization, and related strategies should be provided to help staff. If that could be mandated and supported by the province, that would be wonderful. 

• Dr. Alexandria Peele: I would just add to that—that type of training really needs to exist across the entire health system. Long-term care often sees people at a certain stage of dementia, but that person might have come through a hospital first (where staff might not have training on how to cope with the condition), or through home care before that, or interacted with police, paramedics, or primary care. A base level of competency in dementia care really needs to be spread throughout society and health disciplines in general. When we look at proposed dementia strategies, education across the board is strongly recommended. 

• Emily English: Thank you very much. We have another question for Dr. Tartaglia—a follow-up about new treatments from CityNews reporter Dilshan Burman: How far along are we in Canada in terms of approving these new treatments? 

• Dr. Carmela Tartaglia: There is at least one, and maybe two, currently under Health Canada review. A treatment can be accepted in other parts of the world, but at the end of the day, Health Canada has to approve it for use here. They are looking at the file and will decide whether there is enough evidence to show it is worthwhile for Canadians. The next step, if approved, will be figuring out how we pay for it. Our system is different from the U.S., so each province's funding bodies will do a separate review to see how these disease-modifying treatments can be covered. 

• Emily English: Thank you very much. I have a question for Dr. Linda Lee from Marjo Johne with the Medical Post: What can primary care providers do to improve early diagnosis of dementia? 

• Dr. Linda Lee: That is such an important question. First is awareness: people presenting with memory symptoms should not be dismissed. If patients or their loved ones are concerned about memory, take it seriously and begin investigations. There are cognitive tests that can be done, and in locations with MINT Memory Clinics, providers have access to multidisciplinary teams to take the next steps. The most important thing is awareness that many people experience early memory loss, and there's an opportunity to make a difference through early interventions, recognizing treatable conditions, and providing proactive care.   
• Emily English: Thank you very much, Dr. Lee. We have one more question directed to Dr. Tartaglia: Can you speak to the prevention of dementia? How can we increase awareness regarding what people can do now to avoid dementia later in life?   
• Dr. Carmela Tartaglia: That's a fantastic and super important question, because we have a lot of evidence that things you do throughout your life impact your risk of getting neurodegenerative diseases. There is evidence that aerobic exercise is good for your brain—not just because it increases circulation, but because it promotes new cells and connections in the brain lifelong. Lifelong learning is also essential; even after you retire, keep learning! The brain needs to keep making connections to build cognitive reserve. Even if you have underlying disease in the brain, cognitive reserve can delay onset and slow progression. 

Fundamentally, our brains dictate who we are. Just like we take care of our houses and cars, we have to take care of our brains and bodies throughout our lives—you only get one! (Sometimes people ask about brain transplants, but if we transplant your brain, you are no longer you!) 

There's a lot of evidence that prevention helps. As Dr. Lee and Dr. Peele said, you need to manage risk factors that make disease worse. Family doctors and health professionals should monitor blood pressure, cholesterol, blood sugar/diabetes, smoking cessation, and alcohol consumption (drinking more than two alcoholic beverages a week is bad for the brain). All of these are critical for brain health. 

• Emily English: Thank you very much. Another question from Andrew Pinsent with CFRA: As many people have struggled to keep or find a family doctor, where do those concerned about symptoms go? 

• Dr. Alexandria Peele: That's a very difficult question and something I see frequently in my practice. One option is reaching out to community organizations like the Alzheimer Society or Home and Community Care Support Services—these do not require a doctor's referral. Those organizations also have experience navigating pathways for people without a family doctor to connect them to specialist care. 

• Dr. Andrew Park: This is why we have been so aggressive in our campaign stating that every Ontarian needs a family doctor. Navigating the system without a family doctor is significantly more challenging and puts patients at a disadvantage, because they lack that primary "quarterback" for their care—especially when vulnerable with a disease like dementia. While patients can seek episodic care through walk-in clinics, virtual options, or government registry websites like Health Care Connect, with 2.3 million Ontarians currently without a family doctor, it poses a real challenge. That's why our push for universal access to primary care is so vital. 

Emily English: Thank you, Dr. Park. We are nearing the top of the hour, so I'd like to go around the virtual room for a final thought from each panellist. 

• Dr. Alexandria Peele: The OMA has assembled a panel of three physicians who are extremely passionate about this work. We've had wonderful questions today, and there's so much more to discuss. Please reach out to the OMA media team if you want more information or a focused discussion. Thank you everyone for your interest in this topic that is so close to our hearts. 

• Dr. Linda Lee: We have an opportunity to improve care. We can change the orientation from a reactive system to a proactive system by investing in primary care working in collaboration with specialist care and community care. Programs like MINT Memory Clinics give better care at lower cost; the time is now to invest in our system to help the growing number of older people affected by dementia. 

• Dr. Carmela Tartaglia: I'm happy to see such strong interest. The landscape in neurodegenerative diseases—especially Alzheimer's—has changed, and we need to keep up. People deserve a diagnosis for a degenerative disease just as they do for cancer or cardiac conditions. The brain can't be left behind anymore; it is the most important thing that dictates who you are. 

• Dr. Andrew Park: A sincere thank you to our panellists for their expertise and advocacy, and to the media for attending and asking thoughtful questions. A recording of this session will be available later this afternoon. Ontario's doctors want what's best for their patients, and we need to prepare for our aging population. In our Prescription for Ontario, we called for solutions to increase community capacity and ensure everyone has a family doctor so people can enjoy the best quality of life possible.