In the late winter of 2007, Blair Frost made his way from his small coastal hometown of Yarmouth, N.S., to Kingston. Frost, who had enlisted in the Canadian Armed Forces shortly after graduating high school, could not yet afford university tuition, but hoped for a life of service and fulfillment through the military.
A few months into basic training, Frost sustained an injury that would define the rest of his military career. The ligament connecting his kneecap to his shin became torn and strained. His knee grew inflamed, and the pain was agonizing.
The mindset of the military demands that recruits simply stick it out—so that’s what Frost did. Throughout basic training, Frost participated in kilometers-long marches, heavy physical labour, and demanding obedience drills, all with a kneecap that had swollen to the size of a baseball. He took anti-inflammatory pills every night to manage the injury on his own.
While he was stationed at the 21 Electronic Warfare Regiment in Kingston, the military denied Frost the treatment an orthopedic surgeon prescribed him, saying they could only offer reconstructive surgery if his knee ligaments were completely severed.
For nearly a decade longer, Frost found ways to put up with his injuries, even as the strain of being a soldier took its toll on his body. When he finally retired from the Armed Forces in 2020, he had spent 14 years in the military, and almost the entirety of his career battling multiple chronic injuries.
By the end, Frost said, the Armed Forces treated him like “a burden.”
The military tried to offer him re-education and training opportunities to help reintegrate him into civilian society, but Frost believes their biggest oversight was letting him go without a reliable healthcare provider.
With his injuries, Frost’s mobility is extremely limited, and so too are his job prospects. Combined with the complex mental health issues he developed from his time in the Armed Forces, he’s severely in need of a family doctor to look after his medical needs.
A province and a city wrestling with a primary care provider shortage simply can’t provide that kind of care. People like Frost who are searching for a family doctor have nowhere to turn.
“I have contacted every physician in town with no luck. Not even my wife’s family doctor is interested, although they said they would accept our yet unborn child,” Frost told The Journal.
“I was forced to allow a disability claim to lapse, ultimately foregoing additional disability income that could really help my family because I couldn’t find a doctor to fill in the paperwork. The local clinics won’t even do it.”
A service under strain
29,000 people in Kingston were without a local family doctor in 2020, making it southeastern Ontario’s hardest-hit region in the primary care provider shortage. A CBC News investigation conducted earlier this year found that only 19 per cent of the 125 family doctors in Kingston were accepting new patients, and only from select demographics. None were taking patients from the general public.
Dr. Veronica Legnini is a Kingston family physician who was born and raised in the city. She recalls a day when she had to turn away four separate people from her practice, simply because she could not accept more patients.
“When you don’t support the health care that family docs provide sufficiently, like growing patient loads or high demands, you’re going to see people in family medicine retire early or split their time between family medicine and other things that are better,” Dr. Legnini said to The Journal.
Team-based care, which Dr. Legnini claims is the most well-supported model for patients and doctors, could help alleviate the number and complexity of patients of whom family physicians are expected to take care of. The province didn’t provide the funding needed to sustain this kind of practice, leaving family doctors without the kind of support they might get in a hospital.
Although Kingston is supplied by a medical school and a tertiary care hospital, only a fraction of its physicians practice family medicine, which means the city is still not classified as a “high needs” community despite the demand for family doctors.
“Right now, family physicians deal with all sorts of issues that aren’t really in our wheelhouse, but we’ve grown to develop expertise [in] out of necessity,” Dr. Legnini said.
Today’s family doctors may find themselves taking on the roles of psychotherapists, podiatrists, marriage counsellors, or dieticians to deal with each patient’s health needs, which hinders their efficiency. Team-based care could relieve some of that stress.
Another factor putting pressure on Kingston’s family physicians is the overhead expenses associated with running a practice. New medical school graduates may be dissuaded by the costs of working in family medicine compared to more lucrative specialities, especially when they’re facing hundreds of thousands of dollars of debt from medical school.
“Medicine is medicine, but medicine is also a small business. [Family medicine] just becomes unattractive when you go into a business that doesn’t actually allow you to pay your bills and take home what is an acceptable amount,” Dr. Joy Hataley, a retired family physician and the District 7 chair for the Ontario Medical Association, told The Journal.
Still, family medicine remains a vital part of patient care because it’s what our healthcare system has been designed to work around, Dr. Hataley explained. A family doctor acts as the patient’s gateway to all other aspects of the healthcare system. Without access to a primary care provider, patients are forced to hop between virtual appointments, walk-in clinics, and emergency departments, disrupting a continuity of care that’s crucial to good medical decision-making.
“If you don’t have a family doc, you’ve kind of lost your key to the door. You’ve got to figure out another way—you’re going to have to get through the window, or down the chimney, or something else,” Dr. Hataley said.
For Queen’s students, many of whom come from out of town, living without access to a family doctor can be problematic for their health.
Kate Burke Pellizzari, ArtSci ’23, hasn’t had a check-up since her family doctor retired when she was 12 years old. Now at Queen’s, she’s struggling to find someone who can look after her health. Pellizzari has been on a waiting list to be connected to a family doctor for nearly three years and has contacted multiple clinics in and outside of Kingston, but to no avail.
In the meantime, she relies on Queen’s Student Wellness Services (SWS) and local walk-in clinics for healthcare, but she believes these resources are not adequately equipped to meet her needs. When Pellizzari developed keloids from her ear piercings, she went to see a doctor at SWS. He looked at her ear, told her he didn’t know what he was seeing, and sent her away with nothing.
“You can’t actually build a rapport with any of the physicians there because it’s always someone new, and they don’t know anything about your history,” she said to The Journal.
According to Cynthia Gibney, executive director of SWS, healthcare providers at SWS can request a confidential release of records from a student’s regular practitioner if they need information about their past illnesses.
“At Student Wellness Services (SWS), we have always encouraged students to continue the relationship they have with their home community family physician, as continuity of care and knowing medical history is important when responding to a new [sic] or ongoing medical issues,” Gibney wrote in a statement to The Journal.
Pellizzari recalls times she felt dismissed by healthcare providers working in local clinics or turned away because they thought she could be seeking drugs. The result, she worries, is people will struggle to find care until their health issues escalate into emergencies—but students without a family doctor are left with few other options.
Pellizzari is especially concerned about how her health needs will develop as she gets older. She’s approaching the age where she’ll need to get regular Pap smears and watch for the signs of breast and ovarian cancer. With a third of the family doctors in Kingston planning to retire within the next ten years, the city is scrambling to train and recruit more physicians not just to replace outgoing physicians, but also to take care of an aging population.
To Dr. Hataley, these changing demographics are just another factor putting strain on family physicians. Many family physicians are choosing to pursue other fields alongside traditional family medicine such as palliative care, a discipline needed more than ever as Ontarians grow older. While these other specialties are important, they leave fewer physicians with the capacity to deliver full-time primary care.
“There are many more people living longer with more complex illnesses now, and palliative care is engaged with the end stages of life that don’t just last for the last few weeks anymore, but years,” she said.
Drs. Hataley and Legnini believe the situation will get worse before it gets better, if the Ontario government remains as slow on the uptake as it is right now. Until then, they’ll continue to call for change.
Undervalued, underestimated
Jonathan Tung, HealthSci ’26, hasn’t had reliable access to a family doctor since he first moved to Kingston in 2013. His family doctor, who lives in Markham, is a two-and-a-half-hour drive away. Unless he experiences a health issue that would make the journey worth it, Tung typically waits until his yearly check-up to address any health issues he’s experiencing. In the meantime, he too relies on SWS and local walk-in clinics.
Like Pellizzari, Tung has been on a waiting list to find a local family doctor for years. He knows friends who’ve had to drive as far as Ottawa or Toronto to meet their family doctors. The first time his family tried to contact a family doctor in Kingston a few years ago, they were told the clinic couldn’t take on any more patients. Last year, they called again, only to find out the doctor was retiring. Tung expects his own family doctor to retire soon as well.
Provincial family doctor shortages are exacerbating local ones. Although Tung no longer lives near Markham, he can’t find a family doctor anywhere closer to him—an issue that’s become widespread across Ontario.
According to an analysis on the city’s physician shortage co-led by Dr. Legnini in 2020, many people who move away from Kingston also have trouble finding a physician elsewhere, and so choose to stay with their old family doctor here. As a result, many doctors are seeing patients who currently live in other areas, which prevents them from taking on more locals.
Tung’s difficulties accessing a family physician have inspired his career goals. Having spent nearly a decade in Kingston without a family doctor, he hopes to enter primary care and practice in the region to help address the same shortage he’s faced for so long.
“Being a family practitioner is more about the personal connection to patients. You get to witness the growth of a person because you’re most likely going to be their family doctor for 10 to 20 years,” Tung said to The Journal.
These longitudinal relationships are precisely what make a family physician so valuable, according to Dr. Hataley. A family doctor gets to see their patients in both sickness and in health, which allows them to sense if something is wrong and intervene early on. Convincing the government to appreciate this kind of care is crucial to ensuring family doctors get the support they deserve, she believes, especially when preventative care could save the province billions in the long run.
Dr. Anthony Sanfilippo is the associate dean of undergraduate medical education at Queen’s, and the senior advisor on educational innovation and expansion. Although he’s a cardiologist by training, Dr. Sanfilippo is determined to address the family doctor shortage in Kingston by enhancing medical training at the University.
While the causes of the shortage are complex, he believes the proliferation of new specialties in medicine have crowded out the traditional kind of family medicine that’s sorely needed today. A generation ago, all medical students would have been trained to become a general practitioner, but their options after graduation have multiplied since then.
“Today, students come into medical school and they do the same four-year program. At the end of that program, they have to choose from one of 30 residency positions to go on and do their further training, and then those 30 positions diversify further into over 100 different kinds of doctors. Family medicine remains only one of those choices,” Dr. Sanfilippo said in an interview with The Journal.
Dr. Sanfilippo is a part of a team at Queen’s developing a six-year special curriculum for prospective family doctors. The University is planning to expand their medical admissions by 20 seats in 2023 for students who’ve shown a dedicated interest in family medicine and plan to practice in communities in need.
While this new program will help meet short-term local primary care demands, Dr. Sanfilippo says simply training more family doctors is unlikely to address the most significant issues leading to this shortage. Rather, there are bigger dilemmas with who is selected to enter medical school, what beliefs and assumptions they hold, how young doctors are trained, and the way healthcare in Ontario has evolved.
The solution doesn’t lie in just offering doctors more incentives to practice in high need communities either, according to Dr. Hataley, who believes this will only move the shortage from one place to another. More systemic changes are needed—changes that will guarantee every Ontarian a family doctor and a team to support them.
Earlier this year, Dr. Hataley became a proponent of the Life Without a Doctor campaign, which has been lobbying the provincial government to give family doctors more time to see patients, promote team-based care, and recruit more physicians to the province, with the ultimate goal of connecting every Ontarian to a family doctor.
Dr. Hataley knows that a better future is within reach, which is why she’s become so outspoken about the importance of primary care.
“The government, the public, needs to really highlight the value of long-term family physician relationships with patients. If you don’t value something, nobody’s going to be interested in it, nobody’s going to want to go into it, and it’s not going to be adequately covered.”
Stemming the pain
Frost, who still lives in Kingston, is currently studying to become a computer programmer. Although his future looks a little brighter thanks to the work opportunities on his horizon and the self-management strategies he’s developed to cope with his injury, he still can’t find a family doctor, and he still can’t access disability income.
He worries about being able to play or spend time with his first child, who he’s expecting in a few months, and the fact he can’t take part in the sports he loves anymore because of his injuries. All throughout, he’s reminded of the way the military denied him treatment, labelled injured soldiers as weak, and released him back into civilian society without any medical support.
“It’s good to prepare me on how to write resumes and re-educating me, but I’m still very sick, both physically and mentally. That is the piece that is so desperately missing from Veterans Affairs Canada’s offerings,” Frost said.
Frost sometimes finds himself feeling pessimistic about the future of Ontario’s medical system, but he doesn’t think the battle is over quite yet. As providers sound the alarm over the province’s public healthcare system, he hopes doctors and patients alike will be able to harness their power to demand reform.
Until then, he—like so many other Ontarians—will have to find a way to manage the pain on his own.
Tags
doctors, Healthcare, Kingston, military, Student Wellness Services
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