How is health care functioning in Ontario now? What the data say about wait times, doctor shortages and emergency rooms

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When family physician Kamila Premji delivered an academic talk recently on primary care in Ontario, she started her slide deck with an ominous, but apt, photo of a tornado gathering speed in the distance.

Her presentation contained new analyses from INSPIRE-PHC, the research group behind the estimate that 2.5 million Ontarians don’t have a family doctor, a figure cited frequently by Liberal, NDP and Green candidates gunning to defeat Doug Ford’s Progressive Conservatives in the Feb. 27 provincial election.

Dr. Premji, a University of Ottawa professor who practises family medicine in the national capital, said the group’s latest findings smacked of more trouble ahead. The share of Ontario physicians trained as family doctors who practise comprehensive, office-based primary care is declining, while the proportion of Ontario patients being cared for by a doctor on the brink of retirement is growing.

Family doctors who are 65 and older made up 15.2 per cent of Ontario’s family physician work force in 2022, up from 13.9 per cent in 2019 and 10 per cent in 2008.

“We’re seeing that older family doctors seem to be hanging on longer than we would expect,” Dr. Premji said in an interview. “That also means that we have more patients, both in number and proportions, who are attached to family physicians who may retire any day now.”

The new figures, which are slated to be published in the journal Canadian Family Physician later this year, underscore the health care challenges that await whichever party forms the next Ontario government. The three major parties are promising to spend billions of dollars to ensure every Ontarian has a primary care provider, including the poll-leading PCs, who unveiled their primary care plan two days before triggering a snap campaign that has focused mainly on fighting U.S. President Donald Trump and his tariffs.

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There are no quick solutions to a primary care crisis that grew worse during Mr. Ford’s tenure but which began before his party took power, said Michael Green, dean of the Northern Ontario School of Medicine and a past president of the College of Family Physicians of Canada.

“It’s easy to blame today’s government for today’s problem,” he said, “but the reality is this is multiple governments over multiple mandates.”

The same is true of other metrics of health system performance in Ontario. Still, the Ford government had 6½ years to make a difference. Here’s what some of the data say about their record.

The primary care crisis

There’s no mystery as to why Health Minister Sylvia Jones unfurled $1.4-billion in new spending on primary care on Jan. 27, just before the writs were issued. Ontario’s shortage of family doctors providing traditional cradle-to-grave care is a major vulnerability for the PCs in the view of the NDP and the Liberals, who have promised $4.05-billion and $3.1-billion, respectively, to get every Ontarian a family doctor over the next four years.

The number of Ontarians without a family doctor rose to an estimated 2.52 million, or 16 per cent of the population, in 2023, up from 1.8 million, or 12 per cent, in 2020, according to INSPIRE, which anchors its estimates in anonymized Ontario Health Insurance Plan billing data.

The Progressive Conservatives dispute those figures, pointing out that they exclude patients enrolled in some team-based care models. They like to cite Statistics Canada survey data shared by the Canadian Institute for Health Information, or CIHI, that suggest 12 per cent of Ontario adults did not have access to a regular health care provider as of 2023, the best performance of any province or territory.

Dr. Green, who is also the co-leader of INSPIRE, said that whatever the precise number of unattached patients is, the province has a big hole to climb out of. “We’re graduating [family doctors] basically at a replacement rate,” he said. “So, whether they’re aiming for attaching two million or two and a half million, it’s a huge job.”

The PCs say they’re making progress, with $400-million committed before the pre-election announcement to expanding primary care, the pending opening of new medical schools in Brampton and Vaughan, and the appointment of former federal health minister Jane Philpott to lead a primary care action team.

But both Marit Stiles, Ontario NDP Leader, and Bonnie Crombie, Ontario Liberal Leader, deride those actions as a day late – Dr. Philpott just started Dec.1 – and many dollars short. “They gave more money to redevelop Ontario Place to a foreign company than they’re actually investing in health care,” Ms. Crombie said in an interview.

Emergency departments and “broom closet” medicine

Michael Herman, an Ottawa emergency physician, remembers well the marquee promise of Mr. Ford’s first campaign in 2018. “They came to power with the claim of ending hallway medicine,” he said. “Well, given our volumes right now, we’re looking to end broom closet medicine.”

Hannah Jensen, a spokeswoman for the Ontario PC Party, said recent figures on the number of patients treated in unconventional spaces such as break rooms, auditoriums and hallways, wouldn’t be released without a Freedom of Information request. But The Trillium, a news site that covers the Ontario Legislature, obtained data via an FOI request that showed an average of nearly 2,000 patients a day were being treated in unconventional spaces in Ontario hospitals in January, 2024 – the most since tracking began in July, 2017.

Still, Anthony Dale, the president of the Ontario Hospital Association, said “the situation today would be far worse than it is” if the Ford government hadn’t added 3,500 hospital beds across the province since 2018. The PCs say they’re in the midst of adding another 3,000 as part of more than 50 hospital projects.

Ontario hospitals are “holding their own,” Mr. Dale added, in the face of a massive, immigration-driven increase in the population and a rising tide of older patients with major illnesses.

But that doesn’t mean staff and patients aren’t feeling the strain, particularly in emergency departments. At the beginning of 2024, only one in 10 Ontario hospitals met the provincial target waiting time of eight hours for ER patients requiring admission, compared with 25 per cent before the pandemic, according to data The Globe and Mail obtained through an FOI request.

Waiting for scans and surgeries

CIHI data on wait times in Ontario for five priority procedures – cataract surgery, hip replacement, knee replacement, hip fracture repair and radiation therapy for cancer – are a mixed bag since the PCs were elected.

Knee replacements are a quintessential example. In 2023, the most recent year for which CIHI has published data, 76 per cent were completed within the benchmark waiting time of six months, significantly better than the Canadian average of 59 per cent, but slightly worse than prepandemic rates in Ontario. Median waiting times were shorter than during the worst years of pandemic-induced disruption, but not as short as they were before COVID struck.

Cataracts are another story. In 2023, 65 per cent of cataract surgeries in Ontario met the wait time benchmark, worse than the national average of 70 per cent. Again, median waits were shorter than in the peak COVID years, but not as short as in the pre-COVID years.

The CIHI data aren’t recent enough to capture any effects of the PCs’ plans to offer more publicly funded surgeries, endoscopy procedures and diagnostic scans in private, for-profit clinics. Mr. Ford announced his intentions in January of 2023.

However, Ms. Jensen, party spokeswoman, said that 32,000 people got OHIP-covered cataract surgeries at what the PCs call community surgical and diagnostic centres last year, nearly half at new centres. The call for applications to perform hip and knee surgeries in private clinics has not gone out yet, she said.

-With files from Yang Sun