World Family Doctor Day

Breaking down barriers to health care for newcomers

Across Ontario, 2.2 million people are without a family doctor – of those, approximately 500,000 are newcomers. It’s one reason why Dr. Doug Gruner is devoted to providing their health care. Aside from his regular family medicine clinic, Dr. Gruner spends one-two days every week at the Ottawa Newcomer Health Centre.

His interest began in 1999 when helping those affected by violence in East Timor. “It was the power of the resiliency of that population, especially the children, that inspired me to work with refugees,” he says.

Today, the Ottawa-based physician continues to ensure newcomers get the care needed and to break down barriers to access: “We’re finding many refugees are falling through the cracks.”

It’s rewarding work. When a teen from Sub-Saharan Africa with shortness of breath and fatigue came to him, tests determined she had a hole in her heart. “We were able to advocate on behalf of our patient to ensure she saw a cardiologist,” explains Dr. Gruner. “She is going to get the intervention needed to resolve this problem. At the end of the day, there’s a happy outcome.”

He’s also an advocate of improving resources for newcomers, including language interpretive services, the creation of family health teams and better tools for health care providers.

“Success is really not possible unless they have proper health care and access to it,” he says. “We need the necessary supports in place.”

Encouraging physician leadership amid health care reform

For over 20 years, Dr. Kim McIntosh has taken care of Ontario patients—something she views as a privilege. It has allowed her to use her comprehensive skills in primary care, in-patient medicine, emergency medicine, obstetrics and teaching. Currently, she serves as a comprehensive care family physician and lead physician with the Couchiching Ontario Health Team (COHT) in Orillia.

“Working in family medicine is an amazing job,” she says. “It doesn’t get nearly the credit it deserves. And I just really want to highlight. I love my job.” Part of the appeal for Dr. McIntosh is caring for people of all stages of life, helping them manage different diseases and playing a role in preventative health. She’s keen to share her passion with medical students and encourage them to pursue careers in family medicine.

“It can sound overwhelming,” she says, “but I would tell them not to sell themselves short.”

Dr. McIntosh believes that family medicine is a career for those who want to have an impact. Her encouragement directed toward medical students is part of her belief that family physicians are, and should be, leading health care reform in Ontario since they have the full skill set.

Dr. McIntosh is also dedicated to “layering the linkages,” family physicians partnering with various stakeholders, from pharmacists to paramedics, to ensure that everyone across Ontario, especially those who are part of under-served communities have access to a quality patient experience. It’s just one element of her devotion to lifelong learning.

Urgent care gives patients access to family physicians

Working in urgent care centres has played a crucial role for Dr. Naveed Mohammad since 2001. In the last 14 months, it has become a primary focus as he serves communities in northwest Toronto. The shift recognizes that, even patients with primary care physicians may not be able to see them in a timely manner. Serious system-wide inefficiencies are taking up too much time – time that should be spent with patients. Urgent care can sometimes help fill this gap and opens a different avenue for family physicians to provide primary care.

Over the course of his career, Dr. Mohammad has served in a variety of roles, from family physician and emergency medicine provider to advisor to the Ministry of Health. He’s a vocal advocate for shaping urgent care policies and tackling current issues in emergency medicine.

“These are all experiences parallel to my clinical practice and my leadership work,” he says. “They gave me a very broad knowledge base about the pressure points in our healthcare system, which is my passion now.”

He understands there’s a shortage of family doctors but is devoted to ensuring care is accessible and timely for patients. They are at the core of Dr. Mohammad’s efforts. “Even though I may have had one individual encounter with a patient, they will often remember how I helped them years later,” he says. “As physicians, it’s important to remember that we do make an impact on our patients and to use that as a lightning rod to continue our work.”

Promoting health equity for all

Being born and raised in the community has proven to be invaluable to Dr. Latif Murji, a University of Toronto graduate who works for the Scarborough Health Network and its VaxFacts Clinic as the lead physician. He has seen firsthand how social factors impacted his life and the lives of his fellow citizens. Whether he is doing locums in remote, rural and Indigenous communities or caring for patients in his hometown (where about 93,000 residents are without a family doctor), he’s dedicated to ensuring health equity for all.

As the pandemic raged locally in 2021, it exposed vulnerabilities in an area with multi-generational households and a significant lower-income and racialized population. The introduction of VaxFacts gave the community a chance to speak to a physician in a confidential, judgement-free space. Community health ambassadors engaged residents everywhere, from mosques to malls. VaxFacts’ success inspired roll out in Toronto, then province wide.

“We were able to build trust in the community,” explains Dr. Murji. “It not only served for that interaction, i.e. COVID vaccines, but also helped with further health care interactions that will ultimately promote better outcomes for patients.”

VaxFacts Clinic also presented an ideal opportunity to learn. The big takeaway for him was the effectiveness of a community-first approach and being able to engage with marginalized communities.

Practicing family medicine in a Northern setting

Dr. Anjali Oberai has travelled widely in her career—medical school in Ottawa, residency in Calgary and locums across the country—but she chose to work and to live in Wawa, Ontario.

Practicing family medicine in often underserved rural, northern settings has challenges and rewards. “It is a little different than being a family doc in southern Ontario,” she says. “You have to be more nimble because things can change quickly and you’re working with fewer resources.”

It may mean transporting patients several hundred kilometers to receive a higher level of care and confronting potential weather issues. For Dr. Oberai, it could require managing those who are quite sick and not able to be transferred. “We’re often working outside of our comfort zone,” she notes.

The joys of a Northern setting include forging strong relationships with her patients inside and outside the healthcare system. “We see our patients through the whole healthcare journey,” she explains. “In the clinic, then in the emergency department…. And we could be the ones admitting them, following them as in-patients and then checking on them post-release.”

And like the mentors she had when she moved to the area over 25 years ago, Dr. Oberai aims to be a good role model for both her community and supportive colleagues, who have mastered an “all-hands-on-deck approach to medicine.”

Research-driven solutions to the family physician crisis

Ontario is facing a critical shortage of family physicians and Dr. Kamila Premji is focused on how to address the issue through her research. She practices family medicine in Ottawa and is currently a clinician scholar with the department of family medicine at the University of Ottawa and a candidate for Western University’s Master of Clinical Science (PhD).

Research has shown access to primary care is the foundation to healthcare. “It results in better health outcomes for patients, better health equity and lower costs for healthcare systems,” she says. “We also know that Canada, including Ontario, has often struggled to ensure adequate access. I’m interested in research that might help improve it.”

For her, the research underscores how important continuity of care is to a physician’s daily practice. “Seeing the same family doctor or team for the majority of your care results in better health for patients, lower costs and even reduced mortality rates.” This affected her choice of practice setting, opting for one that always provides patients with urgent and non-urgent primary care from a group of family physicians.

Her current research projects the impending retirement of family physicians and suggests ways to remedy the worsening shortfall it will cause. “Innovative solutions are needed,” says Dr. Premji. That may mean expansion of team-based care and easing the administrative burden faced by practitioners.

Ensuring better health care for rural families

Durham is a small but growing town in southwest Ontario. In recent years, city dwellers have been moving to the community. The challenge for many has been finding a family physician. For the last seven and a half years, Dr. Bikramjit Rai has been helping meet the critical need.

Though he had spent his early career in cities (attending school in London and completing his residency in Toronto), he has found working in a rural setting to be rewarding. “I enjoy the small-town atmosphere,” he says. “It’s a reprieve from day-to-day life in the city and I have an opportunity to do a variety of work that may not always be available in an urban environment.”

There’s also a chance to make meaningful connections through the different settings in which Dr. Rai provides care. These include private practice, an inpatient unit, a long-term care home and a hospital emergency department. Dr. Rai recalls riding in an ambulance with a local man in his 60s who had experienced a myocardial infarction and needed to be transported to Kitchener. Being there for the sickest patients is a source of pride for Dr. Rai, along with helping prevent reoccurrence of disease by encouraging patients to adopt healthy behaviours.

He is focused on improving health care in rural communities, recognizing the doctor shortage is more difficult for them. “The issues are compounded since there aren’t walk-in clinics and many patients don’t have family physicians. They end up in emergency departments in small towns – not ideal because there’s no continuity of care.”

Promoting mental health for patients and physicians alike

Dr. Noam Raiter may be just starting her career but she’s already making an impact. After graduating from McMaster in 2022, she began her first year of family medicine residency at University of Toronto. She’s also a content creator, using social media to share her journey. Her posts aim to humanize her experiences as a medical student and now as a resident physician to promote the importance of practicing self-care and maintaining individuality.

While studying medicine, she noticed the negative toll it took on herself and her peers. She realized difficult discussions about mental health needed to happen. Her social media posts have helped get people talking. “It’s been a joy to do this through a creative medium,” says Dr. Raiter. “I enjoy having something outside of my traditional career to [put] my energy into.”

Making a difference also inspired her to choose family medicine when interest in it among medical students has been declining. “I realized while doing my rotations in medical school I was able to have and observe the most profound impact on patients’ lives.”

As she moves forward, she’ll continue to focus on mental health and preventative/lifestyle medicine from a holistic perspective — and not just to benefit her patients but colleagues, too.

Follow Noam’s journey on TikTok.

Advocating for solutions to address pressing community issues

Many family physicians are accustomed to wearing multiple hats. For Dr. Matthew Schurter, a graduate of Queen’s University, his duties include working at the Sunderland Medical Centre, a satellite centre for the Medical Associates of Port Perry and serving as an anesthesiologist at area hospitals. He also offers palliative and end-of-life care and is actively taking steps to address Ontario’s opioid crisis.

Many patients have inspired Dr. Schurter throughout his career, but there’s one that stands out for him– a one-year-old girl who overdosed after being exposed to opioids. (Thankfully, she was resuscitated) “She motivated me to do more in our community around the dangers of opioids,” says Dr. Schurter.

In response, he created educational tools to increase awareness and to destigmatize addiction and overdose. He has done community outreach at a local high school and recently helped develop short videos (see letstalkaboutopioids.ca) covering topics like harm reduction and how to get help. He’s now conducting research into the effectiveness of such programs with Ontario Tech University in Oshawa.

“It’s satisfying to feel like I’m trying to make a difference in this large crisis,” he says. “It’s important to include advocacy as part of our role as family physicians. We know patients in the community and the issues that affect them. When possible, we should advocate for awareness and solutions to problems.”

For Dr. Schurter, it’s complex patients (and families) like this little girl that he needs to be able to spend more time with.

Patient care through all stages of life

Moving from a large city to a small one can be a challenge for some physicians making the switch. For Dr. Vid Singh, a family doctor with 20 years of experience who practices in the Sarnia area, it didn’t talk long before he felt content. “It grew on me,” he says. “It’s an attractive region because of the environment and the lake. It’s beautiful.”

He also finds working there satisfying, thanks to Bluewater Health, a local hospital that provides excellent quality of care, a tight-knit network of colleagues and patients across the spectrum, from newborns to the elderly. In a small community, Dr. Singh can look after patients and multigenerational families throughout all stages of their lives, and really, truly build relationships that result in better care.

That also gives him a chance to work with patients to avoid chronic conditions earlier in life by helping them set and meet their health goals. “It’s always nice to be able to prevent those types of diseases,” he says. “They can be prevented very easily with lifestyle changes.”

Post-COVID, he found diabetes patients were struggling. By getting them back on track with diet and exercise, he saw positive changes. “Some did remarkably well,” notes Dr. Singh. “The best satisfaction is being able to see a patient improve and make that effort. When they see improvement, they’re more likely to follow through and change their lives accordingly.”