“Primary health care is key to maintaining and improving Canadians’ health, and to the quality and sustainability of the health care system.”
~ Health Canada
Canadian older adults are often faced with the challenge of negotiating a complex health care system. Primary health care (PHC) services are usually provided through a nurse practitioner, general practitioner or family doctor. According to the Canadian Institute for Health Information PHC is an important source of chronic disease prevention and management and typically involves:
– Routine care
– Care for urgent but minor or common health problems
– Mental health care
– Maternity and child care
– Psychosocial services
– Liaison with home care
– Health promotion and disease prevention
– Nutrition counselling
– End-of-life care
A report entitled ‘Health Care Canada, 2011: A Focus on Seniors and Aging’ by the Canadian Institute for Health Information reports that “family physicians are the most common point of first contact for primary health care services”. In 2011, 95% of older adults 65+ had a family physician compared with 83% of individuals under age 65. However, this leaves approximately 220,000 older adults without a family physician.
The Canadian Geriatrics Society (CGS) points out that most physicians are qualified to care for older adults but specialists in geriatric medicine, geriatric psychiatry and family physicians who have completed the Care of the Elderly Certificate Course, have additional training specifically designed for the care of older adults. According to the CGS, research shows the benefits of specialized geriatric care to be the following:
– Increased patient, family and staff satisfaction
– Decreased length of stay in hospital
– Decreased healthcare utilization
– Decreased rates of depression
– Improved survival
– Improvements in patient function
Unfortunately, the CGS reports that there is “currently a shortage of physicians with additional training in the care of older persons in Canada and this is expected to worsen in the very near future”.
According to the Healthy Debate, “in 2012, there were 242 geriatricians, 128 family physicians with Care of the Elderly certification and 34 additional physicians with other training practicing consultative geriatric medicine. All in all, there are approximately 325 full-time equivalent physicians working in the field of geriatric medicine in Canada”. With nearly 5 million individuals age 65+ in Canada that works out to 1 geriatric specialist per 15,385 older adults.
How did this happen? There appear to be 3 main reasons:
- The medical schools in Canada do not effectively promote and expose medical students to the field of gerontology. For example, the Healthy Debate reports that only “7 of 16 Canadian medical schools had a mandatory clinical rotation in geriatric medicine”.
- A University of Toronto Magazine article entitled, Care for the Aged, quoted Geriatric Physician Barry Goldlist as saying, “In Canada, you can make more money in fields of medicine that, unlike geriatrics, don’t require any additional training. Or, you can enter a field that requires the same amount of training – nephrology, for example – and make more money”.
- Often there are negative perceptions surrounding the care older adults. Dr. Nathan Stall, a resident at the University of Toronto who plans on specializing in geriatrics, explains that, “I get comments all the time, like, ‘why would you want to do that, you’re too smart to do that. Why are you choosing this field’?” On the other hand, Dr. Camilla Wong, a geriatrician at St. Michael’s Hospital believes that, “geriatricians are among the most happy and satisfied physicians but really it’s because they really want to do it”.
The Centre for Elder Research, in partnership with CARP and Amgen Canada, is interested in exploring ways that the health care system could be made easier for patients to navigate, especially when trying to access specific supports or services. The partnership has put together an online Patient Navigation Choicebook and we invite you to share your thoughts about patient navigation.