Bringing the winds of change to Toronto’s primary care ‘desert:’ Humber River Hospital joins DFCM as their newest teaching hospital site

For some Torontonians, the most notable thing about the northwest region of the city is Yorkdale Mall, a 2-million square foot shopping centre that is home to an exclusive lineup of luxury brands and boasts itself as “Toronto’s ultimate shopping destination.” Yorkdale attracts both local and international visitors to Toronto’s northwest and even has a subway station named after it.

But don’t let the extravagance fool you—the same neighbourhoods that house one of Canada’s largest collections of designer brands also houses some of the city’s most socially and economically disadvantaged populations. Over the years, the residents of Toronto’s northwest neighbourhoods have been identified by several reports from Public Health Ontario and the City of Toronto as some of the most impoverished and materially deprived neighbourhoods in the city. These regions also have an aging population with a higher proportion of racialized groups, greater housing density, as well as some of highest rates of crime and lowest rates of post-secondary education completion.

These intersecting inequities have a compounding effect on health. Studies have shown that social and economic factors—also known as the social determinants of health—account for anywhere between 80 to 90 per cent of health outcomes. Health is about more than just access to health care services; the environment and circumstances in which we are born, live and work greatly impact our health and wellbeing. Family physicians can look to their own practices to see clear evidence of this.

“Throughout my practice in the Jane and Finch neighbourhood I have witnessed how social determinants of health impact patient care. It is a challenge for some patients to afford medication, physiotherapy, or even take time off work for specialists’ appointments,” says Dr. Ryan Banach, a family physician practicing in Toronto’s northwest and the Family Medicine Health Human Resources Lead in the Office of Health System Partnership at the University of Toronto Department of Family and Community Medicine (DFCM).

Given that Toronto’s northwest communities face some of the most inequitable outcomes in the city, it comes as no surprise that they were also among the hardest hit by COVID-19. At the start of the pandemic, the rate of COVID-19 was more than 10 times higher in these neighbourhoods than in the least-affected Toronto neighbourhoods.  Moreover, despite being disproportionately affected by the pandemic, vaccine rollout in these neighbourhoods was much slower than other areas of the city.

On top of this, Toronto’s northwest has also been described as a primary care desert: there is clearly a great need for primary care in the region, but there are a low number of primary care physicians available to address those needs. Dr. Banach notes this may be due to a rising share of family physicians who are now retiring or near-retirement age.

“I have noticed recently that more physicians in our area are retiring, leaving many patients looking for new family physicians. Most of the family physicians I know in my area have been practicing for 30 to 40 years and are generally older physicians,” he says.

“There isn’t a lot of interest from new family physicians to move into this community,” says Dr. Art Kushner, Chief of the Department of Family and Community Medicine at Humber River Hospital (HRH), one of the hospitals serving the northwest communities of Toronto. “And as family physicians retire, attachment rates will decrease.”

Only between 11 and 25 per cent of the patient population in the area are attached to a family doctor or family health team. Between low attachment rates, low supply of incoming physicians and retiring physicians, patients in the area are now finding themselves struggling to access comprehensive primary care.

To address what is quickly becoming a dire situation in primary care in the area, HRH recently joined DFCM as their newest teaching hospital site. The hope is that incoming residents would become a continuous source of new doctors for Toronto’s northwest communities.

“Studies have shown that physicians are more likely to set up their practice in the communities they were educated and trained in. Since they become familiar with the community, the patients, the hospital and the specialists, it’s more comfortable for them to set up practice there after they graduate,” says Sudha Kutty, Vice-President of Strategy and External Relations at HRH.

Humber River Hospital will welcome the first cohort of family medicine residents at their Wilson site in July 2023. Residents can expect to learn from award-winning physicians and experience working in a diverse community—both in their needs and their makeup, says Upasana Saha, Director of Integrated Health Systems and Partnership at HRH.

“This is clearly an equity-deserving population, but that’s not all there is to it. Beyond that is a vibrant community that comes alive through its diversity, and there are a lot of great opportunities for residents to get exposure to many different patient populations and learn how they can serve them better,” says Saha.

Residents can also expect to work with leading edge technologies. Humber River Hospital prides itself on being North America’s first digital hospital and are consistently at the forefront of innovation. For example, their department of surgery makes use of robotics, which have allowed them to treat more patients in less time with better outcomes. Additionally, their state-of-the-art command centre allows for real-time analytics and tracking of patient care. Residents will have the opportunity to learn and practice with these technologies during their rotations.

Innovation is embedded in HRH’s mindset, and they are hopeful that incoming residents will embrace this culture of innovation and bring a wind of change to the primary care desert of Toronto’s northwest communities.

“Our communities need residents and their support,” says Kutty. “So we’re hoping that incoming residents will take an active role in helping us shape the future of family medicine education and primary care at Humber River.”