The primary care pivot: Inside why FPs are fleeing comprehensive practice but staying in medicine

When Dr. Ferrukh Faruqui left a comprehensive family practice in 2021, she was “very, very burned out,” she says. She wrote about why she left family practice in the Toronto Star and the Globe and Mail. But she decided to stay in medicine, opting to work in an urgent care clinic in Ottawa, where she feels she’s making a difference.She is not alone.One in five Canadian family doctors is planning to stop seeing patients regularly, according to a 2025 survey conducted for the US-based Commonwealth Fund in 10 industrialized countries. In Canada, the survey is conducted through the Canadian Institute for Health Information (CIHI).While most of those 65 and over leaving regular patient care are planning to retire, 13% of younger physicians are also planning to stop seeing patients regularly, the survey found. Of the smaller group, 58% plan to continue working in another role. Those planning to continue working tended to be urban and younger, and 65% reported at least one symptom of burnout.Other CIHI data show that about 30% of family doctors are practising outside of primary care, either in other fields such as emergency medicine or in focused practices such as sports or cosmetic medicine, said Sean Chen, manager of health system analytics at CIHI.In 2025 only 67.5% of Canadian practising family doctors three years post-residency were providing—or intending to provide—comprehensive care to a group of patients over the long term, according to the Family Medicine Longitudinal Survey conducted by the College of Family Physicians of Canada. That’s the lowest level in the past 8 years.As CIHI found, many want to stay in medicine and are going to a wide variety of other types of practice.For a study into why family doctors leave comprehensive care, Dr. Wei-Hsi Pang interviewed a small group of Ontario family doctors. Those staying in medicine had moved to urgent care, emergency medicine, clinics specializing in certain diseases, inner-city practice for vulnerable people, palliative care, student health, long-term care and psychotherapy.Keeping doctors in family practice is increasingly critical, as 5.7 million Canadians lack a regular healthcare provider and the ratio of family physicians per population declined in the last five years, according to CIHI. But Dr. Pang, a professor of family medicine at Queen’s University’s site in Bowmanville-Oshawa-Lakeridge, Ontario, says there is a lack of data on why they’re leaving and how to keep them in family practice.The bottom lineThere are many factors affecting the decision to leave family practice. But for respondents in Dr. Pang’s study, “far and away, the top (issue) was remuneration.”With increasing clinic costs and remaining student debt, some FPs struggle financially.CIHI has noted the shift in recent years from fee-for-service (FFS) models to alternate payment plans (APP), including salary, sessional, capitation and block funding. In 2023/24, almost 80% of family physicians in Canada were paid through a blend of FFS and APP, whereas 16.5% are paid only FFS and less than 4% are paid through APP only.“The provincial governments heard the voice from family doctors,” Chen said. “They cannot cover the costs in their clinics.” Some family doctors said their pay was lower than for many professionals.Governments want to “improve the payment models to improve the incentives to family doctors,” Chen said. “The new models can better support comprehensive continuous care and management of complex patients.”But the transition has created a confusing landscape, where the payment structure and physician income can vary from one jurisdiction to another. They can even vary from one practice to another in the case of Ontario, where almost all practices have a blended payment model but the models differ, Dr. Pang pointed out.Dr. Faruqui found the blended payment system for family health organizations in Ontario difficult to follow. Some services she could bill for, others she could “shadow bill” at a percentage and yet others were covered in an overall payment. She felt that capitation payments per rostered patient were low. The urgent care clinic where she works now has a different model.Quality of working lifeDoctors also describe an increasing administrative burden, workload and stress in family practice, ultimately leading to burnout.The administrative burden for family doctors keeps increasing, Dr. Faruqui found. When she left family practice, she was working part-time but doing more paperwork than she had in previous full-time practice. She feels that the higher volume of tests is part of the burden.Automation accounts for another part. It may solve some problems for administration but create others, Dr. Pang said. He said family doctors have become “data-entry clerks.” Because many computerized systems require the doctor to login for security and privacy reasons, clinicians cannot delegate administrative tasks to office staff as they did in the pre-computer age. Respondents in his study found that many electronic medical record (EMR) systems were “chunky, clicky”—not user-friendly.Added to this are multiple referral systems that not only may be difficult to use but also require the family doctor to run more tests and complete more checklists.Chen says that some incentives in payment plans come with strings attached. For example, doctors said that payments based on their hours in clinic meant completing time sheets on top of their other tasks.Chen says the administrative burden adds to the heavy workload FPs are reporting. In Dr. Pang’s study, they mention completing paperwork during their off-hours.Dr. Faruqui says that keeping up with email or messaging can become overwhelming. Her last comprehensive practice had a patient portal where patients could communicate with their physician 24/7. Some expected answers within hours.She and respondents to Dr. Pang’s study say patients have increasing expectations, especially for the doctor to be available. Taking a well-earned vacation means finding someone to monitor the in-box while the doctor is away, Dr. Faruqui said.This leads to a feeling of always being “on.”At the same time, patients’ medical problems are becoming more complex, as they live longer and survive serious illnesses such as cancer and heart disease, says Dr. Faruqui. Patients experience an increase in mental distress because of lack of family cohesiveness, social media and other factors. The explosion of new drugs is difficult to keep up with.The risk for physicians is burnout.When Dr. Faruqui left family practice, “I knew I wasn’t functioning the way I should be functioning. Nobody likes to feel like that. Especially as a doctor, you want to be at the top of your game so that you can look after your patients.”She says functioning well as a family doctor comes down to respect—from patients, from other professionals in the healthcare team for doctors’ training and skill, and from governments in providing remuneration.

The primary care pivot: Inside why FPs are fleeing comprehensive practice but staying in medicine

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