Training spots limited, patient-doctor connection tool outdated, recruitment fragmented, Shelley Spence finds
EDITOR’S NOTE: This article originally appeared on The Trillium, a Village Media website devoted exclusively to covering provincial politics at Queen’s Park.
From training new doctors to connecting them with patients, the Ontario government’s lack of planning has cost the province badly needed primary care resources, the auditor general reports.
For instance, despite the Ford government’s push to graduate more family doctors, it has not adequately planned for the development of training sites, auditor Shelley Spence wrote in her 2025 annual report.
Because of the lack of these sites, medical schools will have created 44 per cent fewer family medicine seats by the end of this academic year than the Ministry of Health (MOH) had originally planned, Spence found.
“Our audit concluded that MOH and MCURES (Ministry of Colleges, Universities, Research Excellence and Security) did not consistently have processes in place to plan for medical school seat expansion for family medicine or to assess its progress,” the report stated.
In an effort to boost the health-care workforce and access to primary care, the government has announced plans since 2022 to add 340 undergraduate seats and 551 postgraduate seats at six pre-existing medical schools and two new ones by the 2028-29 academic year, with about 60 per cent of the new seats expected for family medicine.
Spence said the two ministries didn’t show that their decision to increase the number of medical school seats was “based on comprehensive analysis.”
“These considerations include justification for the most appropriate number of seats to add, the proportion of seats allocated to family medicine, and evaluation of the medical schools’ capacity to implement the expansion,” her report stated.
She wrote that the government didn’t “fully assess” the need to open new medical schools and “did not consider the option to expand the capacity of the existing medical schools to accommodate new students,” such as through satellite campuses.
She also said the Health Ministry “did not, in a timely manner, plan for the development of additional family physician training sites, which are essential in the successful delivery of postgraduate medical programs.”
According to Spence’s report, medical schools warned the Health Ministry in November 2023 that there was “currently a limit on the amount of family medicine training that can occur, with current sites and preceptors already at full capacity” and asked for funding for more training sites.
It wasn’t until a few years later, in 2025, that the ministry started “preparing a framework to assess” how many primary care teaching clinics (PCTCs) were needed and where, the auditor general’s report stated.
This was followed by an announcement this past May of up to $300 million for the expansion of 17 PCTCs in areas with little primary care access.
There weren’t enough training sites available to keep expanding seats by the 2025-26 academic year, so medical schools will have rolled out 89 fewer seats than planned this year.
Spence recommended that the two ministries develop a framework for deciding on medical seat expansions going forward and work with medical schools to monitor and ensure the 17 new and expanded PCTCs are ready for 2028-29.
She also called on the Health Ministry to “evaluate the reliability of source data and assumptions” it uses in its family physicians supply and demand forecast model, noting that the government “used a potentially low estimate of the number of Ontarians who need a family physician but do not have one.”
Asked about the lack of training sites, PC MPP Anthony Leardi, parliamentary assistant to Health Minister Sylvia Jones, said the government has boosted the number of people being trained in the province.
“It’s just like any other profession — when you’re training people to enter that profession, you need the number of people who are qualified, not only qualified in that profession, but also to actually train others in that profession,” he said, adding that the government is going to “try to hit our very high goal.”
The auditor also found that Health Care Connect (HCC), the province’s centralized tool for connecting patients to primary care, is not serving its purpose well.
Over the past three years, an average of only seven per cent of physicians who could accept Health Care Connect patients were doing so, the auditor found.
As of Jan. 1, about 235,000 Ontarians were registered with HCC — only about 11 per cent of the two million Ontarians without a family doctor.
“A group of 12 Ontario Health Teams (OHTs) informed the ministry in December 2024 that they ‘do not support updating the existing legacy HCC tool as it is no longer fit for purpose,’” Spence wrote.
The “outdated system” was “not widely supported” by doctors or used by Ontarians and “required redesign,” the OHTs said.
While 47 per cent of registrants between 2020–2025 waited fewer than 21 days to be connected to a physician, 15 per cent waited over 260 days, the auditor found. More than 108,000 of the 178,000 patients still waiting to be referred had been waiting for longer than a year, as of June.
Spence said during a press conference that her office recommended the government expand the number of languages on the HCC website beyond just English and French.
“Having only about 11 per cent of the people that need a family doctor even knowing about Health Care Connect, there needs to be more education and more widespread information about how to register on Health Care Connect,” she said.
“They should promote it. They should decide, is this going to be the system, or do we need a new system and get it up and running so that people can get better matched to doctors quicker.”
Asked about this, Leardi wouldn’t say, just telling reporters that Health Care Connect is “only one tool to get yourself connected to primary care, there are a lot of people who don’t use Health Care Connect, who are getting connected to family physicians and nurse practitioners every day.”
Meanwhile, a lack of family doctors — and a lack of a centralized recruitment body — is resulting in intra-Ontario competition, Spence added in her report.
Every province and territory in Canada, except Ontario, has a centralized physician recruitment model, Spence wrote, citing research from the Ontario Physician Recruitment Alliance.
A survey earlier this year from the Association of Municipalities of Ontario found that municipalities covering about 89 per cent of Ontario’s population are collectively spending more than $6.3 million per year on doctor recruitment and incentives, the auditor noted.
“The lack of a provincial entity that is responsible for co-ordinating physician recruitment in the province has resulted in a fragmented and competitive approach to recruitment” between provincial and municipal bodies, Spence wrote.
Funding issues are also preventing adequate training, the auditor found. Ontario invited 40 health teams in high-needs areas to submit health-care proposals to be funded. The auditor looked at a quarter of the 75 proposals submitted and found that they received just 36 per cent of their requested amounts, “with one proposal receiving as low as 10%.”
Because the Ministry of Health didn’t request applications for scalable projects, some teams had to spend time figuring out what they could do with the lower amounts.
For example, one Indigenous organization had a letter of commitment from an Indigenous family doctor to practise in their home community — but it was given only 14 per cent of its requested funding, for a nurse practitioner. The doctor signed elsewhere, Spence wrote.
“How is it in the primary care crisis that we face right now that the average approval of a funding request is only 36 per cent of what those key primary care teams are asking for, and in some cases, the approval is as low as just 10 per cent of what they’re asking,” said Liberal primary care critic Adil Shamji.
He pointed to Health Care Connect, saying it’s failing to meet the moment.
“Ontario Health Teams are saying it’s not working, patients are not using it, family doctors are not using it,” he said.
“Behind all of the announcements this government isn’t delivering the infrastructure, the funding, the evaluation or the co-ordination to deliver primary care for Ontarians,” Shamji said.
NDP Leader Marit Stiles said the same: it makes sense doctors aren’t using Health Care Connect with so few people needing a family doctor registered for it.
“Pretty much everything that we have laid out here that’s part of this so-called Primary Care Action Plan is a failure, it’s just fluff, it’s announcements,” she said.
—With files from Jessica Smith Cross and Katherine DeClerq
Editor’s note: This article was updated after it was initially published to include comments from the auditor general, opposition parties and the government.