A new study from Ontario is sounding the alarm about the dangers of living without a regular family doctor — especially for people juggling multiple chronic illnesses.
Published this month in Health Affairs Scholar, the research examined medical records from more than 12 million residents across the province. The findings were stark: individuals coping with several ongoing health conditions faced dramatically higher risks of death if they did not have a consistent primary care physician. The longer they remained without one, the greater the danger.
Researchers found that patients with multiple chronic illnesses who went two years or more without a family doctor had 12 times greater odds of dying. The risk of early or premature death was even more pronounced — nearly 16 times higher than for comparable patients who maintained steady access to primary care.
Dr. Jonathan Fitzsimon, a family physician and the study’s lead author, said the results reinforce how vital continuous care can be.
“When you look at two patients with similar complex medical conditions, the one key difference being access to a family doctor, the patient without that support faces about twice the risk of dying within a year,” he explained.
Of the 12 million Ontarians included in the data, approximately 11.5 million — about 90 percent — had a regular family doctor. Among those, 83 percent had been attached to the same physician for at least five years, suggesting strong continuity of care for most. However, around 1.2 million residents did not have a regular primary care provider. Nearly one-third of that group had gone five years or longer without one, and 7.4 percent had been unattached for 15 years or more.
The implications extend beyond individual health. According to Fitzsimon, patients with complex conditions who lack stable primary care often turn to emergency rooms and hospitals more frequently, increasing pressure on the broader health-care system.
“Managing chronic disease requires regular monitoring, medication adjustments and consistent follow-up,” he said. “Without that continuity, patients are left to navigate complicated medical issues on their own. That often results in more emergency visits, more hospital stays and, as we’re now seeing, a higher link to mortality.”
In related research, Fitzsimon and his team also found that long stretches without a family doctor were associated with increased health-care spending. Patients with significant comorbidities who lacked primary care had median yearly medical costs of roughly $8,100.
Dr. Tara Kiran, a family physician at St. Michael’s Hospital in Toronto who was not involved in the study, emphasized that walk-in clinics and emergency departments are not structured to manage long-term, complex conditions.
“These environments are designed to deal with urgent problems,” she noted. “They’re not built for sustained follow-up or for coordinating care across multiple chronic illnesses.”
Although specialists can oversee particular diseases — such as an endocrinologist managing diabetes — Kiran stressed that this segmented model cannot replace comprehensive primary care.
“A family doctor looks at the whole person,” she said. “They integrate all of your health concerns and help ensure nothing falls through the cracks.”
The researchers argue that their findings highlight the urgent need to strengthen access to primary care, particularly for patients with complicated medical needs. Fitzsimon acknowledged recent provincial efforts, including Ontario’s Primary Care Action Plan, but suggested that focused strategies may be required to ensure high-risk individuals are prioritized.
Kiran agreed that directing resources toward patients with chronic conditions makes logical sense but pointed out that implementation can be challenging.
“In a perfect system, we would focus first on those at highest risk,” she said. “Ultimately, though, the aim should be universal access to a family doctor. If everyone has access, those with the most complex needs will be supported as well.”
As Ontario faces ongoing shortages in primary care, the study adds weight to the argument that having a family doctor is not merely about convenience or improved quality of life — it may be a critical factor in survival.
