Ontario’s failure to plan for its rapidly growing primary-care needs has left millions of residents without access to family doctors, according to a blunt new audit from Auditor General Shelley Spence. Her 2025 annual report concludes that from medical training to patient-doctor matching, the province’s approach is fragmented, outdated, and unable to keep pace with demand.
Spence found that despite the Ford government’s public commitment to expanding the health-care workforce, it has not adequately planned the training capacity needed to produce more family physicians. Medical schools warned the province as early as November 2023 that existing family medicine training sites were at full capacity, with no room to take on additional students. Yet the Ministry of Health did not begin developing a framework to determine how many new training clinics were needed — or where they should be located — until 2025.
As a result, medical schools will create 44 per cent fewer family medicine training seats this academic year than the Ministry originally intended. Overall, schools will roll out 89 fewer seats than planned in 2025–26. This shortfall comes despite a government promise to add nearly 900 undergraduate and postgraduate medical seats by 2028–29, most of them for family medicine. Spence noted that the ministries responsible for health and post-secondary education did not provide evidence that this expansion was based on comprehensive analysis of need, capacity, or long-term workforce trends.
The auditor also concluded that government failed to properly explore whether new medical schools were necessary, or whether expanding satellite campuses attached to existing programs would have been more effective. In her view, Ontario made major decisions on training future physicians without full understanding of how many were needed or where they could be placed.
The report also highlighted serious problems with Health Care Connect (HCC), the province’s main tool for matching patients with family doctors. Although more than two million Ontarians currently lack a primary care provider, only about 235,000 are registered on HCC. Among the family physicians who are able to accept new patients through the platform, just seven per cent on average have actually done so over the past three years.
Spence said the system is outdated and unpopular among both doctors and patients. A group of 12 Ontario Health Teams told the Ministry in late 2024 that they did not support updating the current tool, calling it “no longer fit for purpose” and urging a complete redesign. Wait times for matching have become extreme: while nearly half of registrants were connected within three weeks, more than 100,000 people had been waiting more than a year as of June.
Compounding the crisis is Ontario’s lack of a centralized physician recruitment system. Every other province and territory in Canada has one. Without it, Ontario municipalities — which cover nearly 90 per cent of the population — are collectively spending more than $6 million annually on fragmented recruitment efforts, often competing with one another for the same limited pool of family doctors. Spence said the absence of a coordinated provincial strategy has created duplication, inefficiency, and missed opportunities.
Funding challenges are preventing effective solutions as well. The province invited proposals from health teams in high-need communities, but Spence found that the approved projects received only about one-third of the funding requested. One Indigenous organization, which had secured a commitment from a family physician to return and practise in their home community, received only 14 per cent of the funding needed — enough to hire a nurse practitioner instead. The doctor, unable to be supported, ultimately accepted a position elsewhere.
Spence recommended that Ontario develop a clear planning framework for future medical school expansions, ensure new primary care teaching clinics are operational before 2028–29, and update the province’s forecasting model for family physician supply and demand. She also called on the Ministry to reconsider its assumptions, noting that the government may be underestimating how many Ontarians truly need a family doctor.
Her findings paint a stark picture of a province struggling with a worsening primary-care shortage — one made more difficult, she suggests, by years of insufficient planning and an outdated infrastructure that has failed to evolve with the health-care needs of Ontarians.