New research led at the University of Ottawa has found Ontarians without a family doctor face a higher risk of death compared to those attached to a physician, a risk which becomes even greater for patients suffering from chronic health conditions. 

The study team, led by Dr. Jonathan Fitzsimon, Assistant Professor, Department of Family Medicine, Faculty of Medicine, and Clinician Researcher, Institut du Savoir Montfort and Antoine St-Amant, PhD student in Population Health, analyzed the health records of over 12 million Ontarians to decipher how not having a family doctor (being “unattached”) – and for how long – influences mortality, healthcare costs and hospitalizations. 

The researchers demonstrated the negative impact that not having a family doctor can have:

• There is an 85 percent increase in risk of death for those who remained unattached to a family doctor vs. those attached for over 15 years. 

• Patients with chronic health conditions who do have a family doctor have a five times higher risk of death, which increases to 12 times the risk when the do not have a family doctor.

• Cost and hospitalization outcomes mirrored these patterns.

“We know continuous care is helpful to the well-being of people, but we were surprised by the magnitude of the findings for those without a family doctor, particularly vulnerable patients and those with chronic conditions who do far worse,” says Dr. Fitzsimon, who himself is a family physician in Ottawa’s surrounding Renfrew Country. “The more vulnerable patients without a family doctor ultimately cost the health system approximately double what it does for those attached to a family doctor.”

Researchers surmise that unattached patients may look to coping strategies and alternative care to mitigate their medical reality, with newly unattached patients delaying or spurning care. Long-term unattached patients, meanwhile, may choose to navigate walk-in clinics, emergency departments, self-manage, or rely on alternate clinicians such as specialists and pharmacists. 

Ontario’s provincial government pledged to connect every Ontarian to a family doctor or primary care team by 2029 with its Primary Care Act. Dr. Fitzsimon lauds the initiative.  

“The Ontario government should be commended for making efforts to address the problem by passing legislation that calls for all Ontarians to have access to a family doctor or nurse practitioner by 2029. Our research highlights that whilst universal primary care is the right goal, there is a group of unattached patients with multiple chronic conditions who would have the most benefit of urgent action, both to them and the healthcare system overall,” adds Dr. Fitzsimon.

The research team was composed of Jonathan Fitzsimon, Antoine St-Amant, Michael E Green, Richard H Glazier, Anastasia Gayowsky, Kamila Premji, Eliot Frymire, and Lise M Bjerre.

Primary Care Unattachment; Impact on Mortality, Hospitalizations and Costs was published in Health Affairs Scholar on February 4, 2026.