Accessing gynaecological care in Canada

Updated: Apr 20

TLDR: This post will outline how to access gynaecological care in Canada. For a brief overview, you can access gynaecological care in the following ways:


1. If you have a family doctor

a. Your family doctor may provide routine gynaecological care

b. Your family doctor can refer you to a gynaecologist

2. If you do not have a family doctor

a. You can go to a walk-in clinic which provides referrals and can refer you to a gynaecologist

b. You can go to a walk-in clinic, community health centre, sexual health clinic, or public health unit that provides routine gynaecological care

c. You can seek out a family doctor who can provide routine gynaecological care and/or refer you to a gynaecologist


Note: If you need emergency gynaecological care, it is best to go to the emergency department at your local hospital. They can see to any urgent needs and refer you to a gynaecologist or OB/GYN if necessary.

I would like to thank Dr. Ruth Connelly for her contributions to the piece. Dr. Connelly has been working as a family doctor in Ontario for the past 37 years. She was instrumental in verifying and providing some of the information outlined in this post.


This post was inspired by an anonymous submission from a missINFORMED community member. Here is their question and experience:


Why are gynaecologists so inaccessible? Is there an easier way to access one? I don't have a family doctor, but need a referral to get to a gynaecologist. I have spent 3 weeks finding a family doctor, getting an appointment with the family doctor, and by the time I get the referral who knows when that appointment will be. :(


Dear Community Member,


We are sorry it has been so hard for you to see a gynaecologist! It is not okay that it is so difficult to access a physician who specializes in care that at least 50% of the population will need at some point in their lives! We hope that this post can help. You do need a referral to see almost any kind of specialist in Canada, including a gynaecologist. Many people who need gynaecological care are speaking out on how difficult it is to get a timely referral and access this type of care. See this Ontario change.org petition which is fighting to move gynaecology to primary care (that is, care delivered at a family doctor’s office) – the petition already has 13,000 signatures!


How can I access gynaecological care in Canada?

In this post, we will discuss how to access gynaecological care in Canada. Gynaecological care focuses on providing sexual and reproductive health care for individuals who have female anatomy and/or those who were assigned female at birth (1, 2). What this means is that if you currently have or have ever had a uterus, ovaries, vagina, cervix, vulva, and/or breast tissue, you may need to see a gynaecologist.


A gynaecologist is someone who specializes in delivering gynaecological care, as described above. You may commonly hear the term “OB/GYN” – this term refers to OBstretrics and GYNaecology (1). Obstetrics is a branch of medicine that specifically focuses on pregnancy and providing care during the pre-, peri-, and post-natal periods. Doctors who focus completely in obstetrics (i.e. an obstetrician) usually will not provide gynaecological care. An OB/GYN is qualified to provide both obstetric and gynaecological care.


In this post we will go over how to access gynaecological care:

If you need emergency gynaecological care, it is best to go to the emergency department at your local hospital. They can see to any urgent needs and refer you to a gynaecologist or OB/GYN, if necessary.


Accessing gynaecological care if you have a family doctor

If you have a family doctor, it may be a good idea to ask them if they provide gynaecological care! Many family doctors do in fact provide routine gynaecological care. What counts as “routine” really differs based on the doctor. The following services may or may not be included within routine care and provided at a family doctor’s office: pap tests, breast exams, STD tests, contraceptive care, IUD insertion, and/or pelvic exams. The best way to determine if a family doctor provides routine gynaecological care and what that includes is to call their office and ask directly.


For more complex gynaecological care, you may need to see a gynaecologist or OB/GYN.

Accessing any type of specialist doctor (whether this is a gynaecologist, dermatologist, cardiologist, etc.) is easier if you have a family doctor. This is because accessing a specialist in Canada usually requires getting a referral from a family doctor, meaning you are first required to see your family doctor who will assess your situation, and refer you to a gynaecologist if necessary (3). They will typically find a gynaecologist in your area and schedule an appointment for you. The family doctor or specialist clinic will then follow up with you to let you know when your appointment is and any instructions you may need to follow in preparation for your appointment. After your appointment with the specialist, your family doctor or the specialist clinic should follow up with you about the results and any next steps.


The rationale behind the referral system is that a patient may not know the type of specialist they need to see, or a family physician may be able to provide the necessary care without referring to a specialist. The referral system sets up the family physician as the first point of contact. Ideally, the family physician will provide preliminary care and get you an appointment with a gynaecologist or OB/GYN, if necessary.


Unfortunately, the referral system in Canada is far from perfect. An Ontario-based study that looked at 461 referrals from 2014 to 2015 found that the average wait time between a patient being referred to a specialist and actually seeing the specialist was 11.3 weeks for non-urgent cases and seven weeks for urgent cases (4). Referrals can be forgotten, overlooked, or denied, which is frustrating for family doctors who want to provide timely care and for patients awaiting the specialized care (3). From the specialist’s perspective, referrals sometimes do not include necessary information such as the reason for referral or sufficient information about the patient in order to effectively triage their care and determine how quickly they need to be seen. At the end of the day, those who suffer the most are patients as they face health risks and sometimes grievous consequences due to delays in care.


Despite these issues, the referral system is virtually the only way to see any type of specialist in Canada. Therefore, it is best to get a referral from your family doctor if you need to see a gynaecologist or OB/GYN, as they are best equipped to address your needs and connect you to a specialist who can help. If you believe your concerns are urgent, always remember to advocate for yourself and express your needs to your family doctor. If you are in an emergency situation, please go to your local hospital’s emergency department; they can refer you to a gynaecologist, if necessary.


Accessing gynaecological care if you do not have a family doctor

If you do not currently have a family doctor, another way you can get a referral to see a gynaecologist or OB/GYN is to go to a walk-in clinic that provides referral services (5). Not every walk-in clinic is able to get you a referral. It is best to call ahead and ask whether they will be able to refer you to a specialist after your visit, if necessary.


You do not need a referral and usually do not need an appointment to visit a walk-in clinic (5). However, during COVID-19, there may be some visiting restrictions so please call your local clinic and ask about the best and safest way to visit them. There is no fee for visiting a walk-in clinic; you just need to provide your provincially-registered health card. Some walk-in clinics may also provide routine gynaecological care. This is again something you should call the clinic to confirm.


For routine gynaecological care, you may also seek out your local community health centres, sexual health clinics, and public health units. These health services usually provide routine gynaecological care, but it is best to call ahead and ask to make sure.


What counts as “routine” gynaecological care can differ based on the clinic. The following services may or may not be included within routine gynaecological: pap tests, breast exams, STD tests, contraceptive care, IUD insertion, and/or pelvic exams. To determine if a clinic provides routine gynaecological care and what services this includes, it is best to call the clinic and ask.


If you are located in Ontario, you can find walk-in clinics, community health centres, sexual health clinics, public health units, and other services in your area by using this search engine provided by the Government of Ontario.


Another way to access gynaecological care and be referred to a gynaecologist or OB/GYN is to find and establish care with a family doctor. Once you find and visit a family doctor, they can refer you to a gynaecologist or OB/GYN or any other specialist you may need. Additionally, some family doctors can provide basic gynaecological care at their clinic. If this is something you would prefer, then remember to call the clinic and ask if they provide this type of care and what is included. If they do not provide this care, ask if they know another family doctor who does.


If you would like to find a family doctor and you are located in Ontario, you can use the Health Care Connect system provided by the Government of Ontario. In order to be eligible for this service, you must have a valid Ontario health card, have an up-to-date mailing address associated with your health card, and not currently have a family doctor. Once you sign up for Health Care Connect, your request for a family doctor will be given to a Health Care Connect nurse in your area. The nurse will provide you with the contact information for a family doctor in your community who is currently accepting patients. In Ontario, you can also use the College of Physicians and Surgeons of Ontario (CPSO) Doctor Search. You can filter the search by location, gender identity of the physician, and language spoken by the physician.


If you are not located in Ontario, there are likely similar search engines available in your province or territory through local governing bodies and medical organizations.


References

  1. Wooster Community Hospital Health System. What is the difference between OB/GYN and gynecology? 2020 Feb 7. Available from: https://www.woosterhospital.org/what-is-the-difference-between-ob-gyn-and-gynecology/.

  2. Mayo Clinic. Gynaecological care for trans men. 2019 Nov 13. Available from: https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/gynecological-care-for-trans-men/art-20473719.

  3. Keely E & Liddy C. Transforming the specialist referral and consultation process in Canada. Canadian Medical Association Journal. 2019;191(15): e408-e409. Available from: https://doi.org/10.1503/cmaj.181550.

  4. Liddy C, Nawar N, Moroz I, Mcrae S, Russell C, Mihan A et al. Understanding Patient Referral Wait Times for Specialty Care in Ontario: A Retrospective Chart Audit. Health Policy. 2018;13(3): 59-69. Available from: https://dx.doi.org/10.12927%2Fhcpol.2018.25397.

  5. Government of Ontario. Walk-in clinics. 2019 Mar 22. Available from: https://www.ontario.ca/page/walk-clinics#section-3.



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