The Agenda with Steve Paikin (Audio) - Is Ontario Really Fixing Its Primary Care Shortage?

Episode Date: March 31, 2026

Ontario says its Primary Care Action Plan is working and promises universal access by 2029. But with many still without a family doctor and a deadline to publicly fund medically necessary care from nurse practitioners about to be missed, is the primary care crisis really easing or just shifting? Family physician and researcher Dr. Tara Kiran, Ontario College of Family Physicians CEO Deepy Sur, and Nurse Practitioners’ Association of Ontario CEO Michelle Acorn examine whether government optimism matches reality and what stalled nurse practitioner funding means for the future of care.See omnystudio.com/listener for privacy information.

Hi, I'm Nam Kiwanuka, host and producer of mistreated, a podcast on women's health. There just hasn't been a lot of money put into researching women's health issues. If women are in pain, it's hysteria, it's an emotional issue. And this is what we see consistently. Women's health is not taken seriously. How did we get here? Find us wherever you get your podcasts, and be sure to check out the video version of the show on the TVO Today YouTube channel. Hope to see you then. When TVO first went on air in 1970, the idea that public television could have a positive impact on learning was visionary. From beloved kid shows that sparked the joy of learning, pioneering must-see favorites exploring society and culture,

and series that made navigating life in Ontario a little easier, TVO's commitment to lifelong learning has stood the test of time. Renew your support now and help preserve this legacy. Visit TVO.com.me slash 2026 renewal to make your donation today. The Ontario government says its plan to connect people with primary care is right on track. Here's health minister Sylvia Jones providing a one-year update in January. Ontario has already attached over 275,000 new patients to a primary care clinician. Now, the government has said they will clear the provincial wait list by, well, now spring

2026, and in this year's budget, they're dedicating another $325 million, making the total investment $3.4 billion over four years, with the goal of connecting everyone with primary care by 2029. So, is that really achievable? We look at the progress that's been made and what else needs to be done. Then, Ontario's plan isn't just about GPs. Nurse practitioners also play a huge role, but a plan to fund them and expand their care is now behind schedule. So we untangle what happened here and how will it affect your health care. This is the rundown. The province says its primary care action plan is producing results, and it's optimistic that all

Ontarians will have access by 2029. So we ask the question, are we really at the tail end of this crisis? Dr. Tara Kieran is a family doctor. and researcher at St. Michael's Hospital and the University of Toronto. She's also the founder and national lead of the Our Care Initiative. D.B. Sour is the CEO of the Ontario College of Family Physicians. Great to have you both here. How are you guys doing? Nice to be. Great. Thanks for having us.

All right. Dr. Karen, I'm going to start with you. According to the Ontario Medical Association, OMA, more than 2.5 million Ontarians don't have access to a family doctor. The province has said it's on track to meet its goal of connecting 100% of Ontarians by 2029. Is this real progress or are there some key issues that are being overlooked? So first of all, I want to just praise the goal. I think it's great that we've set a goal for everybody having care, not just like 90% or 92%. Because I think that transforms the way that we try and solve the problem.

And from what I've seen of the data, I do think that they're on track. Now, there's a lot of work still to be done, and in fact, I think some of the work that's to be done is going to be even tougher as we get to those end stages of like trying to make sure everyone has care. But I do think that there's some good work happening behind the scenes, and so I have hope and confidence we're going to get that. When you say some of those tougher challenging issues, what are we talking about? Well, I think to really get us to where we want to go, we have to really transform the way that we work. And we have to transform the way that we work in two different ways. One is, I think, we don't have enough family doctors or family doctors and nurse practitioners to go around to have everybody have care the way that we deliver it now. So we need to change that by actually having doctors be

able to care from our patients by empowering other team members like nurses, pharmacists, and social workers. And that kind of change on the ground level takes time. People have to learn how to work in different ways. So it's not just about like adding professionals and expecting the change is going to happen. So I think that's one piece. I think the second piece that's going to be a lot harder and I'd love to come back to a sort of can we actually rethink how our model works so that it is more like a public school model when you're in a neighborhood. You have, you have clarity that like this is where I can access care, whether it's something small or something big, you know where to go and that where to go is not a walk-in clinic or an emergency department. All right. Hold that thought on

solutions. We'll definitely get to that. But DP, you know, when we talk about the family doctor shortage, you have to think about retirement, doctors who have been holding the fort down for quite a while. When we talk about primary care being an attractive, you know, stream, these are some of the issues when we talk about the shortage. So when it comes to this target meeting it, is this real progress or are there some issues there? I agree. This is real progress. This is the first biggest investment we've seen in a long time. We represent 18,000 family physicians. and medical students. And by far and large, the working conditions

is what we got to double click on. We zero in on making that more sustainable with digital tools that work and reducing the amount of time family physicians are chasing referrals or paperwork. Patients will be seen faster. And so I think the solution to access is improving the working conditions

and making it much more desirable for people to choose the profession, stay in the profession, and do what they signed up to do, which is care for patients, right? You talked about investment while the province released their budget last week. D.B., was there anything in that budget that stood out to you in terms of the primary care shortage? Yeah, I mean, we're seeing some great opportunities to make improvements right now on the ground.

It's about actually putting them into action. Access for us is going to mean that we need to see improvements in digital health. So we're seeing some great opportunities for something like a centralized referral and intake system. So imagine going to see your family doctor and being able to talk about the care you need and possibly getting a referral done in a system for diagnostic test or access to specialists and not waiting and not waiting three months, six months, or up to a year for some of that access. So these kinds of investments help us make those system-wide improvements. I agree on team-based care.

I mean, family physicians work best when they're supported in family medicine by other professionals like nurse practitioners, social workers, other great professionals who are dedicated to providing good care for patients at the right time and providing the care when they need it most, right? No, Dr. Karen, there was a price tag

there of $325 million that would go into expanding the primary care action teams work that they're already doing. That's a good signal as well? Yeah, I mean, I think the government over this next few years has committed, I think it's like $2.1 billion

and now that maybe that's grown. to expanding, most of the money is to expanding team-based care. They also put in a few hundred million, I think, to support more medical students. And then there's also money, I think, that's been earmarked now for a primary care, provincial-wide electronic medical record. So we don't actually have any details, I think, on really what that is. But at the end of the day, I think the goal, it seems to me, is to try and make the systems work better behind the scenes, both for clinicians,

and for patients. So to give patients access to their data, which I think it's going to be a huge win. We've heard over and over again through our research. Patients really want that. But then also to make it easier for physicians to communicate with each other and other parts of the system

and have an information system that supports them and isn't working against them because sometimes I have to say in the clinic you kind of feel like, ooh, like if only my information system work differently, like I could... Or they actually talk to each other, right? Yeah. Like I could be so much more efficient.

I want to talk a little bit about recruiting, because that's been an issue for a lot of communities, particularly in Northern Ontario. Now, you spend some time in Northern Ontario as well. Just to give a view as an example, in Niagara Falls right now, if doctors did sign up to practice there, they would get a $100,000 signing bonus for opening a new practice. Just down the street, you go to St. Catharines, comparatively small, $5,000 for as a relocation grant to attract family doctors. Now, Dr. Dominic Novak, the former president of OMA, has likened this sort of competition that municipalities have to go to to the hunger games. Now, I have to ask, D.V., does the metaphor capture the reality of how communities are recruiting right now?

Well, it's a symptom of a larger issue around access, right? And we won't benefit unless we make system improvements that are equitable, sustainable, and customized to the communities and geographies that people live in. We're not doing better if we don't make those improvements that are system-wide. We're just shifting doctors around, but it tells us about a real need and a real symptom for how access is not sustainable in many communities. So we would like to see the profession become more attractive so people stay and actually succeed. And so medically or internationally trained family physicians are important. They're important part of the solution, but not the only solution,

because we won't address the shortage by just bringing in more doctors who will burn, out and not be able to provide care if they're bogged down by paperwork, don't have the right digital tools, don't have the right teams. So I think we need both. It's a yes and, right? Yeah, I think it's really interesting, you know, because I think it's a, it really illustrates how people on the ground see what, how primary care is so important, right? So municipalities see that in order for them to have healthy populations and attract people to come to live in their cities,

and keep people in their city and have them working effectively. They need to have family doctors. They need to have primary care, and that's not happening. And so what you're seeing is them trying to take control of a situation where they don't feel like they necessarily have a lot of control. But then the downside is that, you know, municipalities have different kinds of resources, right?

They have different financial resources, different human resources, different leadership kind of vision, potentially. And so we see some innovative stuff coming out of the municipality saying like, okay, yeah, let's build a clinic, so doctors just have to come in and don't have to actually deal with the business stuff we can just practice. But the flip side is then we see, you know, potentially inequities across how primary care is delivered across the province. And, you know, we've had teams actually in Ontario primary care teams since about 2005.

But the challenge has been is where those teams are. And those teams, you know, research we've done is shown they're not equitably distributed. So in fact, you would want the teams, if only 25% of people in Ontario have access to not just a doctor, but social workers, pharmacists, et cetera, and a team, you want them to be in the highest needs neighborhoods, right? And actually, we saw the reverse. So the areas of highest needs, whether those are urban or rural, were actually the ones that were least likely to have the team. And so this is what points to the importance of the province, really taking that planning role to some degree making sure those resources are, distributed where they need the most. All right, I want to talk a little bit more about the fixes,

some that you've already touched on a little bit. TPA had mentioned internationally trained doctors. So are they part of the solution here? I imagine when we look at all of the issues here, we can kind of, there are a number of ways that we can go. There are doctors who are waiting on the sidelines to get it. Are they part of the solution here? Yeah, absolutely.

So I mean, we did these consultations with patients in the public across the country over 16 months, and we talked to people, to people about what they would like to see in a better system. And one of the consistent things that we heard from them, of course they want everyone in our primary care, but we consistently heard that they wanted foreign trained health professionals to be better integrated and faster integrated into our health care system. They saw that as a way to improve our health human resource shortage, but also as a way actually to increase the diversity of the practitioners

that are serving our communities. And so the challenge, though, of course, is that like we need to build pathways to ensure that the people who are coming in have the medical knowledge and also the cultural and system knowledge that's gonna allow them to be effective. And I think some of the challenge there too is that, you know, that requires family doctor supervisors. And we already have a family doctor shortage.

So you're asking some of the same strain to workforce to take on some of those other roles. But absolutely they play a role when we need to better figure out how we can get more of them into our system in a way that's fair globally. Okay, DB, we talked about the electronic medical record system. Obviously, that's something that needs to work its way through. Throw away the fax machines.

I don't know if you, if both of you are familiar with using, I'm sure you both are quite comfortable using fax machines. They still exist. There exactly, there you go. Are there any other new technologies that could help cut down on the workload that we need to know about? Yeah, we want to see digital tools in the hands of family doctors every day. A part of those improvements include things like AI scribes or, What's AIScribe for people?

So it's like an ambient tool or a tool that works in the background when you're getting in to see your family physician having a conversation about your care, and that Scribe captures that interaction. And so you're spending your time with your family physician. I know for me, when I go in and see my family doctor, I like that they're spending the time with me, not at the computer, not logging in, not taking notes,

but the Scribe actually helps them do that work, integrate seamlessly. But these tools, things like the AI Scribe, or things like a centralized referral system that I mentioned, whereby we have access to cutting down wait times through one system that inputs your access or referral to diagnostic testing or a specialist. Those kinds of tools, they need to integrate seamlessly.

They're not useful if we're just creating electronic, more modernized fax machines. We want them to be integrated with each other, talking to each other so that when you go in and you see your pharmacist that your family physician knows about the care that you had When you see your family physician, you're not having to repeat your story. So those kinds of tools are very promising in this new budget.

And I think we see a lot of will, interest and desire from the primary care action team and Dr. Jane Philpott and many other partners who are really working hard to bring this to our patients right now. You know, I'd really love to see us have electronic systems that support me as a family doctor to better communicate with my patients. And that also support me to have better communicate. with other parts of the health and social system. And so, you know, I've had a chance to travel to some other countries, and, you know, in many of those countries, you can have an app as a patient where you can see all your records,

and that's great. I would love my patients to have that so that they can feel empowered with that information, but then they can also potentially e-message their doctor, and it's all kind of seamless. They can book their appointments online in a very standard way. Some patients here in Ontario can do that, but most of them can't.

And then, you know, I think in the electronic medical record too. You know, we, ours is, it's a very separate system. We're not really connected into the hospital in a way that's easy for us and, and they can't see our records. And the way that we see the hospital records now is a way that's almost like overwhelming and too much information. We need like the right balance of information so that we can see what we need to, when we need to, be notified when a patient is admitted, for example, but not like be inundated. And, you know, the other piece that I point out to is something just very simple, like medications. So in Denmark, they have an app that the doctor, the pharmacist, the specialist, and the patient all see the same medications.

And when one person updates it, it's updated for everyone. So can you imagine as a patient that would be incredible, but also as a doctor saves me so much time, better for patient's safety, more efficient, better for me figuring out what the right medications are for that patient. Okay. Let's move away from technology. I want to talk about human resources. We talk about doctors, but there's nurse practitioners, as we mentioned. There's physiotherapists. There's social workers. Can they help in sort of filling these gaps? Family medicine works best when we have a collaborative team.

The best system is built with a team that supports not just the family physicians, nurse practitioners, physios, pharmacists, and they're integrated, and their communication systems talk to each other. And those kinds of systems are benefiting our patients. That means they're getting care when they need it. They're cutting down weight times, but as you mentioned earlier, not everyone has access to that kind of a team. And that's what we'd like to see. It's promising to see the collaboration around teams happening, and we see what optimizing scope looks like.

So everybody practicing to the top of their scope or through their optimal scope working together means that patients are getting care faster or exactly when they needed at the right time. Now, if you had a question for both of you, but DPL, I'll start with you, if you had the ear of the ministry, which you both do, What are you telling? I would say let's work on retaining the doctors we have, making those conditions better. Access can be addressed by making sure family physicians and other primary care professionals have what they need today to practice well,

make it sustainable, reduce their paperwork, give them the digital tools they need, the teams to support them, and patients will benefit from that as well. Dr. Karen? I'd like us to think about 10 years from now. How do we prevent this problem from how? happening again. And I think really the only way to do that is to move towards one of those

neighborhood-based types of models. So I'd say keep going with your efforts in primary care. You've got a lot of other competing priorities, economic priorities, but investing in your population being healthy, absolutely important. But let's do that also by not just tweaking the system, but really making wholesale change so that 10 years from now we don't have the same problem. And I think the only way to do that is to try and have these neighborhood-based clinics where people really know that they don't have to like registered and go through the loopholes of like in the or the sorry the they don't have to leap to try and find a family doctor they don't have to figure out the waiting list their networks they know that they're guaranteed access just in the way that a child

would be guaranteed access to primary school education all right we are going to have to leave it there tp dr karen i really appreciate your passion your work your time thank you so much thanks had until April 1st to set up public funding for medically necessary care from nurse practitioners. But the province is set to miss it. So what exactly happened? Michelle Acorn is CEO of the Nurse Practitioners Association of Ontario and she joins me in studio. How are you doing? I'm great. Thanks for the opportunity to be here today. Great. Great to have you. Now let's talk about the family physician shortage in Ontario. How can nurse practitioners help us? alleviate the problem. Language matters. So calling this primary care provider shortage recognizes

that care can be delivered by nurse practitioners and physicians and interprofessional team members, such as registered nurses, registered practical nurses, pharmacists as well. Nurse practitioners have the ability to expand so substantially access to care in urban, rural, remote areas as well and across all sectors as well. And more importantly, we also know nurse practitioners are well-evidenced, trusted, and safe, and provide cost-efficient care. Well, let's talk about it, because people hear the title a lot, nurse practitioner,

but it's not always clear just how wide their scope of work is. What can a nurse practitioner do? A nurse practitioner title is protected, by the way. They marry nursing and medicine, and they can function as independent, autonomous provider. So that means they can assess and diagnose. They can treat and prescribe from preventative, chronic diseases, pain control, for example.

Medical marijuana would be another one. They can actually emit treat and discharge from hospitals and long-term care. They can be your most responsible provider. They can do medical assistance and dying. They can do procedures, for example, as well. And they can also be leveraged as not just clinicians, but leaders across the health care system. All right.

One thing that they can't do, and we're learning a little bit more of this, when we talk about some nurse practitioners in the province, is they can't Bill O'HIP at the moment. So help me understand here. Do Ontarians pay out of pocket to see a nurse practitioner? The lived reality is some patients right now and residents are paying out of pocket because of a lack of fully modernized funding

that's integrated across Ontario right now. There are some nurse practitioner rules and positions that are funded publicly, while there are others that are not fully integrated right now, so patients do have to pay out of pocket. So right now in the province, I believe it's 27 nurse practitioner-led clinics. But then are we seeing a uptick in sort of private clinics? Absolutely.

So the 27 nurse practitioner-led clinics are funded by the government. That's clear. What is not clear are the private clinics that they're calling. They're solo independent clinics where nurse practitioners are delivering care because they are not publicly funded roles right at this point in time. So that is really important. However, they are delivering medically necessary services that should be deemed physician equivalent

and should be reimbursable for not just primary care, specialty care as well and across all the health care system. When we talk about health care in this province, and when we hear the word private, sometimes it can sound like a very scary word, a dirty word, Does a rise in private clinics undermine the public Medicare that we have in Ontario? These clinics are established because of need, not greed. They are not actually undermining.

They're actually being responsive to improving access to care for Ontarians in your local community as well. What is undermining is the lack of public clarity and modernized funding that it should be expedited right now to ensure that patients have access to union, universal health care. All right. Well, you mentioned clarity. Let's talk about that. Ontario had up until April 1st to set up a plan for a public funding model for nurse practitioners.

We asked the Ontario Ministry of Health about missing the federal deadline. And they wrote back to us saying that provinces have until March 31, 2027, to implement new changes required by the Canada Health Act. Is that correct? Technically, the implementation was to begin for April 1st. for publicly funded, medically necessary services. I think what the government is referring to is financial penalties or levers or enforcements that are in place

for potential clawbacks on the Canada Health Act transfer funding agreements for the ministry. What the big divide and disconnect is, patients need care now. Nurse practitioners are ready, willing, and able to provide that care right now, and patients shouldn't have to pay out of pocket. right now because there's no available system in place.

So fair to say, the province has missed the deadline. The province has missed the deadline. Okay. Well, I want to talk a little bit about the province. Last week, they had released their budget, and I wanted to know if there was something that you had seen in there that you thought was a win. Well, the government made important investments.

I had the opportunity to be at the budget in obviously primary care, home and community care, hospital and long-term care. What they did is they missed a critical opportunity and overlooked nurse practitioners by not explicitly mentioning them. They didn't actually embed nurse practitioner education seats that could be helping with recruitment and retention and distribution of nurse practitioners for access to care. They didn't embed any Candid Health Act funding and implementation of flexible funding of what that would look like, whether it be a schedule of benefits, a fee for service, a capitation or blended model. And another big thing is they didn't embed any equitable, respectful, or competitive compensation for nurse practitioners to keep them practicing, to ensure that it's publicly funded, and more importantly, to keep them also in Ontario. All right, Michelle, so on the issue of funding, the Ontario Ministry of Health also had this to say about the lack of support from the federal government.

The federal government must be an equal partner in this effort, including coming to the table with adequate health care funding to see. support the provinces. Currently, the federal government provides Ontario with less than 1% of our total health care budget through transfers. Is it fair to say that the federal government also needs to step up here? I think both federal and provincial investments are important way to go, but as you know, health care is provincially or territorially runs, so that is dependent on Ontario right now. I think with some of the policy levers that are put in place to ensure compliance with the Canada Health Act that actually has been clearly done right now. And I think we need to move forward in these investments.

There's 6,000 nurse practitioners in Ontario right now. More than 50% across Canada are embedded in Ontario right now. So everybody's looking at us to see how we can fully improve access to care as well as ensure that our workforce is being utilized. Is it fair to say that, according to that statement, that Ontario is sort of passing the buck to the feds? Resources are limited. I think it should be a shared mutual responsibility, but the federal government already shared that the Canada Health Act implementation policy

and what that looks like right now, and it's up to the provincial and territorial, such as Ontario, to actually implement that right now. Obviously, making sure there's good return on value and investments of nurse practitioners is important right now, and it is a value-ad profession that can meet Ontario needs.

When we look across this country, how does Ontario compare when it comes to nurse practitioners? Ontario has been a leader. Actually, Ontario has invested in an open nurse practitioner-like clinics. We've expanded from 250 to 6,000, for example, right now. They're embedded in not just nurse practitioner-like clinics, community health centers, family health teams, indigenous centers. They can be attending in long-term care and in corrections for health equitable. as well. But what that actually comes down to from the funding question is there's pockets of funding

but it's very laborious and it's not easily accessible and equitable right now. Right now we have nurse practitioners that are under-employed that are available to serve right now and delivering care and they are not able to get remunerated respectfully in a timely way and open

up clinics and practices where Ontarians need them. If Ontario's health ministers have was sitting across this table right now. What would you tell her to prioritize? We need to modernize and expedite funding for nurse practitioners right now, enter into a nurse practitioner main agreement,

service delivery agreement, and actually ensure that patients don't have to pay out of pocket right now and that we can provide care immediately across all our communities right now. I would also say that teams can be within four models, four walls in a model of care, they can be across communities. We still can be connected with team-based care that can be either nurse practitioner or physician-led and leveraging everybody's expertise. And nurse practitioners need to be leveraged as leaders and as clinicians

as well and be part of the solution. We could really exploit OIP billing codes right now or some type of transitional envelopes to address this date within two days. It can be done that quickly. Why not? It's important, why not? We don't have to just wait another year to ensure we're in compliance. We want to ensure patients don't pay out of pocket.

All right. Michelle, we are going to leave it there. Really appreciate your time. Thank you so much for your passion. Thanks for the opportunity to be here. And thank you to Ontario for your trust. All right. That's Michelle Acorn, CEO of the Nurse Practitioners Association of Ontario.

Thank you. Thank you. I'm Jan. Thanks for watching The Rundown. we'd love to know what you think. So send your suggestions and feedback to us at rundown at tb0.org or leave us a comment on YouTube. Until then, I'll see you tomorrow.