The Ben Mulroney Show - The Real Reason we have a Family Doctor Shortage

Episode Date: May 29, 2025

Guests and Topics: -Ontario has more physicians, but fewer are taking patients with Guest: Dr. Nadia Alam, Family Doctor and Past-President of The Ontario Medical Association -Anti-elitism is antithetical to the conservative tradition with Guest: Anthony Koch, Managing Principal at AK Strategies and former National Campaign Spokesperson for Pierre Poilievre -WestJet CEO says government is ‘fundamentally wrong’ to treat air travel as a luxury with Guest: Robert Kokonis, President of AirTrav, a global aviation advisory If you enjoyed the podcast, tell a friend! For more of the Ben Mulroney Show, subscribe to the podcast! https://globalnews.ca/national/program/the-ben-mulroney-show Follow Ben on Twitter/X at https://x.com/BenMulroney Enjoy Learn more about your ad choices. Visit megaphone.fm/adchoices

Hey, so what did you want to talk about? Well, I want to tell you about Wagovie. Wagovie? Yeah, Wagovie. What about it? On second thought, I might not be the right person to tell you. Oh, you're not? No. Just ask your doctor.

About Wagovie? Yeah. Ask for it by name. Okay. So why did you bring me to this circus? Oh, I'm really into lion tamers. You know, with the chair and everything. Ask your doctor for Wagovie by name visit what gov.ca for savings exclusions may apply. Welcome back to the Ben Mulroney show and thank you so much for joining us. Health care in this in this country is a cherished

right. It is a cherished institution so much so that it's poll after poll after poll suggests that this government program is viewed by so many of us as something that defines us as a country. And so we spend a lot of time particular attention on the ills that are facing our healthcare systems across this country. And one of the hardest things to do these days is to find a family doctor. And so when I hear that nearly 40% of the 6300 family doctors who entered the physician workforce in Ontario have devoted their careers to something other than office

based cradle to grave comprehensive primary care. I was like, ah, therein lies one of the problems. So talk about that. And much more a great friend of the show and a great friend of mine is Dr. Nadia Allam. She's a family doctor and past president of the Ontario Medical Association. Doc, friend of the show. And a great friend of mine is Dr. Nadia Allem. She's a family doctor and past president of the Ontario Medical Association. Doc, welcome to the show. Thank you so much, Ben.

Okay, so these numbers are in the Globe and Mail today. What do they mean to you? It confirms everything that my colleagues and I have been saying on the front lines for a very, like for years, Ben. I'm talking about years. So pre pandemic, we started, my colleagues and I started noticing that more and more family doctors knew grass, we're choosing to go into these focused practices where they're, they're sub specializing in something as opposed to doing what I do, which is taking care of

people from birth to death. So comprehensive care. We started talking about it, but this is the first time I've seen data to prove it. Yeah. You've been seeing it with your eyes and anecdotally you knew it to be true, and now it's being confirmed by the data. Is it because of the flexibility and perhaps a higher pay that, you know, the schedule allows them to be in more control of their, their, their schedules and make more money? Is that why they would be making this choice? That's part of it. Family doctors have for a couple of decades now been slowly seeing reductions in their take home pay. And that's partly because they run small businesses, which is challenging. We're not trained in running a small business.

We're trained in medicine and the costs of business going up. But part of it is also that we're just not paid as much as we used to in terms of proportion. A lot of it though, I think, has to do with the burden of paperwork and Yeah. And the burden of trying to use electronic medical records that are not user friendly. Yeah. You and I've talked about this a lot. There are solutions on the horizon, probably not, not just on the horizon, but in market right now that could help reduce that, that burden, that time on paperwork versus time with patients. Correct. Yeah. And that's what I'm hopeful for. We've got artificial intelligence scribes that some family doctors swear by

because they find it really helps them take off one administrative task off their list, right off their shoulders. Yeah. But doc wouldn't it, I mean, you gotta get these, you gotta get these doctors early. Like once they specialize, that's it. As, as they say, here's another line I use all the time. Les jeux sont faits. The game is up. Yeah. Yeah. So you're right. You're right. When they come out of training, it's a bit of a culture shock, right? Because they come into the real world where they may not be part of a family health team. They may not have nurses. They may have to pay for nurses to be in their office. All of a sudden they realize the

cost of leasing, the work that goes into maintaining an office, the cost of buying medical equipment. Oh my goodness. And then the reality of your paperwork following you everywhere. I had a family doctor who retired and the first thing he said to me that he noticed was he could sleep three more hours a night because he wasn't up at night thinking about, Oh, did I do this for that patient? Did I do that for that patient? Evidently, Ben, you end up loving your patients. Like you really do. Doc, how much of it, yes, the paperwork is the burden and that needs to be addressed. There are some tools with AI. How much of that could, how much of it is superfluous on its face?

Meaning how much of it is bureaucratic busy work that has been added? Just because over the course of years and years and years, like is there, could somebody come in there and do some sort of forensic analysis of the paperwork that is required of a family doctor and say, you know what, 25% of this doesn't need to happen, but it's there because somebody decided to just add one more form to the pile. And then another person added another form. And next thing you know, it's a whole extra hour of work a day that just doesn't need to be there. Oh my God. You read my mind. I wish someone would, I wish someone would come in and some

of it I already know. I know that some of these disability forms need to be filled out by physicians, but some of these insurance forms do not need to be filled out by a physician. Some of these other forms can be filled out by the patients themselves because they know a lot of their health history. Or they could just ask me, I am their health record custodian. The information belongs to them. If they want the information, I just email it to them. Yeah. Yeah. A secure server. But it's, it's just seeing some of these forms come again and again and again. It's frustrating. It's frustrating because nothing's changed with the patient. Yeah. But you have to spill it all out again. All right. Let's, let's, let's switch topics for a moment because there's a headline that I'd love to get your take on. When I read the headline that says,

almost 70% of Canadians surveyed want child vaccines to be mandatory. So a couple of things. One, I'd love to know what you think of that number. Does that impress you or does that worry you? And two, how come they're not mandatory? All right, so first, I actually thought the number would be higher.

I really did. I'm glad it's 70%, I'm glad it's the majority, but I thought it would be close to 80 to 90%. And that's partly because of how you hear about kids not only getting sick from vaccine preventable illnesses, but dying from those illnesses, which is horrifying because it is entirely preventable. Yeah.

I understand that parents are trying to make the best decisions possible and there's so much information, misinformation, disinformation out there that it's no wonder they're confused about what is the best option for their kids. I mean, yeah, cause I can't remember. Uh, I can't remember when my, I remember when my kids were born and I remember that they got their, their childhood vaccines, but I don't, I don't remember being given a choice. Like to walk me through the process. When a child is born in a hospital, the doctors come to them or nurses come to them and say what. So when a child is born, we only keep them about 24 to 48 hours.

So we do the absolute necessity of what we need to do to make sure they've begun their life in a safe way. And then we bump them to the family doctor or the nurse practitioner. And then at that point, we start taking care of them, making sure they're gaining weight, meeting all the developmental milestones. But we also start talking about vaccines, which start at age two months.

What I'm noticing more and more now is there's a certain amount of vaccine hesitancy that you're seeing. People are saying, I need to take a beat. I need to think about this. I need to research it. Oh boy, I gotta do my own research. Those are my favorite people. Hey, doc, we got to leave it there. But great talking to you again, and look forward to

talking to you again in the future. Thank you so much, Ben. Have a great day. You know, we're living in a time where I believe there's a crisis in confidence of those people that we used to trust implicitly, you know, and we've witnessed the byproduct of that in really interesting ways. I've seen now, you know, the, the rise of the, of the standup comedian slash expert slash podcaster, uh, has replaced a lot of those voices that we used to trust.

And our next guest, uh, sort of breaks that down and asks, you know, what role do elites should elites play in society? So please welcome to the show, Anthony Kosh, a good friend of the show and and well, welcome Anthony. Thanks for having me on. Yeah. So you wrote for the you wrote in the National Post, anti elitism is antithetical to the conservative tradition. What's what's the takeaway from your column, your opinion piece? Here's basically the point and you addressed a little bit over

the course of the last decade and a half, even two decades, what we've seen over the course of multi across multiple societies and what we can call Western civilization, the failure of elites, okay, across a number of issues, whether it was, for example, lying about weapons of mass destruction in Iraq, or some of the handling of the COVID crisis, whether that be on the financial side, the great financial crisis in 2008. The point is all these people, like you said, that Joe Bloschmo, people like me and you

used to tune into our televisions, radio sets, the newspapers and trust implicitly because they were the people that had a hand in things. They were the people who knew what was going on and they could tell me what to expect. They were wrong about a whole bunch of stuff. And the problem is as a result of that, as a result of what I think is two pronged, one, legitimate failures and two,

I think overconfidence on behalf of the elites. It's okay to say when you don't have 100% sure bet on something, but oftentimes people feel like they have to speak as if they do. So what's happened is you got a backlash going on right now, and it's not just against specific individuals, it's against the entire idea of expertise and elites in general. Basically what I'm saying is every society ever in history has had hierarchies, every organization, every business, every community hierarchy is necessary.

It's good in most circumstances. The problem is not with hierarchy or elites in general. It's more to do with the specificity of the fact that the ones that we have right now have failed and we need to replace them. Well, and I'm glad that you that you're the one who wrote this because I think I think conservatives and the conservative movement writ large is unfairly tarred with the brush

of being anti-intellectual populist and therefore rejecting of that high degree of specialization and information. And you're saying that's not the case. It's not to be conservative doesn't mean you reject elites. It's just a rejection of sort of the ones that have failed us. Correct. And also a recognition that we probably live in a society today with over credentialization. So it's about prioritizing hierarchies of competence.

It's not just because you have a name, a letter next to your name. Sometimes the letter next to your name is indicative of some competency, but it's not automatic. And that sort of placeholder that we fit in for a lot of people where we jumped the gun because so-and-so went to so-and-so school,

that they must be a genius who knows everything about everything. And then maybe another person who did and doesn't know anything. That's not the way we have to approach this thing This thing, it's about, of course, there's some people who know more and a lot more in many instances about specific important topics than regular people that you find off of the street. And those people should be given influence and the ability to influence positions, public policy or whatever on those specific topics.

But at the same time, we also have to have, in order to be able to get back to that sort of place, a recognition that the sort of automatic trust that's been placed in a lot of people over the course of the last two decades, people rightfully, it's not some sort of distortion, rightfully feel frustrated by the fact that that trust was misplaced in many circumstances

and they were forced to face circumstances that they themselves were told were not supposed to come to pass. So people are upset, they're feeling frustrated, there's a bit of a backlash and a lashing out at the system in general going on. Some of it's fair, some of it's probably torqued a bit, but my point is basically just to say,

the problem is not with hierarchy in general, without the fact that we need greater accountability. To whom much is given, much is demanded in return, that's a good thing. It's a good principle to have for society in many respects in terms of responsibility. And we just got to hone the message a little bit, make sure that we're focusing on the right problem. But, but Anthony, why are we living in a time where it does seem because you lay out some pretty compelling examples. And when you hear them like my God, yet we have been failed by the people that we used to trust implicitly.

How did that happen? How did so many people on so many key files at different times in different sectors all collectively drop the ball? I think it's a great question. If I have a concrete answer for you, I'd probably, you know, be making a lot more money than I have. But I think what it really comes probably be making a lot more money than I have. But I think what it really comes down to, it's a couple of things. I think there's a problem in our society in the sense that there's a tendency towards

elite consensus. Okay? So you often saw it, this was during COVID, this is during economic crises, whatever. And it's fine. I understand that sometimes in crises, you want to have a sort of party line in quotation marks because you want to make sure that If you need people to follow certain rules in a quick period of time sometimes I could do but the point is The silencing of dissenting voices and not regular random joblo schmo

I'm talking about actual people who are experts in their own rights, but dissented with let's say the majoritarian position But I also think we have to recognize we live in a world that is changing faster than ever before. There are more variables to account for than ever before. And in doing so, a lot of people who have expertise are also failing to recognize their own limitations in many respects in terms of predicting certain things, transpiring, whatever. And like I said, I also think a lot would go a long way. If, for example, during COVID, when new policies were coming out, there would have been a bit more honesty. Oh, yeah. How certain people were about certain things being a silver bullet or working out or whatever. I actually am one of those people. And you see this all the time in politics.

When people are honest and they recognize their own limitations and say, hey, guys, we don't actually know if this is 100%. There's a lot of uncertainty. The situation is in flux. It's impossible for me to give you guys 100% certainty on these specific things. Anthony. Yeah. I remember being on TV and being that guy who, who was, you know, I, I got myself vaccinated. I wanted my kids to be vaccinated. I believe that that was the safest path to getting through it. And I was the guy who went on TV and said,

the first shot is the best shot. Whichever one's offered to you, you should take and stop this shopping around for vaccines nonsense. Go get your shot, go get your shot. And then, once I said that, and I got that lesser one, I can't remember what it was called, but once I did that, then I find out that the government turns around and says, Oh, and now we're going to, you know,

we're going to because they were the ones pushing that idea. And then they did an about face saying, well, if you got that weaker one, then we're going to allow you to pair it with a stronger one. It's like, well, that's not the line that you told me as a media person. I was supposed to go out there and share. And now I feel like an idiot. Exactly. And then in the early days, don't go buy masks. They don't do anything. We need to leave them for medical professional. And then it was no, actually masks are great. You need them at all these sort of jobs, right? We had some rest or some facilities that were remaining open,

but playgrounds were closed and then they were, it was convoluted. It was clear that things didn't make all that much sense and if I maintain this and I always will if there would have just been a little bit more honesty in the in the ability of just saying listen there's a lot of stuff that's in flux we don't have all the answers all the time we're doing the best that we can people better but I think that need by so many in elite circles to always give definitive concrete answers and think this is the truth and anybody who has any doubts or asks any questions is automatically some neanderthal. Yeah, that's right.

You know, you weren't trusting the science. You weren't trusting the science. It's like, well, it's more art than science, at least in the beginning. And you're absolutely right. And because it was such a moment of global importance, the fact that we had this absolute certainty that you're supposed to believe it slavishly to your own detriment, and then to be told, ah,

you know, in retrospect, we didn't completely get it right. I think that's probably the most, the biggest contributing factor to that cynicism that we have today. But Anthony Kosh, I want to thank you for writing this. It's a great conversation. I really appreciate it. I know we're going to have you back on the show soon. Thank you so much. Welcome back the Ben Mulry show marches on and I thank you for marching alongside with us. We're going to talk air travel now. Because if there's one B that I have my bonnet all the time, it's how expensive it is to travel across this great country of ours. And I just wish to God things were a little less expensive so that we could,

you know, people could explore and maybe start a business on the other side of the country or spend their, uh, their, their tourist dollars, uh, once they land as opposed to getting to the place that they need to go. So discuss this and a couple of other travel stories were joined now by Robert Kokonis. He's the president of air travel, a global aviation advisory, Robert, thanks so much for joining us. Hey, you're welcome, Ben. So I think the WestJet CEO, I think hit the nail on the head when he gave a speech in Calgary and questioned why air travels like it's treated like a luxury, isn't it? It's treated like a luxury. And I think that for those of us in the industry, we recognize the sheer size

of Canada, 5,000 plus kilometers east to west, north to south, another 3,500. And the efficient movement of people and goods, as you mentioned, for tourism, for business, for visiting friends and relatives is not a luxury. We've got to take care, especially in a country where rail is close to non-existent, as you know. The inner city bus has been taking down significantly the past number of years. So you can't expect grandma and grandpa to hop in the family sedan in Vancouver and get to Halifax. They've got to fly. Yeah. And I guess the CEO said that, you know, other forms of transport infrastructure like bridges and passenger rail, they are helped out

by the government. But then when it's the airlines are left to fend for themselves. And so they've got these massive costs, which they then have to pass on to you and me. Well, that's right. So he specifically noted like ferries or bridges or other areas where they get a lot of support from the government. The problem with the air travel sector is it's a high capital cost. It's very cash intensive business. It's easy. What did Warren Buffett say, the big US billionaire? You want to become a millionaire from being a billionaire, buy an airline, right? And that's very true, but it's very, very cash intensive. And we levy a lot of charges and fees on airlines in this country, and it makes it cost-effective. That's why

some of our discount carriers struggle. Lynx is gone. WestJet integrated swoop into the main line. We're left with flair. They seem to be doing kind of okay. But the name of the game for the lower fare carriers or the lower fares of a WestJet or an Air Canada is to stimulate the marketplace. But when the starting point to stimulate is like 70 bucks or 65 bucks, we'll call it $70 one way round trip. That's 140. And I always sort of connects this down to a family of four. That's 560.

I was just looking at a fair five minutes ago, Toronto, Winnipeg, one way WestJet and Air Canada at about 65 to $70, between 37 and 42% of the total fare going to fees and taxes and charges. And a lot of families can't afford that. Exactly. So Robert, I'm not precious about airlines as part of our national character, right? I don't think Air Canada makes me, I don't think I swell with pride knowing that there's a maple leaf on a plane. I think if we want to strengthen this country and make it the best version of itself,

then getting people from point A to point B at a low cost is the ticket to get there. I don't care what they're flying on. And so I wonder what your thoughts would be on really opening up the competition in those spaces and allowing foreign airlines to operate as if they were domestic. I know that it presents challenges for our airlines.

I can see that. But if the end result is Canadians being employed by an airline, whether it be Air Canada or United or British Airways, I don't know that that's a trade off I wouldn't explore. Yeah, anybody who's been on global travel, you sort of look agnosticly who's carrying you, right? It comes like going to the supermarket

to buy bread and sugar and flour and eggs. But the challenge in this country, because we are such a large country with a low population density, owning a couple of pockets where we have a very significant amount of population, we call this cabotage. Yeah. Allowing foreign carriers to come in, just as it won't fly, I'll tell you right now,

as DOA is dead in the arrival with a transport can, it's never going to go forward. Really? The shareholders, it won't because what would happen if you allow British Airways or American Airlines to come in and say, we're going to open up the market to international carriers, they're going to cherry pick the best of Canada's routes, the Toronto to Calgary, Vancouver's, the Ottawa, Montreal to Calgary. Who's going to serve the small routes between Winnipeg and Regina or between Halifax or Quebec City and wherever, right? And even smaller communities than that. And we have a problem

in this country with enough airlines that can serve our smaller communities with small aircraft. So I think the way to fix it in this country is by lowering costs, which will enable more competition. Flir Airlines would add five more airplanes in the get go. We're gonna lop some of these costs. I see if those fees were eliminated. And don't forget, so I just wanna say quickly, as far as competition, we have two big ones. There are Canada WestJet, Grand Zest still there, but don't forget Porter, there's big investment in jets, they're up to

about, must be 80 aircraft already and they've got more airplanes in order to fly all over the US across the country. So we have competition there, but we need to make sure we foster that, Flair is the same, there are 20 airplanes, we need to foster that competition by reducing costs, which enables those carriers to reinvest money, this capital intensive business into their operation, not by allowing British Airways to come in. I gotcha. Okay. Well, I'm glad we settled that one, but I want to talk now about the other side of the equation as it relates to air travel is the people who are supposed to keep us safe and

keep the flights organized in the air, air traffic controllers. And there's a story that a frustrated Air Canada pilot, he got so frustrated that he got onto the microphone and slammed the air traffic controller shortage to the passengers on the flight. Is the airline industry understaffed on the air traffic controller side? Is that a real problem?

This is a real problem, but it's not the airlines, we have a not for profit corporation in this country headquartered in Ottawa called NAV Canada created back in 1996. And like a lot of other entities, especially in air transport, airports, they laid off a lot of people, they lost a lot of people in the early stages of the pandemic. And they train all the people in Cornwall, Ontario takes one to two years to train up an air traffic controller and there's a big deficit. And so anybody on this listening to the call right now to our show knows you can be on a plane in Toronto or Vancouver

and the announcement, our departure is delayed by 30 minutes. We've got to sit here on the runway or on the taxiway waiting for clearance. There's none of controllers. So we're safe, but we have to restrict flow, especially out of the Vancouver area and the Toronto area. Unfortunately, for the big network carriers like WestJet and Air Canada, there's a trickle down effect. You delay Ben's flight inbound from Calgary, and that aircraft was supposed to go onwards to Montreal or Halifax or wherever. And that's a challenge. So, you know, the airlines have a right to be upset with with this. They have to pay. That's the fee, right? Every second that they're at that every minute they're at the gate longer than they're supposed to. They have a fee to pay. Well, well, first of all, there's a Canada fee that they charge the airlines, which trickled

down to you and I. But there's also these things that you and I talked about before the airline passed her protection regulations in Canada and the only entity to get hit by a delay or cancel the airlines, airports don't have to pay that Canada doesn't have to pay. If there's a delay in security screening, they don't have to pay only the airline. And there's no there's no there's no measurement. There's no recourse for the airline. I mean, if it's not a if it's not a fault of their own and and they are racking up fees That they're gonna they're gonna cost them reputation Lee and financially and then they pass out onto like There's no recourse for them to go to the air traffic controller There's update there's updated legislation whining is weighted to to to Parliament right now to actually update these these paths and protection regulations

But they actually make it even more punitive to the airlines. So you know, you and I need to have a call with Minister Freeland, who was our new Minister of Transport. By the way, I'll just put one more pitch in, which is the Prime Minister of the country, no matter who it is, has got to stop treating transport as a secondary file because inevitably they give that minister two portfolios, Minister and then before this minister of transport and of course, Treasury Board as well too. And splitting their attention doesn't do anybody a service, especially in a government with 29 full-time ministers, 10 or so secretaries of state.

You think we'd have enough bodies to have a single minister for a critical file. It's the, you know, it came back to Alexis, the CEO WestJet said is a critical file is that you know, it came back to it, Alexis, you have a CEO WestJet said is a critical industry, we gotta put everything behind this and penalizing it and give me as part time ministers, certainly not the way we want to go, Ben. Well, I'm certainly glad we were able to highlight that that first part of this conversation that the WestJet CEO brought up that because I think this is a really important, we need a

paradigm shift, we have to change the conversation. Hopefully that speech will find purchase and we'll be able to do just that. Robert Coconis, thank you so much for joining us on the Ben Mulroney show. Good night. Thanks for the invite. The My Choice sales event is back at Nissan and the choice is yours. Choose our best selling rogue, always ready for adventure. Or the dynamic Sentra, packed with safety features. Or the all-new, boldly redesigned Kicks.

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