The Current - Why more Canadians are finding family doctors

Episode Date: December 10, 2025

If you're looking for a family doctor, maybe some good news? More Canadians are finding primary care providers. We look at the ways funding, government policy and some innovation in healthcare are moving the dial when it comes to family medicine.

This ascent isn't for everyone. You need grit to climb this high this often. You've got to be an underdog that always over-delivers. You've got to be 6,500 hospital staff, 1,000 doctors, all doing so much with so little. You've got to be Scarborough. Defined by our uphill battle and always striving towards new heights. And you can help us keep climbing.

Donate at lovescarbro.cairbo. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. If you are searching for a family doctor, we have a bit of good news. The federal immigration minister, Lena Dia, announced on Monday that her department will allow provinces and territories to nominate 5,000 doctors, currently working in Canada for a fast track toward permanent residency. Many of these doctors are already treating patients in our communities.

we cannot afford to lose them. These barriers we are removing today and the measures we are putting in place to recruit and retain, our doctors will have a significant impact on the lives of everyday Canadians and the services they will receive. In the best case scenario,

that will mean thousands more doctors practicing in Canada long term. You know, we have talked on this program a lot about the shortage of family doctors and the ripple effects that that has on the entire health care system. But new research shows there has been some improvement in that. In 2022, 6.5 million Canadians were without access to a family doctor or nurse practitioner. Today, that number is 5.9 million.

Obviously, that is still a very big number, but it is also a notable difference. And in a moment, we will hear what one community did to increase access to primary care. But first, I'm joined in studio by Dr. Tara Kieran. She's a family physician at St. Michael's Hospital, the Fadani Chair in Improvement and Innovation at the University. University of Toronto, also a project leader at our care. It's an organization that is behind this new research focusing on the future of primary care in Canada. She's with me in studio. Good morning. Good morning. We will get to this announcement from the federal government in a

moment. But tell me about the survey. I mean, I gave the big picture of numbers. What did you find? Yeah. So, I mean, I think, as you said, the big things are getting bigger. We had our first survey in 2022, and that's when we found that 6.5 million adults or so didn't have access. And that number, you said, has now dropped to 5.9. A notable improvement, especially given that there's been significant immigration over that three-year time period. But although 5.9 is better than 6.5, it's still far too many without care. I think the other thing that we see in the survey is that even those who do have access to a family doctor and a practitioner, they're often still struggling with aspects of care, including getting care in a timely way. So, you know, we see challenges getting

care when you need it urgently. Challenges getting care outside Monday to Friday, 9 to 5. Actually, only 31% of people said that they could do that with their clinic. And actually, less than 50% of people said that if their family doctor is a way that they'd be able to get care from someone else at the clinic. So those are still big access issues, even for people who have care. But I will say our survey also, I should say, you know, it looks at a comprehensive picture of primary care. One that we wanted to look out because it matches what patients in the public told us through our care they wanted to see in a better system. And we also look at things like do they have access to health records, you know, are they empowered? And so there are a number of

other nuances there that we can talk about that, you know, really paint a picture of how primary care is in Canada. Let's talk about what is happening, and the positive that's happening. One of the reasons why we wanted to have this conversation is because often this is looked at as one of those intractable problems. It's too big. We couldn't possibly address this. The number keeps going up. You're not going to get a doctor or primary care. What is behind the increased access to primary care? So, yeah, I mean, I think of this as a complicated problem and one that we can fix. And I think there's many different things that we need to do when governments have started to do some of them. So first off, governments have recognized that this is an important thing for people and that too many

people don't have access. So they've made commitments and they've made investments. So in many provinces, we now have new agreements between the government and doctors that actually make family medicine more financially attractive. And I think better respected because it addresses things like recognizing that administrative issues or burdens are something that family doctors face. We also have initiatives to increase medical school enrollment and increase the number of family medicine residency spots specifically. We also saw, as you mentioned, the fast-tracking of international medical graduates. And then we also see important funding investments.

So, you know, I think of Ontario as one example where the government has committed to more than $2.1 billion, specifically to fund teams. And these teams, we hope, actually extend the ability of doctors to be able to see more patients. Of course, in Ontario,

they've also appointed to Dr. Jane Philpott as the head of the primary care action table. And they actually passed a new law in Ontario in June. This might have gone a bit under the rules, radar, but I think it was a really positive step. It's called the Primary Care Act. And it actually legislates that primary care is the foundation of the system and that everybody deserves access and they have six objectives. And those six objectives, Matt, actually mirror concept for concept, the hour care standard, which is something we put forward

as six elements that what the patients in the public want to see in a better primary care system from our research. That suggests that people are taking this issue, not that they didn't take it seriously before, but they are taking it seriously now. Absolutely. And I think that's actually the first step and then setting the goal that everybody needs access. So in Ontario, they've set the goal, 2029, everybody is going to have access. We have to see how that plays out. But I know there's a lot of people working behind the scenes to make that happen. So where are we falling short then? 5.9 million people. You can imagine if you're one of those people, you're saying, well, that's great. But it's not me. So where are we falling? Well, I mean, I think there's still a lot of work to be done, obviously, in many different areas. We know, for example, that many people who graduate from medical school. still don't find family medicine an attractive profession and even those graduating within family medicine residency are often drawn to other parts of the system. We've talked about how that's even happening within the medical schools themselves, where people

are being not told, but steered out of family medicine. You should head into specialty rather than something like a family practice. Yeah, so we need a whole change in narrative. And so a change of narrative that family medicine is not just like important, but also really hard and something that we respect. And, you know, that's something that people need to go, should go into because it's fun and it's full of joy. And is that happening? I think it is happening. I think actually when they see, when people, when young graduates see that governments are making new investments, it makes it more attractive. We've also seen that people want to work in different ways, right? They don't want to own a small business. They want to have teams. And we see governments,

not just in Ontario, but like in Manitoba and Nova Scotia and other places, invest in teams where there are other options for new graduates. So I think that we're in the right direction. We do need, though, continued – we need to keep our foot on the guess, so to speak, you know, continued investment, keeping primary care a priority. And I will say not all provinces have stepped up equally. And so we need all provinces to make this a priority, all territories to make it a priority, and then follow through with the investments, particularly in teams.

I said the other thing I'll say, Matt, is we've really hung our hat on team-based care. here, partly because we have a doctor shortage. But some of our other research has shown, you know, that it's hard for teams to work effectively together if you just throw different people together and, you know, don't actually tell them what each other should be doing. And so we need to make our teams even more effective so that they can care for more people. Right now we have a very unequal situation where some people have a lot of care, maybe with a family doctor, maybe with a team, and some people have nothing.

I actually think we need to even that out and have some hard conversations. about, you know, does it mean that in some teams, you know, some people are actually going to get less care than they're historically used to because, you know, others need it? We're going to talk in a moment about what's happening in Kingston, this health clinic there that seems to be taking an innovative approach. Are you seeing, I mean, giving an example of innovation elsewhere that you've seen in the country? Somebody else who's doing something interesting. So I actually host my own podcast. It's called Primary Focus. And it's really about trying to tell stories about how it is that we can get to the vision that patients in the public wanted to see.

So we talk about other countries, but this season we're actually focusing on Canada. And, you know, we have a few stories that come to mind. One is we went to a clinic in Calgary. In that clinic, they've really figured out how to make team-based care work. They actually, each doctor, their target roster size is 250 to 300 patients per half day. So that's almost double, basically, what other doctors in the field usually take care of. So we really can learn from them, I think. There's a great clinic in Renfrew County.

So my colleague, Jonathan Fitzsimmons, there, he developed a hybrid approach to care to try and really serve a really underserviced community where there's not enough doctors by allowing some doctors from big cities to actually provide care in a hybrid model with the team being in person and sometimes the doctor being away. And then I have a story in Quebec where we talk about researchers who are actually trying to help teams work more effectively to provide timely access, something that we know is not happening well in Canada in general. So really like there's these pockets of leadership around the country that I think we can learn from and that people are learning from and that I think are going to spread. And you think just finally you're confident. Again, Ontario has put this pin in the map saying by 2029, everybody's going to have access to primary care. There's millions of people perhaps who are in that. cohort who are thinking me, will that be me? Will we address this across the country, do you think, in a meaningful way? Is that a deadline that is actually achievable? 2029 or 2030?

I think it is achievable in Ontario. I think it's going to take us starting to do things differently, and we can already see that with the new monies that have come out. They're asking teams to look after a whole geography, not just people who come in through the door. And so what I'd like to see, Matt, is every province and territory passing something like the primary Care Act, which actually would hold governments accountable to ensuring primary care for all, and actually reporting on it. You know, we actually don't have many reports that say what, you know, each province saying how re-faring in comparison to what it is that patients in the public want to see.

I also want to say that there's some things in the hour care standard that, you know, like having access to your own record that I absolutely think are achievable. There are no technical barriers there. It's just political will. So I'd like to see that move forward. And I actually, I think it's very possible if we legislate access to records as an example. We like talking about problems that seem intractable but are actually solvable. Dr. Kieran, thank you very much.

Thank you, Matt. Dr. Tara Kieran is a family physician at St. Michael's Hospital, Fidani Chair in Improvement and Innovation at the University of Toronto, and the project lead at Our Care, an organization focusing on this new research, looking at the future of primary care in Canada. You can find the full report and a dashboard at ourcare.ca. This ascent isn't for everyone. You need grit to climb this high this often.

You've got to be an underdog that always overdelivers. You've got to be 6,500 hospital staff, 1,000 doctors all doing so much with so little. You've got to be Scarborough. Defined by our uphill battle and always striving towards new heights. And you can help us keep climbing. Donate at Lovescarbro.com. Scarborough.ca. Are your pipes ready for a deep freeze? You can take action to help protect your home from extreme weather.

Discover prevention tips that can help you be climate ready at keep it intact.ca. In the province of Ontario, the premier, Doug Ford, has given, as we said, the former federal health minister, Dr. Jane Philpott, the job of fixing primary care in that province. And her vision, which she outlined in her book, Health for All, guaranteed, primary care for everyone based on their postal code. It's similar to a public school catchment area. In Kingston, Ontario, that is already happening for one postal code. Megan O'Leary is Director of Clinical Service as a Kingston Community Health Centers and oversees the Midtown Kingston Health Home and other clinical spaces and joins us now. Good morning to you.

Good morning. We know that, and you just have to look at the images to see the people who need a family doctor. You need to call around. You've got to beg. You have to line up by the hundreds and the freezing cold people have called it the hunger games. How does it work at your clinic if somebody needs care? Yes, well, we've been working really closely with our Frontenac Menick and Addington Ontario Health team. So again, the regional body coordinating efforts to address the primary care crisis. And we really have pulled together across different primary care organizations and with the

OHT leadership to come up with a coordinated strategy for attachment. And so we really are all aligning ourselves around this provincial idea of geographical attachment. And so we've worked together to identify what clinics are attaching, who has capacity, and looking at neighborhoods specifically and kind of carving out postal codes. And so with our new Midtown Kingston health home, we did settle on attaching those who are in the K7M geography, which is a large area of Kingston with about 50,000 people. But it was a good starting point. And so if you were in that postal code, you have access to care. Yes, exactly. And so we are pulling off health

Care Connect, which, you know, does take time to attach everyone and then have those intake appointments. But we are visibly moving through that list and clearing people up Health Care Connect in K7M. What are the services that you offer patients? Your clinic is called a health home, which is the name that Jane Philpott used for the primary care hubs that she was kind of thinking of. So what are the services that you offer? So we do attach people to ongoing primary care.

But then one of the novel pieces of a health home is really taking a community health approach and a population health approach. And so really, which is founded in some of the core pillars of community health centers, but so also offering population health intervention. So while we are attaching people to ongoing primary care, we also know that timely access to care for specific populations is really vital during this time when there is such a shortage. And so we continue to see people who need timely care like those who are pregnant and so need

prenatal supports. We're providing access clinics for well babies as well. So again, newborns who don't have access to care. And then we also offer broad sexual health and reproductive health clinics as well. So again, making those services available to the whole community. And so they really are geared towards serving those who are unattached while we, you know, work as hard as we can to attach people to care. And cancer screening is another important piece there too. So we do do a lot of cancer screening and preventive care for the whole community. I was going to say you know the need because, I mean, there are these photos, and they were from Kingston from 2024. If people lined up down the block waiting to get a doctor, your clinic actually used to be home to, what, eight family doctors who all retired or left.

So how would you describe the need in your community? Yeah, well, we certainly feel it every single day. So again, you know, people just desperately trying to search out care. And this is why we do think this multiple approach of attachment to ongoing primary care plus these access. allowing timely access of population health needs really does have the biggest impact and serving the most number of people. And, yeah, I think addressing just the population health needs of the community. And so we know there was a lot of people waiting, but again, I think a coordinated effort

working with all our different primary care providers and health system partners really is making a difference in Kingston. How many people have you been able to get off of the wait list? Over 2,000 have come off Health Care Connect for the K7M. And then we also are working with our system partners, particularly at the hospital, some specialists. And so they're identifying people who live in K7M who are engaged with services at the hospital when really they should be followed by primary care. So we have created something called these formalized pathways for attachment. And so while we're pulling off Healthcare Connect, we are also working really closely with our specialists and other...

places within the healthcare system that are really feeling bottlenecked and the pressure of supporting unattached individuals. And so we are attaching people through those pathways as well. Which I think we can. Health Care Connect is the Ontario kind of service that connects people with family physicians. One of the things that you hear from people is that they feel like they're just languishing on that list, waiting that they're there, but they don't know whether the call is ever going to come. When you're able to move 2,000 people off of that, I mean, what kind of reaction have you had from those patients. I definitely feel like the tides have changed where people do feel that sense of hope, they do feel like there's some traction and movement off healthcare connect. And so we are on track

to be able to clear the last, like for the K7M postal code, there's still another 2,000 people left, but we are very hopeful that we're going to be able to move through those before the end of March. How have you been able to address the concerns that some in family medicine have articulated on this program and elsewhere, that they want a better work-life balance. One of the reasons why perhaps they want to get out of family medicine or they don't want people to go into family medicine that they know is because of just how overwhelming the workload can be.

How are you addressing that? Yeah, and we really are trying to change that narrative. I think one of the values of our model and benefits that is quite appealing to new family physicians is that it is salaried. So it's a team-based care model and everyone is salaried. including the physician.

So that does come with some balance in terms of paid vacation time, paid sick time, so you can actually be off when you are sick, and working really closely with a multidisciplinary team to provide care collaboratively. And so some of those pieces really are what new grads are looking for to be able to strike that balance. And that also deals with some of the overhead issues. Again, issues of billing, paperwork, what have you, things that people feel like, you know, workload that is taking them away from actually seeing patients because it's time that they have to

spend on this other stuff instead. You're able to address that as well? Well, exactly. Like this, in essence, really they are then an employee in the community health center, right? And so their role is to provide ongoing primary care and continuous care to patients and are not having to deal with any overhead. We don't do any shadow billing or billing. And so that administrative piece really is cut out of it. They aren't responsible for human research. resources in HR, you know, like those are big time-consuming pieces that there are other people on the team who are responsible for those. And so physicians really can do what they do best in terms of practice medicine and provide comprehensive care. Let me just ask you quickly two final things.

One is make the pitch. Why is this money worth spending in a time when we know that the system is being stretched in all sorts of different directions? People understand the need for primary care, but from your perspective, why is it an investment that governments need to make? Well, as we mentioned, you know, primary care really is the cornerstone and the entry point into the broader health care system. And so it is the starting point in the foundation. And we really need to be investing money where we can build long-term relationships with people in the community and provide that ongoing primary care and really then support them effectively and efficiently navigating the rest of the health care system. You know, referrals shouldn't be going into specialists for things that can be done in primary care. And so I think it starts with investing in primary care so that the rest of the system can also, you know, work to the top of their scope and do what they do best and reduce some of the bottlenecks that we are feeling in the system. And so I think team-based primary care is where there can be a lot of efficiency in terms of coordinated, integrated care.

And also taking that community approach as well, really being embedded in community, creating a sense of community and focusing on the health and wellness of the whole population. Just finally and briefly, you're dealing with one postal code. How do you get beyond that? Yes, I think, I mean, we have our work put out with our K7M postal code alone. But this is where it's all, I think, about partnership and coordinated planning. And so this is, again, we're working with the Fronten, Lenox, Addington, Ontario Health Team, and taking a very coordinated approach and pulling all partners together to plan it in a coordinated way and understanding where there's capacity and where there's gaps.

And so this is, like, in our region, we've identified. where there is areas, you know, north of town and to the west of town where we do need to set up, you know, another clinic and another team because there is an existing capacity to attach people. And so I think through our efforts, you do see where the next steps are towards, moving towards that goal of attaching everybody to care. It's really interesting to hear what you've done already and where this might go. As I say, this is a good news story, and we don't hear a lot of that particularly when we're talking about people getting access to primary care. Megan, thank you very much.

Thank you. is Director of Clinical Services at Kingston Community Health Centers and oversees the Midtown Kingston Health Home and other clinical spaces. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon.

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