Loading ...

The Canadian Medical Association (CMA) and the College of Family Physicians of Canada (CFPC) have issued a joint statement demanding that the federal government address healthcare systems "on the verge of collapse," starting with primary care.

In the statement, Michael Green, MD, MPH, professor of family medicine at Queen's University in Kingston, Ontario, Canada, and president of CFPC, and Kathleen Ross, MD, a family physician in Coquitlam and New Westminster, British Columbia, Canada, and president of CMA, pointed out that a year ago, the federal government promised "the most significant investment in healthcare in more than two decades" after COVID-19 compounded years of struggle to provide timely care. But much of the money has reached a bottleneck, and agreement on how it should be spent is lacking.

Provincial Agreements

A large part of the government's intended $100 billion investment, wrote Green and Ross, depends on provinces and territories creating action plans and signing bilateral agreements with the federal government. But at the time that the letter was issued, only four provinces (of the 10 provinces and three territories) had signed agreements with the government. They included British Columbia, Prince Edward Island, Alberta, and Nova Scotia.

On February 9, Ontario became the fifth province to reach an agreement when Prime Minister Justin Trudeau and Doug Ford, premier of Ontario, signed a $3.1 billion deal to put the investment dollars to work.

Waits are long for surgeries and life-saving treatments, wrote Ross and Green. They added that clinician burnout is high, with "overwhelming administrative burden" and "inadequate" pay.

"More than 6 million Canadians do not have a family physician," they wrote. "We need action. We need it now."

"Our healthcare system has not been living up to expectations," Trudeau's office acknowledged in a February 9 press release. "From overwhelmed emergency rooms to surgery backlogs to healthcare workers under enormous strain, Canadians deserve immediate action to deliver better healthcare when and where they need it. That is why the government of Canada is making transformative investments to improve how provinces and territories deliver healthcare across the country."

For Ontario, the federal government is promising to "add hundreds of new family physicians and nurse practitioners, as well as thousands of new nurses and personal support workers."

Mental Health Investments

The government is also investing in mental health in Ontario, pledging to add five new Youth Wellness Hubs to the 22 that have been opened since 2020. The measure is intended to help youth access mental health and substance use services in remote and Indigenous communities. "The province will also continue to expand its Structured Psychotherapy Program, helping thousands more Ontarians get timely help for depression or anxiety through free cognitive behavioral therapy and other related supports," according to the press release.

The joint letter by the physician groups links to a letter-writing page with information on calling for further reforms.

The state of the healthcare system in Canada "has deteriorated considerably in the last 5 years," Green told Medscape Medical News. Investment in healthcare was prioritized from about 2003 to 2014, he added.

In about 2014 and 2015, "the government took its eye off of where things were going in healthcare," said Green. The population was growing and aging, healthcare was becoming more complex, and physicians of all ages were prioritizing work-life balance. Supports in mental health couldn't keep up. The pandemic then heightened the accumulated deficits.

Family Medicine 'in Crisis'

Now, "family medicine is in crisis across the country," said Green, "and that's the basis of what everybody needs." In Canada, he explained, to access any specialty service, a patient must first go through primary care.

The Organization for Economic Co-operation and Development has calculated that Canada's spending on primary care, the bulk of which is spent in family care, is just over 5% of the country's total spending on healthcare. High-performing countries are at 10%-12%, Green explained. "We are way underinvested."

The biggest issue in Canadian healthcare now is the growing number of people who have no access to healthcare, according to Green. The average proportion of people without access is 25%, he said, though it varies greatly by province.

Even with the new provincial agreement, the question remains how quickly the money can start flowing to programs in Ontario, said Green.

The Ontario Medical Association (OMA) said in a press release that the February 9 agreement is welcome, but more resources are needed.

"Urgent priorities include fixing the crisis in primary care, addressing the growing burden of unnecessary administration, and increasing community capacity to tackle hospital overcrowding," the OMA wrote. "Far too many Ontarians, a staggering 2.3 million people, are already without a family doctor, and that number is expected to nearly double in only 2 years," they wrote.

The new funding will also help modernize the collection of medical data, which should help decrease paperwork, said the OMA. "The average family physician spends almost 40% of their work week on administrative tasks," it wrote.

No relevant financial relationships were reported.

Marcia Frellick, a graduate of Northwestern University's Medill School of Journalism, has been a Chicago-based healthcare journalist for more than 20 years. Her move to writing followed a progression of editing roles at the St. Cloud Times, the Iowa City Press-Citizen, the Cincinnati Enquirer, and the Chicago Sun-Times. Her writing has appeared in the Chicago Tribune, Science News, and Northwestern Magazine in addition to Medscape Medical News, MDEdge, and WebMD.