March 6, 2025
The Empire Club of Canada Presents
Moving Primary Care Beyond Crisis – What Should Canadians Expect From Our Elected Officials?
Chairperson: Jenna Donelson, President, Board of Directors, Empire Club of Canada
Distinguished Guest Speaker
Dr. Joss Reimer, President, Canadian Medical Association (CMA)
Moderator
Kelly Grant, Health Reporter, The Globe and Mail
Panellists
Dr. Dominik Nowak, President, Ontario Medical Association
Dr. Ojistoh Horn, President, Indigenous Physicians Association of Canada
Head Table Guests
Saurabh Popat, Director of Business Development, Public Sector, TELUS Health
Joby McKenzie, Managing Director, Teladoc Health Canada
Welcome Address by Jenna Donelson, President, Board of Directors, Empire Club of Canada
Good afternoon, everyone. I’m Jenna Donelson, Chair of the Board of the Empire Club, and your host for today’s event.
To formally begin, I want to acknowledge that we are gathering on the Traditional and Treaty Lands of the Mississaugas of the Credit, and the homelands of the Anishinaabe, the Haudenosaunee, and the Wendat Peoples. I encourage you all to learn more about the Traditional Territory on which you live and work.
Today’s event would not be possible without the generous support of our sponsors. The Empire Club is a non-profit organization. Our sponsors generously support the club. They make events like this possible, and they make viewing complimentary to those of you that are online. So. Please join me in thanking our Lead Sponsors, TELUS Health and Teladoc Health Canada. Thank you. Thank you, as well, to our VIP Reception Sponsors, Scotia Wealth Management. Thank you for your support. And thank you to our Supporting Sponsors, Lifespire and Santis Health. We appreciate you. And a big thank you to our Event Partner, as well, because we could not have done it without the Canadian Medical Association. Thank you to the CMS. And we also deeply appreciate the ongoing support of our Lead Season Sponsors, Bruce Power and Hydro One, and our VIP Reception Season Sponsors, Waste Connections of Canada and Ellis Don. Thank you for making these happen. And finally, thank you to our Media Partner, the Toronto Star, and our AV Partner, Bespoke Audio Visual. Thank you.
If you have a question for our speakers, please scan the QR code that is found on your program. If you’re online, use the Q&A function to ask a question. For those of you who are online, if you require technical assistance, reach out to our staff using the chat function.
Here in Ontario, we have a government with a recently renewed mandate. Across the country, other provinces and the federal government are also looking ahead to elections. And the question we all must be asking is, what should Canadians be expecting from their elected officials, when it comes to primary care? How can we make sure that policy and funding commitments translate into real improvements for patients? And how do we hold decision-makers accountable for closing the gap that has left 6.5 million Canadian adults without a primary care provider? A strong healthcare system is a core expectation of Canadians. It may be even core to our national identity. It wasn’t an easy thing for us to create, and it isn’t always easy to sustain. But it’s now become a part of who we are.
And the Empire Club was one of the places where the idea of universal healthcare in Canada was first discussed. In fact, in 1945, Tommy Douglas stood on this very stage to talk about his post-war plans, including the free health services being offered in Saskatchewan. He spoke of what would eventually become Canada’s universal health system.
Today, we find ourselves at another defining moment. Core aspects of our primary care system are in crisis. It is, if we are honest, straining under the weight of an aging population, increasingly complex care needs, and significant workforce shortages. And while these challenges affect all Canadians, they are particularly acute in rural and Indigenous communities, where disparities in the healthcare system and access and outcomes remain stark. Indigenous communities continue to face systemic barriers to care, with significantly lower life expectancy, higher rates of chronic illness, and limited access to primary care providers. Addressing these inequities in our health system is critical for policy change, and it is a moral imperative.
One of the great things about being Canadian, I think, is the deep knowledge that there is always more to do. As Canadians, we know how to roll up our sleeves and get the job done. And thankfully, we have an expert panel here today to help us with that very thing, and help us explore these pressing issues. We’re all looking forward to hearing how we can make something that is good, and something that is such an important part of who we are as a country even better.
So, to get the ball rolling, it is my pleasure to invite Saurabh Popat, Director of Business Development, Public Sector at TELUS Health, and my colleague on the board, our third Vice Chair of the Empire Club Board of Directors, to deliver opening remarks. Please join me in welcoming Saurabh to the stage. All yours, sir.
Opening Remarks by Saurabh Popat, Director of Business Development, Public Sector, TELUS Health
Thank you, Jenna. Welcome everybody here today, and everybody online. On behalf of TELUS Health, we are very pleased to support today’s event, and the very important dialogue about how to improve primary care across Canada. As a proud, Canadian-based leader in digital health, TELUS Health is focused on supporting primary care clinicians across the country. We are seized with the sense of urgency to innovate, enable, and empower frontline primary care clinicians with the solutions to help them improve care delivery. We believe that supporting clinicians and citizens at the primary care level is foundational to improving the health and well-being of all Canadians. Whether that be through virtual care, home health monitoring, our electronic medical record solutions, which are available in every province and territory across this great land, or our unrelenting focus on advancing data interoperability, personal health records, and building practical AI tools to improve clinical workflows. These are all paramount to improving primary care.
Now, we have all heard and seen the challenges in primary care across Canada, including the lack of access to family doctors, the stress and burden on current practitioners, and the need for more innovative recruitment, retention, and licensing strategies. While we have crossed many thresholds, we are still faced with the daunting task of addressing critical gaps in primary care. Collectively, we must persevere, and continue removing barriers, and working collaboratively to implement practical, innovative, and sustainable solutions, while maintaining a relentless focus on supporting our clinicians and patients, so that they can thrive.
It’s with this collaboration in mind that I’m pleased, here, to introduce Dr. Joss Reimer, President of the Canadian Medical Association. Now, the last time the Empire Club of Canada hosted the CMA President was in 2011, so we’re very honoured to have you here today, Dr. Reimer. Many of you know that Dr. Reimer is an expert in public health, health equity, physician leadership, and health communication, which is evidenced not only in her current role as CMA President, but also through her previous role as Chief Medical Officer for the Winnipeg Regional Health Authority. She was the medical lead and official spokesperson for Manitoba’s COVID-19 Vaccine Implementation Task Force, and spent nine years as Director of Population Health at the University of Manitoba. Dr. Reimer practises maternity care at Women’s Hospital in Winnipeg, and has received numerous awards, such as the Humanitarian of the Year by Doctors Manitoba, Distinguished Alumni from the University of Manitoba, the Queen Elizabeth II’s Platinum Jubilee Medal, and recently, a recipient of the King Charles Medal. She completed her medical training at the University of Manitoba and McMaster University, and holds a Master’s in Public Health, focused on health communication. I look forward to hearing from Dr. Reimer and her colleagues here today, and I invite you all to please help me welcome her to the stage. Thank you.
Dr. Joss Reimer, President, the Canadian Medical Association
Good—was it afternoon or morning? I don’t know what time—good day, everyone. Thank you so much for this opportunity. Merci a tous [Remarks in French ] And specifically, to talk about this topic, because I think it’s something that’s front of mind for many of us, and something that’s personal to all of us. And we’re going to talk about access, we’re going to talk about how to make the system better. But what I know for sure is that every single person in this room, either yourself or someone you love, has struggled to access the care that you need. And so, this is something that’s deeply personal to me, but I think also to everyone that’s here. So. Thank you for coming.
And I’m going to speak from a few different hats today, because I’ve worked in a variety of different settings. So. I’m a public health physician, that’s my main training. I worked at the provincial level, I taught at the University of Manitoba. But I also continue to work in clinical medicine at Women’s Hospital in Winnipeg, delivering care directly to patients. In the past, before the pandemic, I worked in both team-based and in a solo physician clinical practice in primary care, and also spent several years as a health administrator, as you heard in the start. And so, I’m speaking from all of these different perspectives: as the clinician in primary care, in the hospital, in health administration, and then, of course, also currently, as president of the Canadian Medical Association, where we represent all physicians across the country, and medical learners, and advocate on their behalf, but on behalf of all of us, to make the health system better. And we know we can make it better.
So, I’d like to explore a few of the challenges that we face, when it comes to primary care in this country, and some of the potential solutions that could make a big difference for Canadians. We, of course, can’t ignore what’s going on around us. And I think from the time when we started the conversation about this session to today, there’s been a few shifts in the context of the discussion. Let’s be honest, 2025 had a wild start. From the prime minister’s resignation, to the prorogation of parliament, to the quick election that was just completed here in Ontario, it’s looking highly likely that we’ll be heading to the polls this spring for a federal election, and on top of that, the US proceeded earlier this week with imposing tariffs—tariffs on Canadian exports, which will no doubt worsen the affordability crisis in Canada, and put a strain on Canadians’ health. As a public health physician, I know, and I think all of you know, that income is the number one determinant of health. So, when we’re talking about the healthcare system, we know that these tariffs will impact Canadians’ health, and will increase the burden on the health system. And so, it’s critical that we have a strong healthcare system, to help mitigate the impacts of what’s going on around us.
Information coming out of CD Howe Institute in January showed that affordability is already a significant barrier to healthcare across the country. Many people forego medications, forego mental health services, or home care, because of the cost. These are all preventative aspects of care, that can make people’s health not only better in the moment, but prolong their good health throughout their life. We also know, from a recent study that Health Canada did, that we are short 23,000 family physicians in this country. That is a jaw-dropping number to me. We graduate about 1,700 family physicians per year in Canada. And so just think about those two numbers: 23,000 and 1,700, and think about how many years it would take for us to fill that gap—assuming nobody retires, nobody gets sick, nobody decreases their hours, and knowing that only half of the people we graduate end up doing comprehensive family medicine. Without many other solutions, we will not be able to fill this gap, just with the training that we’re doing right now. And these gaps are even greater, when we look at remote communities, marginalized communities, and populations.
This is all happening at the same time as we also right now see, in the US, a complete disregard for science, where there’s been devastating cuts happening to research funding, there’s been major controls going into the language in science communication. As a public health physician, we really depend on a lot of the work that the US does in public health. And so, to see some of their public health communications just disappear is something that we’re really struggling to grapple with, because they were a bit of a given, that we had that partnership, that we had that resource. And to suddenly not have a reliable partner in this work means that we’re going to need to step up in Canada.
So, for all of these reasons—and a myriad of other reasons that we don’t have time to talk about—we need a strong healthcare system today more than ever.
So, now that all sounded quite bleak—and despite that, I swear I am an optimistic person, and I am optimistic about this, as well. I am optimistic because we do have solutions, and we have seen examples of good policies being put in place. I am optimistic because everywhere I go in this country, I meet healthcare providers, decision-makers, everyday Canadians, who care deeply about this country, and about the health of Canadians. Last year, for example, the CMA talked to over 10,000 people, healthcare providers, patients, stakeholders, about where the system was failing them, about what they wanted to see, and what solutions could help bridge the gap for them. What we heard loud and clear across the country was that Canadians strongly value our public health system. They also told us that they need access, and they need that system to be responsive, and based on need, and not their ability to pay. They want a public system, though, that works. They want care where they need it, when they need it. They want a wider array of publicly-funded services, and that includes medications, mental health, home care—the same things that people are foregoing because they can’t pay for them.
And so, this is one example of a policy that gives me hope. The first Pharmacare agreement was signed last week, in my home province of Manitoba. I was so excited to get to be at the announcement, to see that first one get agreed to, and hopefully get medications to people. I work at Women’s Hospital in Winnipeg, so the fact that contraception was in there was, personally, really wonderful—because I’ve had so many patients who have either had to go for tubal ligations, because the surgeries are covered by the system, so it’s free, or have had an unintended pregnancy. And both of those are not great options, because having an invasive surgery that you don’t need: not a great option. It also costs the system thousands of dollars, whereas contraception would be tens per month, depending on what you’re, what type of contraception you’re using. And then obviously, having an unintended pregnancy is going to cost a lot more—even if we ignore the social elements, and that’s the cost side. And so, speaking from my practice, that was an exciting part to see. And I look forward to other provinces following suit, and I know there will be some others get announced very shortly. Because Canadians need to have access to care, and that includes medication, that includes the diabetes medication, contraceptives, and hopefully in the future, others, as well.
We also welcomed the clarity that the federal government recently brought to the Canada Health Act, and we agree that medically necessary primary care services should be publicly-funded, within a team-based approach—and I’m not going to delve too much into team-based, because I know we’re going to end up talking about that with the panel, because I’ve talked to these two other physicians quite a bit, and we all agree on team-based approaches—but we do also urge the government to eliminate any ambiguity that allows for fees to be passed on to patients. And we hope to see similar clarification on the provision of virtual care, because there’s no going back on virtual care. That is something that is in our system, that Canadians want to have access to, and so we want to see that as part of the publicly-provided system, as well.
There are many things that we need to do to expand the capacity in the public system. I already mentioned we’re 23,000 family physicians short. And so, just increasing the number of physicians is not going to be the only thing that fills this gap. We need more doctors, there’s no question. But graduating more doctors takes a lot of time. The average family physician has 10 years of post-secondary education. Time is not on our side right now. There are already 6.5 million Canadians who don’t have access to a family physician. So. We need to also be expediting pathways for internationally-trained physicians. That needs to be part of the solution. And some provinces are doing just that. For example, in Halifax, they recently opened up a new clinic, where the purpose of the clinic—other than providing care to patients, which it will do—is to assess internationally-trained physicians. And so, much like how we have clinics where we have medical students and residents that come through, and are assessed as part of their training, this clinic’s whole purpose is to spend several months with internationally-trained physicians, and have them come through on a rotating basis to make sure they’re ready for practice in Canada. So. There are these really unique ideas out there, that we can learn from, and expand across the country. We also know that this is not something we want physicians alone to be carrying. There are so many amazing healthcare providers who have different expertise, that can, that can balance really well with the expertise of the family doctor. And having the right health provider deliver the most appropriate care is the way of the future.
When we work together in teams, our health providers can work more efficiently, they can respond to community needs more effectively. I can speak from my own experience where, like I said, I worked in a solo physician practice, and then I moved to a clinic where we had occupational therapy, a social worker, a dietitian, nurses, a pharmacist. There was no comparison between those two clinics, both for what my patients experienced, but also for me as the physician. When I had someone coming in with gestational diabetes, and being able to send them to our dietitian to talk about low-cost, diabetes-friendly diets, or seeing our pharmacist, who could teach them how to use a glucometer to check their blood sugar, that took a lot of weight off of my back. But also, they spent half an hour with the dietitian, who has more expertise in nutrition than I do, and was such a wonderful service to be able to provide patients. And sometimes, they came in, and just saw the physiotherapist—they didn’t need to see me, because they just needed some exercises, because they’re having some hip pain related to their pregnancy. That’s what we want to see in the future, where we work together in these teams, where we share a health record, where the physician is working with the other healthcare providers in the same space, and where we go in, and we get the care from the right expert at the right time. We know this is something Canadians are ready for.
A national survey that was conducted by Dr. Tara Kiran through OurCare showed that 90% of respondents are comfortable seeing other healthcare team members, if recommended. That’s a pretty big number—it’s rare that you get 90% of people to agree on anything, so clearly, Canadians are okay with this idea. And the CMA has endorsed the OurCare standard, which is a new benchmark for assessing quality of primary care in Canada. And we’re proud to support the second iteration of the OurCare survey, which is currently in the field, to measure how care in Canada is stacking up against the benchmark. So. Hopefully, we get to come back and let you know what the results of that are, but right now, they’re in the midst of doing that.
Other solutions to expand capacity in the system include eliminating time-consuming repetitive administrative tasks. So, this means bringing in AI and other technologies, in a safe way, in a way that is going to be sustainable. I know that here in Ontario there’s been some funding to bring in AI—and hopefully, Dr. Nowak can talk about that, because he’ll have more expertise than I do about what Ontario’s been doing.
We need to connect all points of care to empower patients with their health information. And this, there’s major variation across the country, how much access to our own information we as patients have. We need information and data to be interoperable—and by that I mean, accessible—that we can see it not just from hospital-to-hospital, but also from hospital to community centres. You want your doctor to be able to see what happened to you when you were in the hospital, when you come into the clinic. Because let’s face it, it’s hard to remember everything that happened. When I go to my own doctor—and I am a doctor—I walk away going, “Okay, did they tell me to take this twice a day or was it once a day? Am I supposed to go up or down, if it doesn’t work?” Like, these are hard things to remember. And you want your doctor to see what medications you’ve already tried, when you had a bad reaction, what somebody diagnosed you with, if you were in a different province. These pieces of information can sometimes be life or death. Sometimes, I don’t know that someone’s had a bad reaction to something, and if I prescribe it, they could have serious consequences. And so, we need to invest in being able to communicate throughout our electronic systems.
We also need to support our healthcare providers, so that they can thrive in their work. When I talk about administrative burden, it’s not minor. Our family docs, depending on what survey you look at, spend 10 to 19 hours a week doing paperwork. Like, 19 hours a week, that’s a half-time job on paperwork. Think about how much more we could do, how much more care we could provide, if we even cut that by a quarter—that’s a dramatic amount of time that’s being spent not caring for you.
And even things like changing physician mobility could have major impacts. Right now, physician mobility is limited. With a few exceptions, practicing in a different province or territory involves quite a burdensome process; it also requires thousands of dollars in fees. So. If I am living and working in Winnipeg, where I am, and Kenora—which is not far away, it’s a two-and-a-half-hour drive, it’s a really nice lakeside town, that Winnipeggers love spending time in. Let’s say their ER needs help for the weekend. I can’t go help out—not only because I really shouldn’t work in the ER; you wouldn’t want me as your ER doctor, but separately—even if I was an ER doctor, I can’t go help out there, because I don’t have a licence in Ontario. And so, I would have to apply for a licence in Ontario, I would have to pay the several thousands of dollars to get that licence. There’s also other—I mean, even beyond the licence, I would need to get privileges at the hospital. There’s many steps. But how many Winnipeggers, who already love to spend their summers in Kenora, would be like, “Yeah, I’d go there for a weekend. That sounds great.” Or who would be willing to go up north for a week every couple months, to a community that doesn’t have a doctor living there? But do they want to apply for a licence, and pay thousands of dollars? Maybe not. This fragmented approach contrasts with the spirit of the Canadian Free Trade Agreement to support mobility rights of workers, and patients are the ones paying the price. So. We particularly were excited to see that there was a creation of a national registry of physicians. So. It’s being worked on right now; I feel like we’re about to roll it out with details any day now. But the Medical Council of Canada is going to have this registry, so that across the country we can see who’s where, and whether or not they’re in good standing. And that’s a first step towards mobility. Because if we all can agree on who’s where, and whether or not we think that they’re a trustworthy doctor, maybe we can get things going. And right now, when we’re talking about interprovincial trade barriers, and labour mobility barriers, I feel like there’s—this is the time to move that topic forward.
We also want to expedite tailored processes to make sure that qualified international medical graduates can safely practice in Canada. And sometimes, their training is quite different than ours, so it’s not just as simple as saying, “Yep, you’re good to go. Go be a family doctor.” Because some people will come with training where they’ve never treated children, or they’ve never treated women—and you obviously aren’t going to be able to say, “Just go run a family practice if you’ve never treated children.” And so, having things like the clinic in Halifax, where they can do that tailored assessment to figure out what someone can do, is something that will benefit all Canadians. But it requires investments, because you have to pull doctors out of their own practice to go do those assessments. Now, that’s a win, if you end up with two doctors coming out, but it still requires that investment.
I’m going to briefly also talk about Indigenous health—but we have the president of the Indigenous Physicians Association of Canada, so I can’t do any justice to the topic, compared to what she can offer today—but we do need to make sure that we include and hold space for the unique needs of Indigenous Peoples, because all of the barriers that I just talked about are experienced by Indigenous Peoples, and then some. This includes anti-Indigenous racism, discrimination, both at the individual level, and at the systemic level. This is something that no one should have to face. In September, the CMA apologized for its role, and the role of the medical profession in the past, and ongoing harms that First Nations, Inuit, and Métis Peoples experience in the Canadian health system. And now, we’re working towards a Reconciliation Action Plan. It’s a plan that outlines how we will advance health and well-being alongside Indigenous Peoples, and make measurable ongoing improvements to their health and wellness, supported by a transformed health system. This means we need to be doing government advocacy, to break down barriers to good health. We need to be working alongside Indigenous partners to support them, and call on government, for example, to guarantee clean water to Indigenous communities. There was a bill that, with prorogation of parliament, is not now moving forward, but we hope gets reintroduced, and we supported that for clean water for First Nations communities. We want to see an end to forced and coerced sterilization, and shut down Residential school denialism. The CMA Foundation [Applause]—the CMA Foundation is also working to support Indigenous-led work. For example, the Winds of Change is a national standard for cultural safety and humility, in the development with the Health Standards Organization. These are just a few of the ways that we can and must do better, to protect Indigenous Peoples’ right to health.
Now, something as a public health physician that is front-of-mind for me always is misinformation. And it may not be front-of-mind, when we talk about the primary care crisis. But let me tell you why they absolutely are deeply related. We did a survey, and we found that 37% of Canadians say they have no choice but to get their health information online, because they don’t have access to a family doctor; 23% told us that they’ve experienced harms, because they followed advice they saw online. That’s 23% who first recognized that that’s what happened, and are willing to admit it in a survey. So. A quarter of Canadians are experiencing harm, based on lies that they’re seeing online. It’s spreading at an incredible rate. And so, it is not an exaggeration to say health is at risk. We know that a quarter of people are recognizing that in themselves, and more are not recognizing it.
And when we have this double crisis of no access to care, and misinformation online that gets pushed at us from social media algorithms, it spreads way faster than the truth. We know that. We are seeing real outcomes because of that, and everything happening south of the border—misinformation does not respect borders, and we are impacted by that, as well. We’ve got measles outbreaks happening in both countries right now, and that’s devastating. As a public health physician, I find it heartbreaking to hear that a child died in the US from measles, because the measles vaccine is 97% effective to prevent measles. That should not happen. We have the tools. And care providers play a critical role, in helping Canadians understand what’s true and what’s not, when it comes to their health, and how best to look after themselves. So. Not only do we need to make sure that, as the CMA and other organizations, that we are trusted sources of online information, but we’ve got to fix this access problem, because it’s one thing to know where to find online information; it’s entirely another thing to have a trusted health provider that you can have those conversations with, who can help you interpret everything you see online, and apply it to your own health.
So. When so many Canadians just can’t access medically necessary care, we have to use all of the tools at our disposal to strengthen the health system. I am grateful for the chance to be here with my colleagues today, to discuss how we move primary care beyond crisis. I dream of the day where we’re not talking about a crisis. We are always going to want to do improvements, to make things better, but let’s get out of this crisis. I look forward to the conversation with these experts that we have. Thank you so much for the time. Merci beaucoup. Miigwech.
Jenna Donelson
Thank you, Dr. Reimer, for those substantive remarks. For what it’s worth, your optimism shines through. So, thank you for bringing us the gravity of the moment, and the tools we need to move forward. It is now my pleasure to invite the rest of our panel to the stage. Dr. Dominik Nowak is President of the Ontario Medical Association. He is also a family physician at Women’s College Hospital, and a faculty member at the University of Toronto’s Department of Family and Community Medicine, and the Dalla Lana School of Public Health. Please join me in welcoming Dominik to the stage. Dr. Ojistoh Horn is President of the Indigenous Physicians Association of Canada, and a family physician from Kahnawake, working in Akwesasne. She integrates both Western and Traditional knowledge in her practice, with a focus on environmental health, the impact of pollution, and holistic healthcare for Indigenous communities. Welcome, Dr. Horn. Thank you. Have a seat. And of course, leading today’s discussion is Kelly Grant, National Health Reporter at The Globe and Mail. Kelly has a deep background in investigative journalism, and has reported extensively on healthcare issues, from chronic disease to the challenges of primary care, and access in remote communities. Welcome, Kelly. Thank you so much. Over to Kelly, and our panel.
Kelly Grant, Health Reporter, The Globe and Mail
Hello, everyone. Thanks so much for joining us today. Before we dive into what I’m sure is going to be an interesting and exciting conversation, I want to let everybody know I’m holding this iPad, because towards the end of this session, we’re going to be taking some questions from the audience. So. I think Jenna mentioned earlier that if you do want to submit a question, you can do it electronically, and I’ll go through the iPad, and hopefully, take some from you in the audience.
So. Here we are. I know we’re here to talk about primary care today, and I’m excited to get to that topic, but I feel like I would be remiss if I didn’t start off by talking about the American elephant in the room, which I think is something that’s on all of our minds this week. And so, for you, Dr. Horn, because you practice in Akwesasne, which is on the border, Québec, Ontario, and New York State, I wonder if you could start by telling us what concerns you have about some of the policies that we’re seeing from the Trump government.
Dr. Ojistoh Horn
Thank you very much. This is a very interesting time. Akwesasne is a Kanienʼkehá:ka, or Mohawk community, and we’re bisected by the Canadian-American border, as well as the Ontario and Québec provincial border. So. We have multiple jurisdictional issues. And a lot of the people in the community get their information from the American news networks, and of course, the misinformation streams that we were talking about. And so, the expectations of the people there may be a little bit skewed towards the American side. We also have incredible problems with access to care. And so, a lot of our people have to seek care in other jurisdictions. I do practice with an Ontario and Québec medical licence; I don’t have a New York State medical licence. A lot of our people will have to, for access issues, go into the American side. But now, we’re seeing cuts to Medicare, and we’re also having concerns about many issues.
We have a huge environmental issue that’s happening in our community for 50 years or so. And so, we have an incredible amount of toxic accumulation of pollution, such as PCB, aluminum, lead, mercury, and fluorine. And now, because a lot of these places right upstream and upwind from us, we have all sorts of new industry coming to the area, and this untreated land and water is now at risk of being redistributed over into our community. And so now, with one of the big changes we’re seeing in the south side of the continent, Turtle Island, is the decrease in the, in the Environmental Protection Agency’s ability to survey, and hold accountable different, different industries that are polluting. And so, I’m really worried, because we already have incredible health issues because of these chemicals—our endocrine, neurotoxic, carcinogenic concerns, as a family doctor, are very paramount. And also, we are not able to monitor, we don’t have any surveillance systems. How can I actually, as a family doctor, clinically address something that is environmental? We’re not really looking at that. And right now, this is across the board. Right now, we’re having a massive re-look at the way that Canada procures its natural resources, and are we going to forget about the environmental cost? We have to take, first and foremost, in all of our discussions about what’s going to happen in Canada, the tenants of Bill S-5, which is a right to live in a healthy environment, as well as Bill C-226, which is an act to create a strategy to address environmental racism and injustice.
And so, here we are, on the Canadian side, an Indigenous community. And now, we have to hold the Environmental Protection Agency, we have to implore them to hold account these American industries. And how are we going to do that, when we have a border, we have jurisdictional issues, and now, we have an administration on the southern side, who doesn’t want to hold the environment to account? And so, I have a lot of, a lot of concerns, as a family doctor working in Akwesasne. These are also concerns seen in other parts of Canada, and I appreciate us always taking into account the environmental exposome that seems, that often is put to the side, but is a very strong predictor of health. Thank you.
Kelly Grant
Those are all issues we’re going to have to be keeping a very close eye on, as a country. But just to get back to sort of politics, for a second here, I wanted to turn to you for a second, Dr. Nowak. Particularly, to talk about the outcome of the Ontario election, and the fact that when it comes to primary care, the major development we’ve had here in Ontario is that the provincial government has appointed Dr. Jane Philpott to lead a primary care action team. And her main sort of vision is one in which every Ontarian has access to a family doctor and a family health team, but that people are assigned based on where they live, based on their postal code—which is pretty different, as I’m sure all of you know, from how you go about getting a doctor today, which is kind of beg, borrowing, and stealing your way onto whatever roster you can. So. I wanted to ask you, Dr. Nowak, what you think about that vision, and whether you think it’s possible?
Dr. Dominik Nowak
Yeah, lots of thoughts. I’ll start by asking, who here has a family doc, or a health home right now? Raise your hand. Around maybe half of folks, or maybe a bit more. And actually, I’d say this is a more connected room…
Kelly Grant
M’hm (affirmative).
Dr. Dominik Nowak
…than what the majority of Ontarians or Canadians have, in terms of access to the healthcare system. This has the potential to be historic, right? If we connect everyone to a family doctor, to a health home, it has the potential to be historic, legacy-defining for our government here in Ontario, and rebalance our healthcare system, in terms of it being, again, a source of pride for all of us. And a part of how this has to happen is, let’s say you have a family who’s a newcomer to, to Ottawa or the GTA, or you know, Timmins, for that matter—anywhere in Ontario—they have to have a way of getting access to primary care, to a family doctor, to a health home. That’s true on one hand. That’s geographic attachment. On the other hand, it’s also true that the relationships matter. So. Any family doctors in the room here? Or people training to be family doctors? Give a round of applause for our family docs, here in the room.
Dr. Joss Reimer
Yeah.
[Applause]
Dr. Dominik Nowak
So. I’ll say, we did, we’ve done lots of studies on this, and the relationships matter. If you have a relationship with your doctor, your health professional, you’re more confident in your care, you get better care, you use fewer tests and healthcare resources, you probably live longer, as well, and at a lower cost to the healthcare system. And you preserve the parts of our system that really need to care for those really sick people, like hospitals and emergency rooms, for the people who need them most.
So, the relationships matter. Sure, you know, we need to find a way for everybody to be connected. That can be historic—and it will be historic, with the right leadership from this government—and we’re ready to work with Dr. Jane Philpott, a remarkable physician leader, to getting that done. And at the same time, we have to preserve what makes those relationships with your family doctor truly special, and make a difference for people in the healthcare system.
Kelly Grant
I want to just follow up, and ask you another piece of Dr. Philpott’s vision, the health home that was approved in Kingston, which is where she sort of started the ground floor work of this experiment—and Dr. Kim Morrison is here, I think, as well, who’s really been instrumental, in that work, up in Kingston and Napanee—the health home has a model where the doctors are salaried, right? As most people in this room probably know, you know, doctors are independent, small business owners, in a lot of cases. She is a supporter of the idea of hiring doctors as employees, making them salaried physicians. Do you think that’s a good idea?
Dr. Dominik Nowak
What I’m hearing from doctors across Ontario is that there’s a willingness to be part of models like this. And the benefit of models like this are that you get to focus on doing the clinical work. You get to focus on doing the clinical work, rather than the administration, and the red tape, and bureaucracy of the healthcare system, that’s taking up 19 hours per week of doctor time right now, for our family docs especially. And on the other hand, what makes models like this successful—I’m looking at Dr. Moore over here, as well. Dr. Kim, on the side—is physician leadership. And on one hand, we need to make sure that doctors are supported to being docs; on the other hand, it’s so important that we have physician leadership in these models, to make these teams successful. And some of the best teams I’ve seen have had dyads of physician leaders, and administrative and healthcare leaders, working side-by-side, to getting things done for their community.
Kelly Grant
Yeah. Do you want to add on that?
Dr. Joss Reimer
Yeah. Because I would say what we’re hearing, particularly from our younger physicians, is they’re more open than ever to these ideas. The fee-for-service model is something that was pushed for by, I think, even by the CMA many years ago. But as things are shifting, as the stresses on running a clinic seem to be increasing—I mean, even when we think about the tariffs, our family doctors, they have to pay for everything in their clinics. So. They’re paying for all the medical equipment, but they’re paying for the toilet paper, they’re paying for everything. So, if—and they can’t raise their prices, if their costs go up. And so, the idea that they wouldn’t have to have that stress front-of-mind, and instead, could focus on the patients, particularly the younger physicians, seem to be much more open to that. And I worked for several years as a health administrator, and we ran clinics where our physicians were hourly contractors—so, not employees, but they weren’t responsible for hiring or anything like that—and we never had openings. We were fully staffed, pretty much all the time, while we saw our fee-for-service clinics that were run by the physicians struggling to recruit. So, it’s clear that there’s a desire for change, and to be able to refocus in on the patient.
Dr. Dominik Nowak
Can I “Yes, and” to that?
Kelly Grant
Yeah.
Dr. Joss Reimer
Yeah. Please.
Dr. Dominik Nowak
So, some of the happiest doctors I’ve seen have been the ones that are working in teams.
Dr. Joss Reimer
Yep.
Dr. Dominik Nowak
And there’s a reason for that. And that’s part of how we get our healthcare system back on track, and make family practice, generalism—the parts of the healthcare system that, where we need our doctors—joyful again, and sustainable and viable as career choices, for our medical students and residents.
Kelly Grant
But when we’re talking about teams here, you know, part of, part of trying to make sure that people have access to healthcare without only ever seeing a family doctor has been these sort of moves towards expanding the scope of practice of people other than doctors—your pharmacist, your nurse practitioners. You know, I sometimes hear doctors kind of get their backs up at the idea, the suggestion that perhaps NPs could do their job, or pharmacists could do part of their job. I wonder if I could ask you, Dr. Horn, what you think of these expanded scopes of practice?
Dr. Ojistoh Horn
So, I do think that—I do support the expanded scopes of practice, but I do have some concerns. I know that where I work, my patients are very, very complicated. And there’s no such thing as, you know, just a UTI, and just a sore throat; there’s always so much more. And it takes a long time, and the fee for service model does not account for the complexity that my patients have. And so, when these particular people, who are, have very simple presentations, and they’re seen by our colleagues, that’s very good. But that means I have such a heavy, heavy burden of the people who are not so—who are more complicated. And so, and because the fee for service model does not adjust, it just is very burdensome.
So, recently, our clinic went from a fee for service model to a salaried model. And I can very much attest to the complete the satisfaction with being unburdened from having to fill out the chits, and send it in, and do all that billing. Wow. It’s like night-and-day. And so, that really has had a major change in my happiness for working. And so, as far as having a team approach, it is really wonderful, because I don’t have to think about the billing, to have now a team who can take care of the things, and give me the time to take care of my complicated patient presentations.
The only concern that I have is I don’t ever want us family doctors to be replaced. You know, we do have AI, and now, we’ve all started using them in our clinics. It’s wonderful to now be doing patient-centered care again. I was doing EMR-centered care for a long time, where I’d be typing, and I’d ask questions, and then I’d look, and then I’d continue, and look—and I wasn’t even talking to my patient. And then my exam, I’d get up, and it was very cursory. Now that I have AI, I can actually communicate, talk, and it’s doing its work right here, and I can examine them, and it’s wonderful. It’s like I have a scribe in there, that is helping me to do patient-centered care. I do think I’m doing a better job. However, I’m teaching that machine how to do my job. So, I want to make sure that I’m not replaced one day by this AI machine.
So, what is it that we can do that is different from everybody else? We as family doctors, we’re generalists, we’re diagnosticians, and we do excellent physical exams, when we’re given the time and the space to do that. So, we can have teams where we can once again do what we were trained to do, physical exams, diagnose complicated issues, work with our patients, helping them understand some of the complexities of their care, make these treatment plans that are truly working, and have the time to do that, because of a model that is more salary-focused, rather than billing. I think the team approach is the best way. And I think by doing that we can somehow have the AI as part of our team, and not replace us.
QUESTION & ANSWER
Kelly Grant
I hope I’m reading it right, but I’m seeing my time counting down pretty quickly here. So, we have about three minutes left, if I’m looking at the clock quickly, so this flew by. So, I might just quickly go to the iPad, to take one question here—and I think this is probably what we’ll do. There’s a question here about what role you think municipalities have in playing in attracting doctors. And maybe I could ask you this, Dr. Reimer. Do you think that that is the job of cities and towns, to bring in their local doctor?
Dr. Joss Reimer
Yeah. I mean, I guess I would say it shouldn’t have to be.
Kelly Grant
M’hm (affirmative).
Dr. Joss Reimer
But we’ve seen some really creative examples, where municipalities have taken some leadership steps, to create spaces where the physicians feel supported. And I think that’s the key point, is that whoever is creating it, we want these clinics where the physicians feel like they can thrive, where their work is what they trained to do, where they get to focus on the patient. And so, I’ve seen some municipalities come up with these funded clinics, where the physician really can come in and focus in, and they’ve got the tools and the team to make it happen. The way we organize our system right now, it’s typically the provinces and territories that, that run that, but that doesn’t stop municipalities from taking that step, and trying to attract physicians. I think we just all need to be pushing in the same direction. And that’s the main goal.
Kelly Grant
That’s fair. I think both of you want to add something here, so….
Dr. Ojistoh Horn
Go ahead.
Dr. Dominik Nowak
It’s a hot topic. I’ve spoken with probably over a hundred mayors…
Kelly Grant
M’hm (affirmative).
Dr. Dominik Nowak
…and councillors, and other folks on this—they don’t want to be doing this, right? But they have no choice but to get involved in healthcare. And that’s because we’ve had chronic underfunding, underinvestment in the parts of our healthcare system that serve as that foundation, right? So, there is a role for all levels of government to play, in making healthcare sustainable. But the focus should be on that provincial role, in getting our healthcare system back on track. That’s why I’m encouraged and optimistic about the announcements that we’ve heard, in getting everybody a family doctor in Ontario, as one big example, and the work led by Dr. Jane Philpott.
Dr. Ojistoh Horn
I will say that, when a community is trying to attract a doctor, it’s not just the doctor, but the doctor’s family, their partner, you know, the children, what kind of schools are available, is there affordable housing, are there green spaces, are there safe places to participate in the environment—you know all of the stuff that makes up communities. And so, it’s not just the doctor incoming and having a salaried position, it’s all of the other supports that are not necessarily health.
But this brings me to the second thing. Public health includes all of the other social determinants of health. So, we’re talking about clean water, waste management, roads, public utilities, all of these things that make it, that are very much part of health. And so, that really is the purview of the municipalities. And so, it’s not just creating medical spaces, but community spaces, that will also help with public health. And I think those are part of the magnets that will attract a family doctor to their, to those places.
Kelly Grant
Well, thank you to all three of you. I wish we had a longer time to talk—there’s so many great questions on my iPad here. But unfortunately, we are out of time, so I’m going to turn things back over to Jenna, I believe. All right.
Jenna Donelson
Appreciate it. What a great, substantive conversation. Let’s give our panellists one more round of applause. And thank you all, for the critical work you are doing, to strengthen our healthcare system here in Canada. And thank you, Kelly, for leading such a compelling discussion. I also want to extend our gratitude to Teladoc Health Canada, for supporting today’s event. And so, it is my pleasure to invite Joby McKenzie, Managing Director at Teladoc Health Canada, to share a few words of appreciation. Welcome, Joby.
Note of Appreciation by Joby McKenzie, Managing Director, Teladoc Health Canada
Wow. What a fantastic panel. I know I’m going to start from where we started this lunch, and such great pride. When I hear the Canadian national anthem, I get goosebumps. And this is a moment for us to truly shine as Canadians. I had the privilege of representing Team Canada, using this giant-sized body that I have to play basketball. And so, I know on the world stage, it means a lot to us that Canada is shining. And it is sad for all of us that we think our healthcare system is in crisis.
Good news. Good news, from what I’m hearing in this room, is that there are answers, right? We actually all need to be on Team Canada, rowing in the same direction, as we just heard. And I’m a mother of three, I have a husband—all five of us don’t have the same healthcare needs. I am thankful that the healthcare system has prevented, quite frankly, deaths, or tragic healthcare outcomes. So, I’m proud of our Canada, our Canadian healthcare system.
And I also know, as the Managing Director of Teladoc Health Canada, working from coast-to-coast-to-coast, that we have challenges to solve. And systems across this country are solving it, at a system-level, primary care crisis. And there are actual fantastic outcomes. People in rural remote, Indigenous communities, there’s ways of approaching this at a system level. And we have the privilege of providing not just primary care but also acute care and specialty care, so we can really think about how do we actually achieve outcomes across the Quintuple Aim.
It might seem illogical, in fact, that you can have fantastic patient outcomes, fantastic physician experience, at a lower cost, delivering health equity and population health, but you can actually achieve it, if we think at a system level. In Newfoundland and Labrador, we provide care for 20% of their primary care patients, and we support many hospitals staying open, with our technology in those hospitals—which means, we prevent primary care patients from walking into the emergency department, which means, we’re effectively using emergency rooms for emergency care.
And there’s different ways of doing it, if we think about how do we leverage the proof points that exist, whether or not it’s technology, team-based care, AI—there’s many different solutions—and how do we combine them, and truly feel like we’re standing on a burning platform, to solve these problems that are solvable.
We are all patients. We all have family and friends that need our system to work. And so, hopefully when we come back this time next year—I’ll invite ourselves already—we’re going to be talking in a much more optimistic way about the fantastic outcomes we can have. Certainly, I feel a responsibility at Teladoc Health Canada to contribute. But I certainly know, it’s only through partnerships of us all contributing in different ways, to solve this crisis. And so, truly thank you for allowing us to, to sponsor, thank you for your passion to solve these problems together. I’m really optimistic about what the, what’s in store for the future, and for all of us as patients. Thanks so much. Have a great afternoon.
Concluding Remarks by Jenna Donelson
Thank you, Joby, for those passionate remarks, and for what you are doing to support healthcare here in Canada. Thank you again to our panellists, to our sponsors, to all of you for joining us today. I’d also like to just take a moment to recognize our students and young leaders we have in the room. We have students from Queen’s, from U of T, and from the OMA, I believe. Welcome. We’re glad you’re here with us today.
For those of you that would like to stay connected, please subscribe to our newsletter, by scanning the QR code that you will find on your tables. We also have an exciting new membership program, so if you’re interested in knowing more about that, please see our staff at the registration desk to get a bit more information, and be one of our early adopters.
I also hope you will join us for two exciting upcoming events. On March 20th, we are hosting a first-of-its-kind event here at the Empire Club, specifically focused on women’s health. Terri Hart is going to sit down with Karli Farrow, President and CEO at Trillium Health Partners, Joanna Griffiths, Founder and President of Knix, and Dr. Wendy Wolfman, Director of several women’s health clinics at Mount Sinai. So, that’s one you won’t want to miss.
And on April 23rd, we will be hosting an event on different approaches to longevity. Dr. Kashif Irshad, Lifespire’s Medical Director and Co-Founder, will be coming together with Dr. Samir Sinha, to speak about the science of aging and longevity practices. And to round out that discussion, Alex Besharat of Scotia Wealth Management will be talking about how living longer impacts your approach to financial planning. Tickets for both events are on sale now.
As a club of record, all Empire Club events are available to watch and listen to on our website. A recording of this event will be available shortly. Thank you all for being here today, for being a part of this important conversation. I wish you a wonderful afternoon ahead. This meeting is now adjourned.
