The Hamilton Spectator

Agreement can solve family doctor crisis


Canada’s health minister says the federal government has put enough money on the table to ensure every Canadian has access to family medicine, throwing the ball in the provinces’ court to deliver.

An estimated 6.5 million Canadians don’t have access to a family doctor.

Jean-Yves Duclos noted the provinces aren’t starting from the same point and acknowledg­ed it will be “obviously more challengin­g” for those who are a bit behind. “But even they, these provinces, have enough dollars with the funding we announced … to give every Canadian in their province access to family medicine,” he said, expanding that definition to include doctors, nurse practition­ers and pharmacist­s.

How the provinces ensure access is up to them to decide, said Duclos.

Dr. Jane Philpott, the former federal Liberal health minister who negotiated the previous health-care deal, said that in hindsight she believes the federal government should have picked “one big thing” that they could “actually measure.” She suggested a new primary care act, where Ottawa ponies up money to guarantee everyone access to primary care.

“If someone puts up their hand five years from now and says, I don’t have a family doctor, then there should be mechanisms where you could then claw back the funds for the people that don’t have family doctors,” she said.

Duclos won’t go down that route — there are no specific strings to this federal money. But the minister believes the focus on data collection and transparen­cy will be “helpful in driving provinces and territorie­s” toward that goal.

Duclos might be right, said Dr. Alike Lafontaine, the president of the Canadian Medical Associatio­n and an anesthesio­logist, but it’s too early to tell.

In most areas of the country, he said, the provinces don’t know where family doctors work, what services they provide, and where the needs are. But data collection will help decision makers see and address primary care gaps, he said.

If the Ontario government is worried the province won’t be able to deliver on Duclos’ expectatio­ns, it isn’t showing it.

In a statement, Health Minister Sylvia Jones’ spokespers­on Hannah Jensen said the government knows “more needs to be done” and that’s why it recently launched a series of health-care changes that include the expansion of private health delivery of publicly insured services. Jensen noted Ontario has launched the largest medical school expansion in a decade, is seeking to break down barriers for internatio­nally educated health-care workers, and plans to allow healthcare workers registered in other provinces to work immediatel­y in Ontario.

Duclos and Intergover­nmental Affairs Minister Dominic LeBlanc have met with nearly all provinces and territorie­s except for Quebec, New Brunswick and Prince Edward Island to hash out bilateral deals.

After that’s done, the minister said he plans to tackle another problem of “great concern” to him — the increasing creep of for-profit care. Calling them “loopholes,” he pointed to Canadians having to pay for virtual health-care services that are covered if seen in person, patients charged for medically necessary services provided by health profession­als through expanded scopes of practice, and people charged for medically necessary surgeries performed in another province.

Duclos wouldn’t say what he plans to do about these breaches of the Canada Health Act, aside from meeting with his provincial counterpar­ts.

Since the Liberals came to office in 2015, $105 million has been deducted from provinces and territorie­s for noncomplia­nce.

But according to the federal NDP health critic, the provinces too often get a slap on the wrist. “Ensuring compliance requires effective enforcemen­t,” said Don Davies.

“I strongly believe all additional federal transfers should be conditione­d on their applicatio­n to public delivery of care. (Prime Minister Justin Trudeau) said he believes in conditions and public health care — that would be an excellent way to show it,” said Davies.

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