More doctors not the only answer

Recently, Dr. Tara Kiran made headlines when her robust national OurCare survey revealed 5.9 million Canadians still lack a primary care provider — the point-of-entry health professional, like a family doctor or nurse practitioner, who provides routine care.

Those who do have a primary care provider often wait weeks for an appointment, then get rushed through in minutes. Emergency departments overflow with patients who have nowhere else to go.

The federal government has responded to the crisis by creating 5,000 express-entry spaces to fast-track permanent residency for international doctors already working in Canada. But the problem isn’t just more doctors. We have a care-delivery problem. We need a care-delivery transformation.

While providing interprofessional leadership training in Singapore over the past three years, I’ve seen and learned about their remarkable primary care transformation. Recently, a delegation from SingHealth generously shared their approach with over 75 primary care leaders across Canada. Here’s what we learned.

First, Singapore gives patients real choice — with universal coverage and smart incentives for doctors.

Patients enrol with either a private family doctor or a government-funded polyclinic team with a family medicine specialist. Don’t like your choice? Switch.

Health care is universal with a co-pay, funded through mandatory health savings accounts and workplace insurance — with government subsidies if funds run out.

Here’s what makes it work: private family doctors who participate in the national “Healthier SG program” are invited to join a primary care network. In return, they get access to government-funded nurses, care co-ordinators and services solo practices could never afford.

They are not threatened with a hard mandate but a smart one: substantial support in exchange for network membership.

Second, every clinic has a family physician who creates annual health plans with patients.

Government-funded polyclinics are one-stop shops staffed by certified family physician specialists working alongside nurses, pharmacists and other healthcare professionals with lab and X-ray testing on site. Most patients with chronic conditions choose polyclinics because of the accessibility of comprehensive services.

Throughout the year, nurses, dietitians and pharmacists see the patient, bringing in the family physician when needed.

Third, Singapore measures what matters and holds regions accountable — with support. Each regional health system is responsible for population health outcomes: fewer emergency visits, better chronic disease control, reduced hospitalizations. Accountability comes with resources.

The result? Early signs of significant reductions in emergency visits and hospital admissions. Taxpayer money saved — and better health for patients.

What would a Singapore-style primary care approach look like in Canada?

Let’s take for example, a 35-year-old patient — slightly overweight, blood pressure creeping up. The family physician creates an annual health plan which may include goals like losing weight through diet and exercise. Throughout the year, the nurse, dietitian and community supports help the patient succeed.

Same clinic. Different doors.

Mid-year, the patient mentions new shortness of breath. The nurse recognizes this is no longer routine. She knocks on the family physician’s door.

This is where family medicine shines: the ability to reason through ambiguous symptoms, to know what to watch for and when to act. The physician steps in to address complexity team members cannot manage alone, leveraging their longitudinal relationship and seeing the patient as a whole.

Same team, different doors — connected through shared records and relationships. Each health-care professional contributing.

Can we really compare Singapore to Canada, though?

Yes, Singapore is smaller. Yes, their governance differs. But the lesson is universal: when a nation commits to a clear vision, co-ordinates its efforts, provides real support and holds everyone accountable for population health, transformation happens.

It’s about more than just adding more doctors to the system.

Almost six million Canadians without primary care doesn’t have to be permanent. New investments should focus on a co-ordinated national approach to team-based care — with resources tied to keeping populations healthy. The question isn’t whether Canada can transform primary care. It’s whether we have the will to achieve a shared vision.

Dr. Ivy Oandasan is a family physician and full professor at the University of Toronto’s Temerty Faculty of Medicine.