This is the first article in our Coffee with Canadians series, which features conversations with prominent Canadians.
I met with Dr. Alika Lafontaine in a Westin conference room in Ottawa in late March, four months before his one-year term as Canadian Medical Association president was set to end. Even then, Lafontaine expressed no qualms about the job’s short term.
You can only survive this role as a “sprint,” the soft-spoken anesthesiologist and father of four said jokingly.
Lafontaine, who lives in Grand Prairie, Alberta, made headlines in August 2022 when he became the first Indigenous person to lead the CMA, a national physicians’ advocacy association as old as Canada.
He took the reins at a time when, in his words, health care “access has probably never been worse.”
Family physician shortages are a problem across Canada, a 2023 study shows. The percentage of Canadians without a family physician ranges from a low of 9 per cent in Ontario to a high of 75 per cent in Nunavut.
“Without timely access to community care, patients often resort to more costly emergency departments,” the study’s authors note. “[This] leads to an overwhelmed healthcare system that exacerbates physician burn-out and encourages early exit from the workforce.”
Lafontaine and I spoke about some of the ways governments and policymakers are — or should be — responding to the shortage.
Reducing barriers
The cause of Canada’s family physician shortage is multifaceted. Factors include too few spots at medical schools and even fewer residency positions, declining interest in family medicine and significant barriers to foreign-educated healthcare providers practicing in Canada, an RBC research bulletin notes.
Of late, a number of provinces have started to tackle the barriers challenge — something the CMA has long advocated for.
“I’m very excited about the idea of a pan-Canadian standard of evaluation for health providers and the idea of pan-Canadian licensure,” Lafontaine said.
In April, Alberta streamlined the application process for foreign-trained nurses. In May, the Atlantic provinces launched an Atlantic Registry to facilitate mobility of physicians within Atlantic Canada. And in July, Ontario introduced “as of right” rules that allow physicians, nurses, lab technologists and respiratory therapists licensed in other Canadian jurisdictions to start working immediately in Ontario.
“Politicians respond to what their constituents want,” Lafontaine said when asked to explain the sudden momentum on such a longstanding issue. “What has shifted is Canadians are focused on a shared outcome. Sometimes in the past, you get different priorities being discussed. Here, there is unification around the idea of access.”
At the federal level, Conservative Party leader Pierre Poilievre has also promised to bring down barriers by introducing a Blue Seal testing standard similar to the Red Seal certificate that exists for many skilled trades. For Canadian-trained professionals, this standard would facilitate interprovincial mobility. For foreign-trained applicants, Poilievre pledges that the test and results would be available within 60 days.
Currently, foreign-educated professionals often face years of delay getting accredited. When asked whether he thinks such a dramatic shift is feasible without losing something in the process, Lafontaine cited “an old adage in health care: You can have things fast, you can have them less expensive or you can have them high-quality, and you can only choose two.”
“There will be tradeoffs,” he continued. “But I think it is important to note that the length of time it takes for folks to come into the country is too long. The system does need to change.”
Improving retention
“We do know that even if we had mass migration of professionals into Canada, we’d still struggle to shore up the huge gap that we have,” Lafontaine said.
When probed on what other steps Canada could take to address the shortage, Lafontaine returned to a common theme throughout our interview: changing how health care professionals work.
One area Lafontaine said he’d like to see prioritized is redistributing health professionals’ workloads by building team-based models of care.
“How do we add additional folks into the team… and have them be a part of the team that redistributes that workload?” Lafontaine said. He cited examples of hiring physician assistants and medical scribes to reduce physicians’ paperwork obligation and open up more time for them to engage in clinical care.
Another prong would be to boost physician retention by “rehumaniz[ing] the experience of being a provider.” For Lafontaine, this entails not merely introducing system efficiencies, but taking seriously the mental health and well-being of providers.
Leveraging data
Lafontaine also touted the importance of governments starting to collect and leverage data more effectively.
“We have known for a long time that we’ve put money into healthcare without a clear idea of how that money has changed things for the better,” he said.
Collecting better data will enable governments to get a better handle on the true size of the doctor shortage. “There’s not unassailable evidence that the shortages currently stated are ‘the right number,’” Lafontaine noted.
“People go through the system with a general sense of the needs of the system but without really knowing.”
Better data would also help medical school trainees make more informed decisions about what areas to specialize in.
“If people could choose the field where they have the greatest impact, I think most people would choose that.”
Health policy players are experts in steering conversations toward platitudes to avoid being pinned down on the choices they recommend for the people they represent.
I wish you’d pressed Dr. Lafontaine to say explicitly which two-out-of-three policy goals he’d choose in speeding up qualification times for foreign-trained personnel. He speaks of tradeoffs. That often signals a preference for quick-and-dirty. and it sounds as if he favours a fast, cheap process with an elevated risk of admitting poorly qualified applicants to practice. Is this what he was asking CMA members to accept? Is this what he would ask Canadians to accept?
Teamwork is another word that sounds benign until you ask what it really means. What professional wouldn’t want a publicly paid assistant to help with paperwork? But when it comes to sharing the provision of care, neither organized MDs nor governments are particularly imaginative. With the exception of nurses and nurse practitioners, allied health practitioners are rarely integrated into government-funded family health teams as equal partners in healing. Yet rehabilitation professionals – physio, occupational, massage therapists, speech language pathologists and more – play decisive roles in keeping us healthy, active and fully human. Will doctors welcome them