The Canadian Medical Association (CMA) strongly supports the federal government’s focus on housing and affordability as Parliament resumes this week. We also remind political leaders and their respective parties that many people in Canada are still struggling to access the health care they need. Collectively, these challenges are leaving the health and wellness of far too many Canadians at risk and worsening an already profound health care crisis.

Political leaders have been appropriately focused on housing and inflation as Canadians are facing an historic affordability crisis. We support government action on this front as the consequences on health and health equity attributable to food and housing insecurities are well documented. A 2020 study published in the CMAJ identified that 1 in 8 households suffer from food insecurity and that adults who experience food insecurity die 9 years earlier than those with a secure food supply. The health consequences of food insecurity include heart disease, mental health challenges and other chronic health conditions. Similarly, lack of housing also leads to poor health outcomes, including mental health issues, injuries and chronic disease.

Working on policies that contribute to better health is important, however it is only one part of the equation. Without access to health care, all other measures will fall short. Following another summer plagued by emergency department closures and with more than 6 million people lacking regular access to a primary care provider, Canadians remain deeply concerned about their inability to access care. A survey conducted in partnership with the CMA in August 2023 clearly illustrates that Canadians are losing hope in their health system. Only one quarter of Canadians (25%) are optimistic about health system improvements in the next two years, and over 80% believe that federal and provincial/territorial governments need to make health care a bigger priority.

We urge government leaders to work collaboratively to resolve these critical issues.

The CMA looks forward to engaging with the federal government to improve the health care system for everyone in Canada. We continue to advocate for ongoing investment and structural changes to increase access to care, including expanding physician mobility and team-based care, implementing pan-Canadian workforce planning, modernizing health care data systems and reducing administrative burden for health care providers.

Dr. Kathleen Ross
President, CMA 

Canadians are deeply concerned that the health care system is no longer meeting their needs.  With the system under significant strain — patients struggling to access care, intermittent emergency department closures, growing surgical backlogs— there have been increasing calls to re-examine how we fund and deliver health care services in Canada. 

In a recent survey conducted by the Angus Reid Institute in partnership with the Canadian Medical Association (CMA), 68% of respondents said they believe health care has worsened over the past decade, up from 42% who said the same in 2015. Nearly 70% of respondents doubted that things will change for the better in the next two years.

With the health care system at a crisis point, the need to listen to and incorporate the voices of patients and the providers who deliver care has never been greater. 

There is consensus that access to care on many levels must be fixed and that the solution is not just throwing more money at a dysfunctional system. We need actual structural change.

We’re seeing patchwork efforts as political leaders grapple with the gaps. To improve retention and recruitment of health care workers, the British Columbia government recently reformed how family physicians are compensated to reflect the increased complexity of primary care work. The Atlantic provinces and Ontario have taken steps to improve physician mobility. Several provinces now allow pharmacists to prescribe medications for common ailments. To date, however, there is no national, coordinated approach to these issues that reflects patient and health care provider input. 

Some provinces are proposing or have already increased the role of private providers to expand access to care without increasing out-of-pocket costs to patients. We’re also seeing more for-profit, privately funded corporations providing services across Canadian jurisdictions. 

What this means for our public health system — long a source of pride for Canadians — remains to be seen.  

Words matter. Being informed matters.
 
It’s important we’re clear about what we mean when we talk about private care. On the one hand are privately delivered, for-profit alternatives that could result in queue jumping for those who can afford to pay their way to the front of the line — a model we’re already seeing in parts of the country. On the other hand are privately delivered, not-for-profit clinics that are being scaled up in some jurisdictions to help reduce backlogs. It’s important we reflect on and discuss these two realities.

The truth is that Canada’s health systems have long featured a mix of both public and private care delivery. And public health insurance plans – what most of us simply refer to as “public health care” – has always covered a finite list of services provided only in certain settings with certain providers. 

Across the country, the balance of public and private care includes care that is publicly funded and delivered; public health care that is outsourced to private providers; and care that is privately paid for and delivered. 

It’s confusing to many. But looking at funding, as of 2022, governments paid for 72% of all health care. The rest was paid by patients: out of pocket (11%), through private health insurance (15%) or other sources (2%).  

It’s time to talk.

Private care in either form is a sensitive subject – one that many people feel challenges their collective values as Canadians. In the Angus Reid Institute survey from earlier this year, 31% of respondents said that more private care would improve health care, while 44% said it would worsen access to care. The percentage of respondents who are “unsure” how they feel increased in the past year. It’s a topic we can no longer ignore.
 
This is a complex, nuanced conversation that Canadians and health care providers need to have because change will continue to happen with or without our input as jurisdictions grasp for solutions to increase capacity within the system.

It's within this context that the CMA is launching a national conversation on public and private health care in Canada. The purpose of this conversation is two-fold: to elevate our shared understanding of how care is delivered across Canada and to help shape what happens next. Make no mistake: this will be a challenging, charged conversation. Important conversations often are. However, standing on the sidelines while our health systems continue to deteriorate is simply not an option.

The CMA strongly believes that patients across Canada deserve to receive high-quality health care in a timely fashion, regardless of their ability to pay. That belief has not changed. However, the health care landscape and our shared challenges have. It’s time we have an open and honest conversation with Canadians about the future of the health system. We’re here to listen. Please join us and add your voice. 

Dr. Kathleen Ross is a family physician in Coquitlam and New Westminster, BC, and the new president of the Canadian Medical Association.
 

The Canadian Medical Association (CMA) is speaking out in support of children and youth and the importance of creating safe environments for them to explore their sexual orientation and gender identity. 

Gender identity is a health issue, and every step should be taken to ensure that all children and youth can achieve optimal health. Exploring and determining one’s sexual orientation and gender is part of normal childhood and adolescent development. This should be encouraged by creating safe environments in which children and youth can express themselves, absent of barriers, prejudice and restrictive conditions that can lead to harm and stigma. 
 
The CMA joins physicians, health professionals and organizations who recognize the need to support the healthy expression of sexual orientation and gender as a fundamental right of all children and youth. 

Dr. Kathleen Ross
CMA President

Despite bolstered federal investments in health and a firm commitment by provincial and territorial leaders to fix health care, a survey conducted by the Angus Reid Institute indicates that Canadians are losing hope that the system is getting the attention it urgently requires. Only one quarter of Canadians (25%) are optimistic about improvements in health care in the next two years.

The survey, which was commissioned by the Canadian Medical Association (CMA) and conducted between Aug. 1 and 8, 2023, shows that only 26% of Canadians consider the health care system to be in excellent or very good condition, whereas half (48%) considered it to be excellent or very good in a 2015 survey also conducted by the Angus Reid Institute.

Canadians believe that both federal and provincial/territorial governments need to make health care a bigger priority, with 82% calling on provinces and territories and 84% calling on the federal government to do so. Beyond making health care a bigger priority, fully two-thirds (67%) of Canadians believe that improving measurement of the health system will lead to positive changes.

"We’re seeing a decline in Canadians' satisfaction with the health care system, and this is a very worrying trend," says Dr. Kathleen Ross, CMA president. "We need to do everything we can to restore Canadians' trust in the health system. By working together and measuring progress in priority areas, we can build the system that patients and health care workers expect and deserve.”

The survey also shows that:

• among Canadians who do not have a family physician, 26% have given up looking while another 38% have been looking for more than a year; and
• 66% believe that money alone will not fix health care, though 60% believe new funding will certainly help.

The survey also indicates that 24/7 access to emergency departments, shorter waiting times for surgery and shorter waiting lists to see a family doctor were among the top priorities identified by Canadians.

To read the full survey results, click here.

Dr. Kathleen Ross, a family physician in Coquitlam and New Westminster, BC, is the new president of the Canadian Medical Association (CMA). Dr. Ross practises as a family physician while also providing obstetrics and surgical assistance in cardiovascular surgery at the Royal Columbian Hospital (RCH).

Dr. Ross is assuming the role of president at a time when family medicine is in crisis. Her direct experience in front-line medicine will prove significant as the CMA continues to advance solutions to help solve access to care issues confronting Canadians. Recognizing that primary care is foundational to a well-functioning health care system, Dr. Ross is firmly committed to working with policy makers and the medical community to bring team-based care to the forefront of solutions needed now and in the future.

“With the increasing numbers of challenges and disruptions that have evolved to crisis levels over the last few years, the Canadian medical profession finds itself at a crossroads. Important discussions about health care in Canada are underway now, and we must keep the conversation moving to ensure we improve access to care for patients and create better work environments for health workers,” says Dr. Ross.

As a founding member of Doctors of BC’s Diversity and Inclusion Advisory Group in 2018 and physician lead for RCH’s Antiracism and Unconscious Bias Working Group in 2021, Dr. Ross remains committed to fostering learning, awareness, education, and ongoing implementation of inclusive, diverse and antiracist practices in health care.

Dr. Joss Reimer becomes president-elect

Dr. Joss Reimer is the new president-elect for 2023–24. She will serve in that position until May 2024, when she will become president. Dr. Reimer is currently the chief medical officer for the Winnipeg Regional Health Authority.

Dr. Alika Lafontaine completes his presidency

Dr. Alika Lafontaine has completed his term as president after a year spent advocating for physicians throughout the country and for the rebuilding of Canada’s health care systems.  

“Meaningful change can only occur with a break from the status quo,” says Dr. Lafontaine. “It has been an honour to serve as president of the CMA during a year where several status quos were broken. Governments across the country are collaborating again, pushed together by the crises our health systems across Canada are now facing. We can truly transform our health care systems if we continue to make meaningful changes to the way we approach providing care. Let’s continue with meaningful change that will stabilize access to care for patients and improve working environments for health care workers.”

Dr. Lafontaine will sit as past president until August 2024.

The Canadian Medical Association (CMA) and leading experts in health and public policy will discuss bold solutions to rebuild Canada’s health care systems during the CMA’s Health Summit, taking place Aug. 17-18.

The program includes sessions on Canada’s new health care agreements, fighting misinformation in health care, scaling up team-based care, Indigenous health, administrative burden, balancing public and private health care and much more.

Some of the speakers and panelists include:

• The Hon. Mark Holland, Minister of Health
• Dr. Alika Lafontaine, Dr. Kathleen Ross and Dr. Katharine Smart
• Timothy Caulfield, a professor of health law and policy and bestselling author
• Dr. Bonnie Henry, Provincial Health Officer, British Columbia
• Dr. Melissa Lem, President, Canadian Association of Physicians for the Environment
• Shachi Kurl, president of the Angus Reid Institute
• The Hon. Catherine McKenna, Former Minister of Environment and Climate Change

To see the full program and list of speakers, please visit: Program | CMA Health Summit 2023

“Health care providers, policymakers and the public are looking for leadership on the best ways out of our current health care crisis,” says Dr. Alika Lafontaine, CMA president. “We are starting to see significant investments in the health system and increased collaboration across jurisdictions to improve the health of all Canadians. We now need to look at how to translate those commitments into action. The CMA is pleased to convene experts from a variety of fields to discuss the bold solutions needed to seize the moment and build a better future of health.”

All are welcome to join the CMA’s Health Summit. The full program, list of speakers and registration details are available online. 

On August 16, the Canadian Medical Association (CMA) will host its 156th Annual General Meeting (AGM). The AGM provides an opportunity for Canadian physicians and medical learners to help shape their national association’s goals and leadership, learn about the CMA’s activities and welcome the CMA’s new president, Dr. Kathleen Ross.

The CMA encourages members and stakeholders to register before 5 p.m. ET on Thursday, August 10. The virtual format will include live webcasting of all proceedings, secure online voting for those with voting rights, and a moderated question and answer opportunity. Simultaneous interpretation will be available.

WHAT: The CMA’s 156th Annual General Meeting 

• Presentation of annual report 
• Valedictory address from 22–2023 president Dr. Alika Lafontaine 
• Inaugural address from 23–2024 president Dr. Kathleen Ross 
• Question & answer session on the CMA’s work

WHEN: Wednesday, August 16 from 11 a.m. to 4 p.m. ET

HOW: register here: https://na.eventscloud.com/ereg/index.php?eventid=746331&

The AGM will be followed by the Nominations Committee report, where delegates can vote on the president-elect and other nominations. 

Members of the media are invited to register by contacting mediainquiries@cma.ca

The Canadian Medical Association (CMA) is optimistic about the future of health care in Canada following the country’s premiers meeting this week. It’s clear that all premiers recognize the gravity of the situation, and that stabilizing and reforming health care is critical. We were pleased to observe a collaborative and constructive tone from all provinces and territories as they focused their discussions on some of our health systems’ biggest challenges.

The premiers’ joint focus on areas such as supporting a strong health workforce, enabling mobility of health workers, and improving access to primary care and mental health resources are important steps that can spark a better future.

The cracks in Canada’s health systems run deep and are too severe for any single jurisdiction to manage in isolation. We need our federal, provincial and territorial leaders to maintain this collaborative effort to tackle shared challenges. By working together, measuring progress in key areas and investing based on that progress, we can build the health systems that patients and providers deserve.

We urge our leaders to continue to engage the health workforce and patients to ensure that we walk this road together toward more equitable, reliable health systems with accountability and measurement targets in place.

Dr. Alika Lafontaine
CMA President

Every day, too many Canadians struggle to access timely health care. Access is no longer equitable or reliable. Government leaders today have the responsibility to stabilize and rebuild health systems that have been in a downward trajectory for far too long. That is why, as the organization leading a national movement of physicians who believe in a better future of health, the Canadian Medical Association (CMA) is bringing health care solutions to Winnipeg, where Canada’s premiers will meet next week.

Today, the CMA is releasing a series of ambitious targets that governments can use to drive health system improvements. These targets build on the conditions included in the federal, provincial and territorial bilateral agreements on health. They are key to turning our health care systems around, and they build on solutions the CMA has long been advocating for such as pan-Canadian health workforce planning, scaling up team-based primary care, expanding the mobility of health professionals and virtual care, advancing reconciliation in the health system and increasing accountability and responsibility throughout the health system.

“We can all agree that the status quo is not working. Our health systems won’t change unless we change how we’re trying to solve our many problems,” says CMA President Dr. Alika Lafontaine. “These targets are about action — accelerating effective change to solve the number one issue for all Canadians: access to health care services. To achieve this, we must measure the things that matter most for the patient and provider experience. By gathering and measuring data in ways we never have before in our health systems, we can better understand how to move forward. Measurement drives action. If we can agree on what we need to do differently, governments and health system leaders can clearly map out the key milestones needed to achieve real improvements.”

With the new health system targets, the CMA is calling on governments to work toward improving access to care in several ways, including:

• eliminating hospital emergency department closures within three years;
• increasing the number of net new family physicians to 7,500 over five years and 15,000 over 10 years;
• increasing the percentage of Canadians with a regular primary care provider from 85% to 90% within five years, and to 95% within 10 years;
• reducing median wait times for community mental health and substance use services to two weeks by 2028 and one week by 2033;
• increasing the percentage of priority procedures delivered within medically acceptable wait time benchmarks to 80% within five years and to 90% within 10 years; and
• ensuring that 75% of Canadians can access their own electronic health records within five years, 90% within a decade.

The CMA is also calling on governments to engage Canadians in their respective health care systems, keeping them informed about progress made and improving accountability across the health system.

Dr. Alika Lafontaine will meet with Canada’s premiers during their Council of the Federation meetings in Winnipeg, July 10–12.

As the National Assembly’s parliamentary session draws to a close, the tabling of Bill 15 to “improve the efficiency of the health care system” has been one of the most talked-about bills so far this year. Within minutes of its presentation by Health Minister Christian Dubé, opposition parties, labour organizations and stakeholders in Quebec’s health ecosystem commented publicly on its contents. Some were critical of the 300-page document’s direction and suggested improvements to the minister, but all agreed that the status quo is no longer sustainable.

An efficient system — when you can access it

Everyone agrees that the health care system, although severely compromised, still manages to treat seriously ill patients. In fact, the network performs well once patients are in care. The challenge for patients is getting their foot in the door when their condition is not a matter of life and death. 

At this point, it’s essential to come to terms with the reality of our access to universal health care. Access is becoming increasingly difficult, and even if the health care system accounts for 42.6% of Quebec’s 2023–2024 spending, it is not guaranteed to be efficient.

We know that bottlenecks, especially on the front lines, must be addressed once and for all. Of course, achieving this will take time. Patients should be looked after by care teams, not just by family physicians. It’s also important urgent that we improve the image of family medicine, which has been avoided by medical students across Canada because of its cumbersome nature and growing administrative burden. In Ontario, the School of Medicine at Queen’s University recently opened a satellite campus dedicated to training future family physicians. The first students will start in September. Their goal is clear: to address the shortage of family physicians in southeastern Ontario. Let’s take inspiration from what’s being done elsewhere — it can only benefit our cause.

Putting people at the heart of our network

I’ve been a family physician in Val-d’Or for over 30 years, so I’ve seen my share of health care reforms! Every health minister since I started practising has recognized that the system is not optimal and has been eager to improve it. But the stakes are high, and each era brings new challenges. The well-being of the medical workforce, across all professions, is perhaps one of the most pressing issues today. Let’s not forget that the greatest asset of the health care system is its people — the happier the workforce, the healthier the population. This reform must avoid introducing burdensome procedures that would have the unwelcome effect of causing staff to leave the system for other environments, particularly the private sector. Instead, we need to create healthy workplaces that attract people to the public health care network and, just as importantly, motivate them to remain in it.

One thing is certain: the success of this latest reform depends on the good faith and cooperation of all players, whether they are managers, physicians, allied health care providers or other health system employees. As health care professionals, it is our duty to do everything we can to give the population the system it deserves, even if it means doing things differently.

Dr. Jean-Joseph Condé
Francophone spokesperson and CMA board representative for Quebec

This commentary was initially published in Le Soleil

In 2015, Ted Quewezance spoke on the floor of the Canadian Medical Association (CMA) annual meeting, the first residential school survivor to address that gathering in its more than 150-year history. In a speech that brought many to tears (including me), Ted talked about Indigenous Peoples reaching out to the Canadian physicians, hoping that they would reach back; that the status quo was not an option to those suffering unthinkable health impacts. Those words continue to ring true many years later.

Building on past work in Indigenous health, this year the CMA announced an Indigenous health goal to set aside space in our long-term strategy and health system advocacy, developed by a Guiding Circle of First Nations, Inuit and Métis leaders, experts and knowledge-keepers.

As with all other areas of health care, goals are only achievable if trust is found between willing partners. Today, we formally recognize that the deep trust that should exist between health providers and Indigenous patients, families and communities continues to be damaged by racism, inequitable access, and ongoing harm from people and institutions within our health systems.

Trust comes before reconciliation. With that in mind, the CMA recognizes that a vital untaken step on the road to reconciliation remains a formal apology to Indigenous Peoples — rooted in an accurate, shared history and what matters most to Indigenous Peoples.

Today, the CMA announces the beginning of this journey and its commitment to an apology for the harms caused to Indigenous Peoples as the national voice of physicians.  

The path to an apology, informed by an honest examination of the CMA’s history, will require many uncomfortable and painful conversations. We hope through this process the CMA and the medical profession can go through necessary transformation and come closer to reconciliation.

The profession’s history is Canada’s history. It includes the devastating impacts of Indian hospitals, forced medical experimentation on Indigenous Peoples, disparate infrastructure investment, as well as systemic racism, neglect and abuse. It’s a “past” that remains present in the day-to-day experiences of Indigenous Peoples across our shared lands.

To be meaningful, this apology must happen over time, building on aggregated moments towards an end goal of re-discovering each other and rebuilding trust between providers and Indigenous patients, families and communities.

As the first Indigenous president of the CMA, I stand resolute with this organization to take these next steps in a good way. We are committed to an apology as a meaningful step towards reconciliation, and walking with Indigenous Peoples towards a “…transformed health system that is free of racism and discrimination; upholds Indigenous Peoples’ right to self-determination; values, respects and holds safe space for Indigenous worldviews, medicine and healing practices; and provides equitable access to culturally safe, trauma-informed care for all First Nations, Inuit and Métis.”

Dr. Alika Lafontaine
President, Canadian Medical Association

As Canadians continue to struggle to access health care in a timely fashion, organizations representing physicians, nurses and hospitals across the country are calling on all premiers to ensure health system reform is on the agenda at their meetings next month in Winnipeg, Man.

We have seen positive movement recently. The federal government has increased funding for health care. Many provinces have agreed in principle to work with their federal counterparts, developing action plans to improve access to health care while remaining accountable to Canadians.

Consistent, focused action from the federal, provincial and territorial governments is the only way to tackle the many ongoing crises still facing our health systems:

• It is estimated that 4.7 to 6 million Canadians do not have a primary care provider.
• Emergency departments across Canada continue to struggle due to overwhelming demand and a shortage of health care professionals.
• Wait times for surgeries and diagnostic tests are far too long.
• Health care providers who have worked to provide timely care through the pandemic remain on the job, but they are burned out and continue to struggle because of a shortage of resources and immense workloads, including unnecessary administrative tasks that take away from patient care responsibilities.

Governments must continue to collaborate with each other and with providers, patients and other stakeholders to stabilize and reform our health systems.

Although many key topics will certainly be addressed when the premiers meet in Winnipeg on July 10-12, we urge them to ensure health care remains a top priority on their agenda. This is an opportunity for governments to demonstrate to Canadians that they can work together to make meaningful and transformative changes to the way health care is delivered across the country. The need for change has never been greater.

This call to action is co-signed by the following organizations:

• Alberta Medical Association
• Canadian Federation of Nurses Unions
• Canadian Nurses Association
• Doctors of BC
• Doctors Manitoba
• Fédération des médecins omnipraticiens du Québec
• Fédération des médecins spécialistes du Québec
• Medical Society of Prince Edward Island
• New Brunswick Medical Society
• Newfoundland and Labrador Medical Association
• Northwest Territories Medical Association
• Ontario Medical Association
• Saskatchewan Medical Association
• Yukon Medical Association