The Canadian Medical Association (CMA) is pleased to see investments into the health care workforce, healthy Indigenous communities and the social determinants of health in the 2024 federal budget.

Investments in youth mental health and a national school food program can help fill a significant need for our youngest citizens. We also welcome investments in pharmacare and dental care and are encouraged by new funding to alleviate some of the administrative burden faced by Canadian physicians, including for artificial intelligence solutions. In addition, new money to integrate internationally trained health care workers will provide some welcome support for our workforce numbers and expand access to care.  

The CMA is also pleased to see important steps taken to combat anti-Indigenous racism in health, key to advancing reconciliation and improving health equity. We look forward to seeing the Indigenous Health Equity Fund in action.

While we are encouraged, the CMA reiterates that governments must remain focused on stabilizing and rebuilding the health system. Millions of Canadians are struggling to access care in a timely fashion while providers try to hold a crumbling health system together.

Following last year’s historic investments into health care, the CMA applauds federal, provincial and territorial governments for signing bilateral funding agreements. With new money in place, our health system now needs action. It’s time to do the work in a transparent and accountable way so that all Canadians know they can receive health care when and where they need it. 

Together with governments, health care organizations, health providers and all Canadians, we can start to expand access to care and build a better health system for the future.

Dr. Kathleen Ross
CMA President

Federal budget 2024 is looming, and as we await news of the government’s investment priorities, the health system remains under unprecedented strain. 
Consistent, focused investment to stabilize and rebuild our health systems will be needed over the next several years. A comprehensive plan with clear accountabilities will lead to meaningful transformation.

We are calling on all levels of government to ensure investments into the health system are optimized to address remaining gaps to support the health and well-being of Canadians. A collaborative, constructive and focused effort on the part of the federal, provincial and territorial governments is needed to create meaningful change in how health care is planned for and delivered from coast to coast to coast. It’s time to do the work in a transparent and accountable way so that Canadians can receive health care when and where they need it. 

The Canadian Medical Association (CMA) is pleased that all provinces and territories have now signed bilateral health agreements with the federal government, complete with accountability measures and health data modernization metrics. We welcome the efforts of some jurisdictions to increase mobility of health workers, reduce administrative burden and create team-based care models. 

Unfortunately, the same critical challenges remain: 

• 6 million+ Canadians without a family physician or other primary care provider;
• lengthy wait times for surgeries, and diagnostic and life-saving treatments; and
• emergency departments across the country routinely operating well beyond capacity and hospitals well above full occupancy levels.

These are challenges in every province and territory in Canada. Years of neglect have led us to where we are today, and solutions cannot be implemented overnight. Our challenges will not be resolved in silos. Collaboration is needed. 

The solutions to Canada’s health crisis are many: investing in team-based care, implementing pan-Canadian licensure for physicians, reducing administrative burden, scaling virtual care, expediting training and licensing for international medical graduates and creating a national health workforce strategy. The CMA and other medical organizations continue to point to meaningful solutions to our current crisis and are here to help.

We know what needs to be done. 

We need action. We need it now. 

Dr. Kathleen Ross
CMA President
 

More than 6.5 million Canadians do not have access to a regular family doctor. This gap can lead to delayed or undiagnosed medical conditions. It can also increase the risk patients face from another growing health problem — the spread of misinformation.

During the pandemic, dangerous myths circulated online ranging from the idea that drinking bleach will kill COVID-19 to claims that vaccines were unsafe. False or inaccurate information (intentional and otherwise) about subjects from breast cancer screening to the Measles continue to be rampant.

As a family physician, I see firsthand how access to primary care helps patients “filter the noise.” I can feel their anguish as they struggle to make sense of conflicting information and I’ve witnessed how confusion can lead to inaction in the face of significant health issues.

Everyone benefits from a trusted source to navigate the huge amounts of health misinformation online. According to the CMA’s new health and media annual tracking survey, physicians are the most trusted source to provide Canadians with credible information.

Primary care physicians, in particular, have the chance to build long-term, one-to-one relationships with patients and their families. We provide opportunities for people to express their fears and make informed decisions relevant to their particular circumstances. We are the front door for health care issues from birth to death and often serve as navigators for the rest of the health system.

We saw the positive impact of trusted sources in the early days of the COVID-19 vaccine campaign. People were much more likely to proceed with the vaccine if they could discuss it with their primary care provider. But the lack of access to face-to-face health care accelerated through the pandemic. Many people felt alone with their individual health care choices in a way they had not experienced previously.

Trust and health (mis)information in Canada

The CMA commissioned Abacus Data for a survey with 2,500 Canadian adults (including an oversample of Gen Z respondents) from Sept. 19-26, 2023. Some highlights:

One of the challenges in the fight against misinformation is that there can be a toll on patient-doctor relationships.

In the CMA’s health and media survey, 40% of respondents said misinformation about health issues has led to mental distress or increased anxiety; 38% said it decreased their trust in health professionals; 31% said they had difficulty discussing health issues with providers.

As practitioners, it is essential that we respond with empathy and compassion when patients present with questions based on misinformation or disinformation.

The beautiful part of being a family physician is that conversations are not just one-off. We provide space to plant a seed, share evidence-based information, direct people to accurate resources and bring them back for a follow up discussion to optimize their care. The opportunity for two-way dialogue empowers patients.

We can and should support trusted medical sources of information, places where individuals can access vetted and reliable resources when they don’t have access to primary care.

The CMA is supporting a network of passionate medical advocates and experts who share credible health system news and information directly with Canadians. In 2022, the CMA partnered with The Canadian Press to strengthen health journalism in Canada — funding three new reporting positions for a period of three years. The CMA will also continue annual health and media tracking surveys.

To increase access to primary care, the CMA has been calling for urgent action from all levels of government, including scaling up team-based care.

Everyone deserves access to accurate, evidence-based health information. A robust primary care system helps patients weed out fact from fiction, build trusting relationships with providers, and ultimately live healthier lives.

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

This op-ed was originally published in Healthy Debate.

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The Canadian Medical Association (CMA) joins the Fédération des médecins omnipraticiens du Québec (FMOQ) in voicing its concerns about the first round results of the Canadian Resident Matching Service (CaRMS), which has left 91 family medicine positions still vacant in Quebec.

The starting point for increased access to care is a strong frontline, which requires the health care system to do a better job at attracting learners and retaining family physicians. The CMA is concerned about certain provisions in the Act to increase the supply of primary care services and to improve the management of that supply, which focus on limiting the patients that physicians can add to their caseload and monitoring the hours that family physicians work. These measures could drive physicians from the public system into private practice.

We understand that the government wishes to improve access to care and recognize that there is still much to be done. However, any solutions must be considered in close collaboration with physicians and other care providers. The CMA is advancing a number of solutions, including an even greater reduction of the administrative burden so that physicians can spend more time with patients and thrive in the workplace.

The first round matching results show that family physicians’ working conditions must be improved to make the practice more attractive for medical learners. Quebec is already facing a shortage of approximately 1,200 general practitioners, and 60% of Quebec physicians show signs of burnout. Urgent action is needed.

Family physicians in Quebec are determined to provide care for Quebecers and improve access to that care. This is evidenced by the 930,000 additional patients already receiving care since 2022. We ask that our governments continue to work constructively with physicians to ensure a healthy workplace for care providers and better access to quality care for patients.

Dr. Kathleen Ross
President, Canadian Medical Association

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

Medical associations from coast to coast are deeply concerned about any government proposal that would restrict access to evidence-based medical care for patients, including for the transgender population.

Canadians have the right to make personal choices about their health with the support of their families, the guidance of physicians working with other regulated health professionals and free from ideological intrusion. 

There is no one-size-fits-all approach for patients experiencing gender dysphoria. Restricting choices and appropriate care for patients can lead to permanent harm.

We urge all levels of government to consult with physician experts in their field when considering any major changes in policy related to health care impacting the 2SLGTBQ+ community. 

• Alberta Medical Association - Dr. Paul Parks, President
• Canadian Medical Association - Dr. Kathleen Ross, President
• Doctors of British Columbia - Dr. Ahmer Karimuddin, President
• Doctors Manitoba - Dr. Michael Boroditsky, President
• Doctors Nova Scotia - Dr. Colin Audain, President
• Fédération des médecins omnipraticiens du Québec - Dr Marc-André Amyot, Président-directeur général
• Medical Society of Prince Edward Island - Dr. Krista Cassell, President 
• New Brunswick Medical Society    - Dr. Paula Keating, President
• Newfoundland and Labrador Medical Association - Dr. Gerard Farrell, President
• Northwest Territories Medical Association - Dr. Katherine Breen, President
• Ontario Medical Association - Dr. Andrew Park, President
• Saskatchewan Medical Association - Dr. Annette Epp, President
• Yukon Medical Association - Dr. Alex Kmet, President

This month, social media will be awash in posts celebrating International Women’s Day (IWD). As a physician, I would like to reflect on how the same platforms that elevate women’s rights, gender equity and empowerment can create risks to women’s health. 

A recent Abacus report commissioned by the CMA showed that a majority of Canadians – male and female – now seek news and information online over TV or radio. Female respondents were more likely than men to use social media and significantly more likely to go online for information on specific health conditions and symptoms (82%) or treatment options (75%). 

Given the complexity of women’s health issues, which can range from endometriosis, polycystic ovarian syndrome (PCOS), menopause and more, the quest for information is real. Women are more likely to experience dismissal or minimization of their symptoms, perpetuating stigma and shame. And more than 6.5 million Canadians struggle with any access to a regular family doctor, particularly in rural, remote and equity-seeking communities.

Algorithms that favour clicks and likes to the detriment of evidence-based facts make it increasingly difficult to discern health facts from fiction. A 2023 study from Ohio State University reviewed the 500 most popular TikTok posts related to gynecological cancer, with a combined 466 million views. They found an overall poor quality of content and identified at least 73% of the content as inaccurate. 

As a family doctor, I have seen first-hand the negative outcomes on pregnant patients and newborns from missed or incomplete vaccines. In women’s health, misinformation about the vaccine for the human papillomavirus (HPV) – one of only two vaccines that we have to fight cancer – increases vaccine hesitancy and leaves more women at risk for preventable, and sometimes fatal, diseases.

Likewise, false claims that mammograms are unnecessary or harmful may deter women from undergoing regular screenings, potentially leading to delayed diagnosis and poorer outcomes.

Women surveyed for the CMA Health and Media Tracking Report identified the effects from health misinformation: 

• 45% said it led to distress or anxiety
• 38% delayed seeking care 
• 34% cited difficulty discussing health care with providers
• 31% avoided effective treatments because of misinformation

No wonder that 67% of female respondents described misinformation in Canada as a “major” or “moderate” problem, compared to 57% of men. 

So, how do we begin to address the challenge? As doctors, we have a critical role to play in combating this infodemic. Physicians remain a trusted source of truth — the number one source for health information, according to our survey. As a profession, there is value in our continued efforts to take the time necessary to provide patients with accurate information, foster open dialogue and address patients' individual concerns with empathy and understanding. 

However, I would argue that we are just one part of a bigger effort needed to fight the harmful effects of misinformation on women’s health. We need everyone to lean in.

Media literacy, particularly education on critical thinking and source checking, can empower women to make informed decisions about their health. Government and regulatory bodies, as well as digital platforms, also have a responsibility to regulate online content, promote accurate information and hold purveyors of false information accountable.

The IWD campaign this year calls for us to #InspireInclusion and forge a better world together. As we celebrate today, I invite you to imagine a digital landscape that truly embodies that vision — one that empowers everyone to make decisions about their health with confidence and clarity to live their best life. 

And to all the women providing health care, I see you today and thank you.  

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

The Canadian Medical Association (CMA) is deeply concerned about any government proposal that restricts access to evidence-based medical care, including the Alberta government’s proposed restrictions on gender-affirming treatments for pediatric transgender patients.

Canadians have a right to make personal choices about their health with the support of their families, the guidance of licensed, regulated health professionals and free from political interference.

Exploring and determining one’s sexual orientation and gender identity is part of normal childhood and adolescent development. There is no one-size-fits-all approach to treating patients experiencing gender dysphoria. An approach that restricts the most appropriate care options for some patients has the potential to cause permanent harm.

Ensuring children have universal access to a full range of medical care is essential for their well-being. We know that transgender youth have higher rates of mental health issues, including suicidal tendencies, due to stigma that they face. By providing comprehensive health care options, we affirm the dignity and humanity of transgender individuals, reinforcing the notion that everyone deserves access to the medical support necessary for authentic self-expression.

We strongly urge governments to consult with health-care professionals — experts in their field — when considering policy changes related to health care.

Dr. Kathleen Ross
CMA President

Medical organizations call on governments to reimagine primary care to help stabilize, rebuild health systems

One year ago today, the federal government announced the most significant investment in health care in more than two decades. This investment followed years of health systems struggling to provide timely, equitable care, a crisis exacerbated by the COVID-19 pandemic that ravaged health care in Canada.

One year later, our health systems continue to struggle to provide the care that Canadians need, where and when they need it. More than six million Canadians do not have a family physician. Lengthy wait times for surgeries and diagnostic and life-saving treatments remain. Physicians, nurses, and other providers continue burning out, faced with insufficient system supports, overwhelming administrative burden, and inadequate remuneration. Emergency departments across the country routinely operate well beyond capacity. This cannot continue.

We need action. We need it now.

A significant portion of the federal government’s investment depends on provinces and territories creating action plans and setting targets to strengthen their respective health systems, with accountability measures in place to monitor progress. To date, only four provinces have reached agreements with the federal government. Meanwhile, Canadians continue to suffer, and they are rapidly losing faith that positive change is coming.

The Canadian Medical Association (CMA) and the College of Family Physicians of Canada (CFPC), speaking on behalf of physicians and medical learners across the country, are calling on governments to act urgently to address Canadians’ concerns. Health care providers can no longer be called upon to prop up systems that are on the verge of collapse.

Critical to stabilizing and rebuilding health care is fixing its front door: primary care. Family physicians, working with other primary care providers, offer comprehensive, continuous care while helping patients navigate complex health systems. Having a dedicated family doctor significantly improves patient health outcomes and system efficiency, keeping costs low and emergency departments available to treat emergencies. The demands placed on primary care providers — from managing growing administrative demands to caring for patients in a system in need of more support — have never been greater. We need leadership and collaboration between jurisdictions to reimagine family medicine and move to interdisciplinary team-based care.

While the CFPC and CMA urge action, we are also providing solutions including the Health Human Resource Policy Recommendations; the CMA’s Improving Accountability in Health Care for Canadians; and the CFPC’s Prescription for Primary Care and Family Practice Reform Policy Proposal Package.

The CFPC and the CMA are urging the public and health care professionals to join us in demanding action from their local elected officials by using the CFPC’s letter writing tool and participate in the conversation on social media using the hashtag #stopwaiting.

We need action. We need it now.

Dr. Kathleen Ross
CMA President

Dr. Michael Green
CFPC President

Cold and flu season might not be the only reason you’re finding it hard to see your family doctor, assuming you have one in the first place. It may be because your physician is bogged down with endless paperwork, dealing with cumbersome billing procedures or struggling with electronic medical records (EMRs) that can’t communicate with other EMRs. 

The Canadian Federation of Independent Business’s (CFIB’s) Patients before Paperwork report found that Canadian physicians spend 18.5 million hours each year on unnecessary administrative work, the equivalent of about 55 million patient visits. 

The administrative strain on health care providers, notably physicians, has reached an unsustainable level, jeopardizing their well-being and patient care in a health system that’s already stretched thin. More than six million Canadians do not have access to a regular primary care provider. We’re seeing significant surgical backlogs, and emergency departments are routinely operating beyond capacity, resulting in massive wait times. We need to find ways to simplify and streamline administrative tasks in our health system. 

From time-consuming, redundant paperwork like unnecessary sick notes to struggles with multiple, unconnected technologies, the administrative load on physicians has grown disproportionately, leaving them with less time and energy to devote to their patients or having to sacrifice personal and family time to try to keep up with their practice demands. Take for example the federal Disability Tax Credit form: not only is it more than 15 pages long and cannot be submitted by email, many physicians also find they’re not in a position to fill out much of the required information on behalf of patients. 

This excessive administrative burden not only hampers health care efficiency, but also contributes significantly to physician burnout. In the Canadian Medical Association’s latest National Physician Health Survey, 75 per cent of physicians said unnecessary administrative tasks negatively affect their job satisfaction and nearly 60 per cent said these issues contribute directly to their worsening mental health. 

While the physician administrative burden remains a critical challenge, the good news, highlighted in CFIB’s latest report released during its annual Red Tape Awareness Week, is that some governments are making progress in reducing paperwork. Nova Scotia is the first jurisdiction to measure physician burden and implement steps that have reportedly saved physicians an estimated 200,000 paperwork hours per year. Manitoba is not far behind, establishing a joint task force between the government, CFIB and Doctors Manitoba to create efficiencies and make recommendations to reduce physicians’ administrative workload. 

In fact, CFIB’s latest report shows that most jurisdictions in Canada have started to implement initiatives to measure and/or mitigate doctors’ paperwork, except for Saskatchewan, the Northwest Territories, Nunavut and the federal government. This is positive news, but we must not stop there. 

Federal, provincial and territorial governments have all promised to improve access to care. Setting a target to reduce just 10 per cent of the unnecessary administrative burden could save 1.9 million physician hours, reducing doctor fatigue and burnout, improving the quality of patient care, and saving time and money. 

Effective collaboration among stakeholders, policy-makers, administrators and patients is vital for implementing practical solutions. Streamlining bureaucratic processes, investing in technology to automate routine tasks and standardizing documents and forms can significantly ease the burden on physicians, allowing them to focus on what they do best and what we expect them to do – provide high-quality patient care. 

The time is ripe for governments across Canada to eliminate the administrative pressures on physicians. Measuring the burden, setting achievable targets and identifying key irritants can create more efficient health care. The health and well-being of physicians and patients hinge on our ability to untangle the bureaucratic web that currently constrains our health care system. Governments must act now to empower physicians to provide the care that Canadians deserve. 

Dr. Kathleen Ross is a family physician in Coquitlam and New Westminster, BC, and the president of the Canadian Medical Association. Dan Kelly is the president of the Canadian Federation of Independent Business.

This commentary was first published in The Hill Times on Feb. 2, 2024. 
 

Many emergency rooms (ERs) across the country are overflowing and patients across Canada are waiting far too long to receive necessary care. The scene is not new but unless we make major systemic changes, it will continue to repeat itself. Despite the tireless efforts of physicians, nurses and other health providers, testimonies from around the country illustrate that patients in some jurisdictions are waiting as long as 20 hours or longer to receive care.

Staff shortages and hospital overcrowding combined with poor access to high-quality team-based primary care are leaving hospital emergency departments woefully under-resourced for the avalanche of patients with influenza, COVID-19 or respiratory syncytial virus (RSV) at this time of year.

No one wants to spend 20 hours waiting for the care they or their loved ones need. Solutions to ease the pain points for patients and providers are crucial. For instance, ERs shouldn’t be substitutes for walk-in clinics or primary care. We are facing a primary care crisis in this country, and we urgently need to find solutions.

The Canadian Medical Association (CMA) believes it is well past time to transform and rebuild the health care system, including investing upstream in team-based primary care.

The CMA is calling on provinces and territories to prioritize signing and implementing health care action plans to significantly increase access, improve working conditions, and modernize Canada’s health systems. One in five people in Canada do not have access to a primary care provider and cannot access timely care for episodic or urgent conditions, or comprehensive care for chronic conditions. As parliamentarians prepare for the winter session, we urge continued attention on health care with a particular focus on access to high-quality team-based primary care. Without concerted collaboration and focus, we will continue to endure endless cycles of deterioration of our health systems and the people working within it.

Dr. Kathleen Ross
CMA President