Good morning. We take the temperature of a few proposals to fix Canada’s primary care crisis – more on that below, along with the states that’ll tip the U.S. election and Ottawa’s potential overcorrection on temporary residents. But first:
Today’s headlines
- Cabinet ministers voice faith in Trudeau before MPs are set to deliver arguments for his resignation
- Israel confirms the death of Hezbollah heir apparent Safieddine, as Blinken continues to push for a ceasefire
- The Auditor-General launches an audit of ArriveCan’s main contractor, GCStrategies
Sign up for Morning Update:
Reading this online? Start your day with context and insight on the biggest stories shaping our lives, in your inbox every weekday morning.
Subscribe now
Pharmacist Kristen Watt consults with patients in Southampton, Ont.Galit Rodan/The Globe and Mail
Health
Getting Canadians into primary care
Family doctors are a lot like affordable homes: If you find one on the market, hang on with a white-knuckled grip. You’ve heard the stats. More than 6.5 million Canadians don’t have access to a family doctor, a number that’s projected to rise to 10 million within the next decade. Some provinces are in especially rough shape right now: 27 per cent of people in B.C. and nearly a third of those in Quebec and Atlantic Canada go without primary care.
It’s bad! So what can we do about it? The question is top of mind: Several potential fixes for the family doctor shortage have popped up in The Globe recently. Let’s pull out our tiny reflex hammer and give each of them a few whacks.
Prescription #1: Treat primary health care like public school
What that means: Just as every kid in Canada is assigned to a publicly funded neighbourhood school, this plan matches each person to a primary care clinician who works with a variety of health professionals (nurses, physiotherapists, midwives, social workers) in a publicly funded team. Oh, you’ve moved to another part of the province or country? No sweat: You get a new family doctor in a new health clinic, ideally within 30 minutes of your work or home.
The booster: Jane Philpott, whom Doug Ford just appointed to lead Ontario’s new primary care action team, wrote a book on this very subject. She believes the model offloads pressure from both our overburdened ERs and our burned-out family doctors. Susan Holt, New Brunswick’s newly elected premier, is also a fan: She campaigned on the promise of opening 30 community health clinics across the province in the next four years.
The hiccup: This plan isn’t cheap. Philpott says she’s been clear with Ford’s government about the “magnitude of resources” needed, including several hundred millions of dollars in health funding and integration across ministries. But she pointed out that a country like Norway – which has legislated the right to primary care – spends less on health per capita than we do and has better health outcomes.
Prescription #2: Allow pharmacists to play a bigger role
What that means: Provincial governments are now letting pharmacists prescribe a wide range of drugs to Canadians. Alberta has been doing this since 2007, but last year, Ontario allowed pharmacists to diagnose – and dole out prescriptions for – 19 minor illnesses, with potentially 14 more to come. And last month, Nova Scotia announced it would add 14 locations to its program that turns pharmacies into primary care clinics, bringing the total number of clinics to 45.
The booster: Independent community pharmacists say they’re in favour of any measures that increase services to reflect demand: “The whole point of all this is for patient care,” pharmacist Kristen Watt told The Globe. Shoppers Drug Mart owner Loblaw – which has considerable health care ambitions – thinks it’s a pretty good idea, too.
The hiccup: The Ontario Medical Association argues that only doctors have the right training to diagnose illness properly. (And they did not much like when Shoppers president Jeff Leger told The Globe that pharmacists can do “40 to 60 per cent” of physicians’ work.) Also, there is very little rhyme or reason to who can prescribe what across the country: Pharmacists in B.C. can prescribe drugs to treat indigestion but not nausea, while Saskatchewan pharmacists can do so for nausea but not indigestion.
Prescription #3: Take GPs from the healthy and give them to the sick
What that means: Stay with me here! It’s an idea that came from Quebec’s Institut national d’excellence en santé et services sociaux (INESSS), a respected provincial health research body. Its recent report found that among the 17.6 million annual primary care visits in Quebec, 40 per cent are made by healthy people with minor ailments. Quebec has an online portal that pairs physician-less patients with vacant appointments, and the INESSS floated reallocating 1.5 million of the visits assigned to healthy people to those who are more seriously ill.
The booster: Well, Quebec’s government, but only very briefly. After that trial balloon went full Hindenburg, Health Minister Christian Dubé quickly promised that “Quebeckers who have a family doctor will keep them.”
The hiccup: Even the INESSS stresses that the scenario it lays out “cannot be used directly as models for organizing primary care services.” But the province is in a tough spot when it comes to family doctors: Last year alone, 780 Quebec physicians opted out of medicare to open private practices, compared with 14 across the rest of Canada. The unspoken truth of the INESSS report is that you need to be privileged and connected just to get in front of a family doctor. And that, says The Globe’s André Picard, is “a discussion that’s long overdue, no matter how uncomfortable it makes us.”
The Math
Swing and a miss
Charting the path to 270.The Globe and Mail
The U.S. presidential election will come down to the choices of a sliver of voters in just seven states. Curious which of those swing states could tip the race in Harris’s or Trump’s favour? You can game out their different paths to victory here.
The Wrap
What else we’re following
At home: Scotiabank warns that Ottawa could be “overcorrecting” in its attempt to rein in Canada’s number of temporary residents – and that the labour force could contract instead.
Abroad: After spending the past three months in a Greenland prison cell, Canadian Greenpeace co-founder Paul Watson should hear today whether Denmark plans to extradite him to Japan.
Big job: Quebec broadcasting executive Marie-Philippe Bouchard has been tapped to take over as the new chief of CBC/Radio-Canada in January.
Huge fish: A four-foot-long carp has been spotted in the Mekong River, even though researchers thought it went extinct nearly two decades ago.
Hefty cut? The Bank of Canada is widely expected to slice its lending rate this morning, and you can follow our live blog of the announcement here.