Paying doctors more won’t solve Canada’s primary care crisis

It’s time to stop paying for failure and start funding real, team-based primary care

Access to primary care in Canada is in decline and has been for the past decade. This should alarm Canadians. In 2024, one in five Canadians lacked access to a regular family doctor or nurse practitioner. Even more concerning, the share of adults with a regular family doctor declined in seven of 10 provinces between 2015 and 2024.

This matters because access to primary care is the front door to the health-care system. Without a regular provider, Canadians face greater difficulty accessing timely care and managing their health needs. Yet the problem is also not affecting everyone equally. In 2024, lower-income Canadians were less likely to have a regular health provider than higher-income Canadians, and that gap showed no improvement over the previous decade.

The declines have been particularly severe in Atlantic Canada. In Prince Edward Island, the share of adults with a regular family doctor fell from 88 per cent to 53 per cent between 2015 and 2024. Newfoundland and Labrador saw a decline from 86 per cent to 67 per cent, Nova Scotia from 86 per cent to 72 per cent, and New Brunswick from 88 per cent to 76 per cent. Other provinces also experienced declines, including British Columbia, Ontario and Saskatchewan.

One bright spot is the growing role of nurse practitioners. Although they still provide care to a relatively small share of Canadians, access to a regular nurse practitioner increased between 2015 and 2024, demonstrating their growing importance in strengthening primary care.

But the overall problem persists. One explanation is that governments have focused on the wrong solutions. Across Canada, many primary care reforms have centred on changing or increasing physician compensation. Yet these efforts have not translated into improved access to care.

A deeper problem is the continued reliance on the independent contractor model, in which doctors and nurse practitioners are expected to own and operate a business. And because it’s tough to run a business and care for patients at the same time, one result is the growth of investor-owned corporate chains. That trend raises new concerns—about care delivery, quality and the commercialization of patient data.

Canada’s provinces, therefore, need to move away from a system that relies primarily on individual practitioners operating as small-business owners. Instead, governments should invest in not-for-profit primary care infrastructure and expand team-based primary care.

In fact, Canada should implement lessons from the Scottish public health system, which in 2018 began to assume responsibility for clinic premises, reducing the financial risks and administrative burdens for doctors’ practices. It also began to employ multidisciplinary teams with the goal of improving work-life balance for medical professionals and access to care for patients. And the early results suggest that more publicly supported, team-based primary care appeals to the preferences of newer generations of family physicians.

Canada’s community health centre model, Community Health Centres (CHCs), also lets physicians work in multidisciplinary teams without running a business. Ontario’s more than 300 CHCs have been instrumental in expanding access to primary care in that province. However, while their flexible core funding model supports innovation, provincial policy still favours independent physician contractors, and this makes it difficult for the CHC model to become more widespread.

So, there is more work to be done, especially by the federal government, which needs to show more leadership in this space. Federal funding should be tied to progress in closing the primary care access gap, and governments should be held accountable for ensuring that all Canadians have timely access to a primary care provider or team.

The path forward is clear: the primary care crisis will not be solved simply by paying doctors more. It requires structural reform, investment in community-based clinics and a renewed commitment from governments to ensure that access to primary care is available to everyone.

Andrew Longhurst is a senior researcher at the Canadian Centre for Policy Alternatives and author of the new research study Failure, By Design: Ontario’s deepening hospital funding crisis.