Host: The province says its primary care action plan is producing results, and it's optimistic that all Ontarians will have access by 2029. So we asked the question, are we really at the tail end of this crisis? Doctor Tara Kiran is a family doctor and researcher at Saint Michael's Hospital and the University of Toronto. She's also the founder and national lead of the OurCare initiative. Deepy Sur is the CEO of the Ontario College of Family Physicians. Great to have you both here. How are you guys doing?

Deepy Sur: Nice to be here. Thanks for having us.

Host: Alright, Doctor Kiran, I'm going to start with you. According to the Ontario Medical Association OMA, more than 2.5 million Ontarians don't have access to a family doctor. The province has said it's on track to meet its goal of connecting 100% of Ontarians by 2029. Is this real progress, or are there some key issues that are being overlooked?

Dr. Tara Kiran: So first of all, I want to just praise the goal. I think it's great that we've set a goal for everybody having care, not just like 90% or 92%, because I think that transforms the way that we try and solve the problem. And from what I've seen of the data, I do think that they're on track now. There's a lot of work still to be done. And in fact, I think some of the work that's to be done is going to be even tougher as we get to those end stages of like trying to make sure everyone has care. But I do think that there's some good work happening behind the scenes. And so I have hope and confidence we're going.

Host: To get when you say some of those tougher, challenging issues. Yeah. What are we talking about?

Dr. Tara Kiran: Well, I think to really get us to where we want to go, we have to really transform the way that we work, and we have to transform the way that we work in two different ways. One is, I think we don't have enough family doctors or family doctors and nurse practitioners to go around to have everybody have care the way that we deliver it now. So we need to change that by actually having doctors be able to care for more patients, by empowering other team members like nurses, pharmacists and social workers. And that kind of change on the ground level takes time. People have to learn how to work in different ways. So it's not just about like adding professionals and expecting the change is going to happen. So I think that's one piece. I think the second piece that's going to be a lot harder, and I'd love to come back to sort of, can we actually rethink how our model works so that it is more like a public school model? When you're in a neighborhood. Deepy Sur: Your postal codes. Dr. Tara Kiran: You have clarity that like, this is where I can access care, whether it's something small or something big, you know, where to go and that where to go is not a walk-in clinic or an emergency department.

Host: Alright, hold that thought on solutions. We'll definitely get to that. But NDP, you know, when we talk about the family doctor shortage, you have to think about retirement doctors who have been holding the fort down for quite a while. When we talk about primary care being an attractive, you know, stream, these are some of the issues when we talk about the shortage. So when it comes to this targeted meeting, it is this real progress or are there some issues there?

Deepy Sur: I agree this is real progress. This is the first biggest investment we've seen in a long time. We represent 18,000 family physicians and medical students. And by far and large, the working conditions is what we got to double click on. We zero in on making that more sustainable with digital tools that work and reducing the amount of time family physicians are chasing referrals or paperwork, patients will will be seen faster. And so I think the solution to access is improving the working conditions and making it much more desirable for people to choose the profession, stay in the profession and do what they signed up to do, which is care for patients. Right.

Host: You talked about investment. Well, the province released their budget last week. NDP, was there anything in that budget that stood out to you in terms of the primary care shortage?

Deepy Sur: Yeah, I mean, we're seeing some great opportunities to make improvements right now on the ground. It's about actually putting them into action. Access for us is going to mean that we need to see improvements in digital health. So we're seeing some great opportunities for something like a centralized referral intake system. So imagine going to see your family doctor and being able to talk about the care you need and possibly getting a referral done in a system for diagnostic tests or access to specialists, and not waiting and not waiting three months, six months, or up to a year for some, some of that access. So these kinds of investments help us, those make those system wide improvements. I agree on team-based care. Family physicians work best when they're supported in family medicine by other professionals like nurse practitioners, nurse practitioners, social workers, other great professionals who are dedicated to providing good care for patients at the right time and providing the care when they need it most.

Host: Right now. Doctor Kiran, there was a price tag there of $325 million that would go into expanding the primary care action team's work that they're already doing. That's a good signal as well.

Dr. Tara Kiran: Yeah. I mean, I think the government over this next few years has committed, I think it's like 2.1 billion. And now maybe that's grown to expanding. Most of the money is to expanding team-based care. They also put in a few hundred million, I think, to support more medical students. And then there's also money, I think that's been earmarked now for a primary care provincial wide electronic medical record. So we don't actually have any details, I think, on really what that is. But at the end of the day, I think the goal, it seems to me, is to try and make the systems work better behind the scenes, both for clinicians and for patients. So to give patients access to their data, which I think is going to be a huge win. We've heard over and over again through our research, patients really want that. But then also to make it easier for physicians to communicate with each other and other parts of the system and have like a, an information system that supports them and isn't working against them. Because sometimes I have to say in the clinic, you kind of feel like, oh, like if only my information system worked differently. Like I could.

Host: Actually talk to each other, right?

Dr. Tara Kiran: Like I could be so much more efficient. You know.

Host: I want to talk a little bit about recruiting because that's been an issue for a lot of communities, particularly in northern Ontario. Know, you spent some time in northern Ontario as well. Just to give viewers an example, in Niagara Falls right now, if doctors did sign up to practice there, they would get $100,000 signing bonus for opening a new practice just down the street. If you go to Saint Catharines' comparatively small $5,000 as a relocation grant to attract family doctors. Now, Dominic doctor Dominic Novak, the former president of OMA, has likened this sort of competition that municipalities have to go to To The Hunger Games. Now, I have to ask DB, does the metaphor capture the reality of how communities are recruiting right now?

Deepy Sur: Well, it's a symptom of a larger issue around access. Right? And we won't benefit unless we make system improvements that are equitable, sustainable and customized to the communities and geographies that people live in. We're not doing better if we don't make those improvements that are system wide. We're just shifting doctors around. But it tells us about a real need and a real symptom for how access is not sustainable in many communities. So we would like to see the profession become more attractive so people stay and actually succeed. And so medically, our internationally trained family physicians are important. They're an important part of the solution, but not the only solution, because we won't address the shortage by just bringing in more doctors who will burn out and not be able to provide care if they're bogged down by paperwork, don't have the right digital tools, don't have the right teams. So I think we need both. It's a yes and right.

Host: Yeah. I think it's really interesting, you know, because I think it really illustrates how people on the ground see what, how primary care is so important, right? So municipalities see that in order for them to have healthy populations and attract people to come to live in their city and keep people in their city and, and have them working effectively, they need to have family doctors, they need to have primary care. And that's not happening. And so what you're seeing is them trying to take control of a situation where they don't feel like they necessarily have a lot of control. But then the downside is, is that, you know, Mississippi cities have different kinds of resources, right? They have different financial resources, different human resources, different leadership kind of vision potentially. And so we see some innovative stuff coming out of the municipalities saying like, okay, let's build a clinic. So the doctors just have to come in and don't have to actually deal with the business stuff. We can just practice, but we but the flip side is then we see, you know, potentially inequities across how primary care is delivered across the province. And, you know, we've had teams actually in Ontario primary care teams since about 2005. But the challenge has been is where those teams are. And those teams, you know, research we've done has shown they're not equitably distributed. So in fact, you would want the teams if only 25% of people in Ontario have access to not just a doctor, but social workers, pharmacists, etc. and a team, you want them to be in the highest needs neighborhoods, right. And actually, we saw the reverse. So the areas of highest need, whether those are urban or rural, were actually the ones that were least likely to have the team. And so this is the, the, the, what points to the importance of the province really taking that planning role to some degree in making sure those resources are distributed where they need them most.

Host: All right. I want to talk a little bit more about the fixes, some that you've already touched on a little bit. You had mentioned internationally trained doctors. So are they part of the solution here? I imagine when we look at all of the issues here, we can kind of there are a number of ways that we can go. Yeah, there are doctors who are waiting on the sidelines to get in. Are they part of the solution here?

Dr. Tara Kiran: Yeah, absolutely. So I mean, we did this consultations with patients in the public across the country over 16 months. And we talked to people about what they would like to see in a better system. And one of the consistent things that we heard from them. Of course, they want everyone to have primary care, but we consistently heard that they wanted foreign trained health professionals to be better integrated and faster integrated into our healthcare system. They saw that as a way to improve our health, human resource shortage, but also is a way actually to increase the diversity of the practitioners that are serving our communities. And so the challenge though, of course, is like, we need to build pathways to ensure that the people who are coming in have the medical knowledge and also the cultural and system knowledge that's going to allow them to be effective. And I think some of the challenge there too, is that, you know, that requires family doctor supervisors, and we already have a family doctor shortage. So, so you're asking some of the same strained workforce to take on some of those other roles. But absolutely, they play a role and we need to better figure out how we can get more of them into our system in a way that's fair globally.

Host: DB, we talked about the electronic medical record system. Obviously, that's something that needs to work its way through. Throw away the fax machines. I don't know if you if both of you are familiar with using. I'm sure you both are quite comfortable using fax machines. They still exist. They're exactly. There you go. Are there any other new technologies that that could help cut down on the workload that we need to know about?

Deepy Sur: Yeah, we want to see digital tools in the hands of family doctors every day. Part of those improvements include things like AI scribes or. Host: What's AI scribe for people?

Deepy Sur: So it's like an ambient tool or a tool that works in the background when you're getting into see your family physician having a conversation about your care, and that scribe captures that interaction. And so you're spending your time with your family physician. I know for me, when I go in and see my family doctor, I like that they're spending the time with me, not at the computer, not logging in, not taking notes, but the scribe actually helps them do that work, integrates seamlessly with these tools. Things like AI scribe or things like a centralized referral system that I mentioned where by we have access to cutting down wait times through one system that inputs your access to or referral to diagnostic testing or specialist, those kinds of tools they need to integrate seamlessly. They're not useful if we're just creating electronic, more modernized fax machines, we want them to be integrated with each other, talking to each other, so that when you go in and you see your pharmacist, that your family physician knows about the care that you had, or when you see your family physician, you're not having to repeat your story. So those kinds of tools are very promising in this new budget. And I think we see a lot of will, interest and desire from the primary care team and doctor Jane Philpott and many other partners who are really working hard to bring this to our patients right now.

Dr. Tara Kiran: You know, I'd really love to see us have electronic systems that support me as a family doctor to better communicate with my patients, and that also support me to have better communication with other parts of the health and social system. And so, you know, I've had a chance to travel to some other countries. And, you know, in many of those countries, you can have an app as a patient where you can see all your records, and that's great. I would love my patients to have that so that they can feel empowered with that information, but then they can also potentially message, their doctor, and it's all kind of seamless. They can book their appointments online in a very standard way. Some of the patients here in Ontario can do that, but some most of them can't. And then, you know, I think in the electronic medical record too, you know, we are it's a very separate system. We're not really connected into the hospital in a way that's easy for us. And they can't see our records. And the way that we see the hospital records now is a way that's almost like overwhelming and too much information. We need the right balance of information so that we can see what we need to, when we need to be notified, when a patient is admitted, for example, but not like be inundated. And, you know, the other piece that I'd point out to is something just very simple, like medications, you know? So in Denmark, they have an app that the doctor, the pharmacist, the specialist and the patient all see the same medications. And when one person updates it, it's updated for everyone, right? So can you imagine as a patient, that would be incredible. But also as a doctor, it saves me so much time. Better for patient safety, more efficient, better for me figuring out what the right medications are for that patient.

Host: Okay, let's move away from technology. I want to talk about human resources. We talk about doctors, but there's nurse practitioners, as we mentioned, there's physiotherapists, there's social workers. Can they help in sort of filling these gaps?

Deepy Sur: Yeah. Family medicine works best when we have a collaborative team. The best system is built with a team that supports not just the family physicians, nurse practitioners, physios, pharmacists, and they're integrated and their and their communication systems talk to each other. And those kinds of systems are benefiting our patients. That means they're getting care when they need it. They're cutting down wait times. But as you mentioned earlier, not everyone has access to that kind of a team. And that's what we'd like to see. It's promising to see the collaboration around teams happening, and we see what optimising scope looks like. So everybody practising to the top of their scope or to their optimal scope. Working together means that patients are getting care faster or exactly when they need it at the right time.

Host: Now, if you had a question for both of you, but I'll start with you. If you had the ear of the ministry, which you both do, what are you telling them?

Dr. Tara Kiran: I would say, let's work on retaining the doctors we have making making those conditions better. Access can be addressed by making sure family physicians and other primary care professionals have what they need today to practice well, make it sustainable, reduce their paperwork, give them the digital tools they need, the teams to support them, and patients will benefit from that as well.

Host: Doctor Kiran.

Dr. Tara Kiran: I'd like us to think about ten years from now, how do we prevent this problem from happening again? And I think really the only way to do that is to move towards one of those neighborhood-based types of models. So I'd say keep going with your efforts in primary care. You've got a lot of other competing priorities, economic priorities, but investing in your population, being healthy, absolutely important. But let's do that also by not just tweaking the system, but really making wholesale change so that ten years from now we don't have the same problem. And I think the only way to do that is to try and have these neighborhood-based clinics where people really know that they don't have to like register and go through the, the loopholes of or the, the, the, they don't have to leap to try and find a family doctor. They don't have to figure out the waiting list, their networks. They know that they're guaranteed access just in the way that a child would be guaranteed access to primary school education.

Host: All right. We are going to have to leave it there. Deepy, Doctor Kiran, I really appreciate your passion, your work and your time. Thank you so much.

Deepy Sur: Thank you. Thanks.