How Nova Scotia Is Expanding Access to Primary Care with Dr. Nicole Boutilier

What the 2025 OurCare Survey Tells Us About Healthcare in Canada, with Kelly Grant

More than 5.8 million adults in Canada don't have a regular family doctor, nurse practitioner or primary care clinic--and where you live has a lot to do with whether you're one of them. To make sense of the newest research on primary care in Canada, Dr. Tara Kiran flips the script and welcomes award-winning health reporter Kelly Grant from The Globe and Mail to ask her the tough questions. Together, they dig deep into the newly released 2025 OurCare Survey data, exploring why provinces like Manitoba and Ontario are faring better, why Quebec leads the nation in out-of-pocket medical fees, and why patients in the Territories report being more satisfied with care. The data raises as many questions about healthcare as it answers — which is exactly what makes this conversation worth hearing. Explore the Data The 2025 OurCare Survey tracks how primary care is performing in every province and territory. You can dive into the results yourself at OurCare.ca [http://OurCare.ca]  Read the reports at OurCare.ca/survey [http://ourcare.ca/survey]  Explore the interactive dashboard at data.ourcare.ca [http://data.ourcare.ca]  Read Kelly’s piece in the Globe and Mail [https://www.theglobeandmail.com/canada/article-family-doctor-shortage-health-care/]summarizing the key findings Mainpro+ Credits Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026.  This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey [https://ourcare.ca/podcast/mainpro]. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast [http://ourcare.ca/podcast]  Listen to an episode about the genesis of the OurCare Survey A historic win for primary care in Ontario with Peter MacLeod [https://primaryfocus.substack.com/p/a-historic-win-for-primary-care-in] Why millions of Canadians are still waiting for a family doctor with Dr. Danielle Martin [https://primaryfocus.substack.com/p/why-millions-of-canadians-are-still] More about Primary Focus: Subscribe to our Substack newsletter [https://primaryfocus.substack.com/] Have an idea for an episode? Email primary.focus@unityhealth.to [primary.focus@unityhealth.to] Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ [https://maphealth.ca/kiran/]  Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com [https://primaryfocus.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

In Durham: Community Wellness and Black Health

In this episode, Dr. Tara Kiran travels to Durham, Ontario, to visit the Durham Community Health Centre, where CEO Francis Garwe leads a team rethinking what primary care can look like when it is truly rooted in community. Touring a repurposed public school that now houses a wide range of services—from mental health counseling and a regional diabetes team to food security programs, youth programming, and community gardens—Tara sees firsthand how Durham CHC addresses the social determinants of health alongside clinical care. She then sits down with Francis Garwe, Dr. Akeem Stewart, and Dr. Kirk Stewart to discuss how the centre is advancing Black health through initiatives like the Kliniki clinic and a community ambassador model designed to build trust and improve access. Together they explore what it takes to co-create programs with the communities they serve—and what other clinics in Canada might learn from Durham’s approach to equity-driven primary care. Donate to Durham CHC Durham CHC relies on private donations, grants, and other sources to fund some of the important services they offer that address social determinants of health. To support the Durham Community Health Centre’s innovative work, visit their website at www.durhamchc.ca. [http://www.durhamchc.ca] Podcasthon Primary Focus is proud to take part in Podcasthon, the world’s largest charity podcast event! We were tasked with creating an episode dedicated to supporting a charity or non-profit that truly matters to us, and we chose Durham CHC. Podcasthon brings together podcasters globally to raise awareness for important causes - without any money involved. It’s all about uniting voices to make an impact, with more than 1,000 podcasts highlighting a charity of their choice. Listen to more episodes as part of Podcasthon here [https://podcasthon.org/].  Research and programs mentioned in this episode Get more information on the Durham Community Health Centre [http://www.durhamchc.ca].  Learn more about Ontario Health’s Black Health Plan [https://www.ontariohealth.ca/content/dam/ontariohealth/documents/black-health-plan-highlights-2024-25.pdf], informed by the work done by Francis Garwe and the Durham CHC Find out about the Black Health Committee [https://www.allianceon.org/Black-Health-Committee], a committee for the Alliance for Healthier Communities Visit the Black Physicians Association of Ontario [https://www.bpao.org/] website to learn more about their work on Black health MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise [https://www.cfpc.ca/en/education-professional-development/cpd-at-cfpc/linking-learning-exercises]. Listen to other episodes of Primary Focus in our series on community-driven health equity clinics: In Costa Rica: How a middle-income country built a world-class primary care system [https://primaryfocus.substack.com/p/in-costa-rica-health-as-a-human-right]In Costa Rica: integrating public health and primary care [https://primaryfocus.substack.com/p/in-costa-rica-integrating-public]In Vancouver: A Clinic Accountable to the Community It Serves [https://primaryfocus.substack.com/p/in-vancouver-a-clinic-accountable] More about Primary Focus: Subscribe to our Substack newsletter [https://primaryfocus.substack.com/] Have an idea for an episode? Email primary.focus@unityhealth.to [primary.focus@unityhealth.to] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ [https://maphealth.ca/kiran/]  Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com [https://primaryfocus.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

In Vancouver: A Clinic Accountable to the Community It Serves

In this episode, Dr. Tara Kiran travels to Vancouver, British Columbia, to visit the Umbrella Multicultural Health Co-op Clinic — a clinic built by and for newcomer communities. Umbrella pairs physicians and nurse practitioners with cross-cultural health brokers who act as language and cultural interpreters, helping bridge gaps not just in communication, but in navigating the healthcare system itself. Tara tours the clinic with Naomi Armstrong, Director of Integrated Health Programs, and then sits down with Dr. Mei-Ling Weidmeyer, family physician and clinical lead. Together, they discuss Umbrella’s origins as a mobile clinic for migrant farm workers, its cooperative governance model, and how culturally safe, community-accountable primary care can have a meaningful impact on people’s lives. Donate to UmbrellaUmbrella relies on donations from the public to continue offering services to newcomers–especially for those without insurance coverage. To donate to Umbrella Multicultural Health Co-op, head to their website umbrellacoop.ca [http://umbrellacoop.ca]  Research and programs mentioned in this episode Learn about the OurCare Standard [https://www.ourcare.ca/] and how it was developed Watch this 3-minute video [https://www.youtube.com/watch?v=okt3f2QwecA&list=PLt449fUuQr0g0VnKwPh_B0rVx6-r_-V1-] about Umbrella Read a research paper [https://journals.sagepub.com/doi/full/10.1177/08404704241264426] or short report [https://umbrellacoop.ca/wp-content/uploads/2019/02/CCHB-Research-Brief-UMHC_FINAL.pdf] on how Umbrella is integrating cross-cultural health brokers in primary care Find out more about national efforts [https://www.culturalbrokers.ca/] to bring cross-cultural health brokers to primary care MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise [https://www.cfpc.ca/en/education-professional-development/cpd-at-cfpc/linking-learning-exercises].  More about Primary Focus: Subscribe to our Substack newsletter [https://primaryfocus.substack.com/] Have an idea for an episode? Email primary.focus@unityhealth.to [primary.focus@unityhealth.to] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ [https://maphealth.ca/kiran/]  Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, St. Michael’s Foundation, and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com [https://primaryfocus.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

How Nova Scotia Is Expanding Access to Primary Care with Dr. Nicole Boutilier

In this episode, Tara speaks with Dr. Nicole Boutilier, Executive Vice President of Medicine and Clinical Operations at the Nova Scotia Health Authority —  a family doctor leading primary care transformation from within the government. Dr. Boutilier walks Tara through Nova Scotia’s multi-pronged plan to improve primary care access: transforming the province’s centralized waitlist into an active patient management tool, building and strengthening Health Homes (team-based primary care clinics), creating pathways for people without a family doctor to access care while they wait, and modernizing how data flows — so patients can access and share their own health information through the YourHealthNS app. Research and programs mentioned in this episode Read the OurCare reports from the Provincial Priorities Panels [https://www.ourcare.ca/reports] (including Nova Scotia’s). Find out more about Nova Scotia’s Need a Family Practice Registry [https://www.nshealth.ca/clinics-programs-and-services/need-family-practice-registry] and Health Homes model [https://www.nshealth.ca/health-homes]. Get more info on Nova Scotia’s Longitudinal Family Medicine (LFM) [https://doctorsns.com/contract-and-support/physician-agreement/programs-funding/LFM] physician payment model. Watch a video [http://youtube.com/watch?time_continue=1&v=KOJBpRqrTPA&embeds_referring_euri=https%3A%2F%2Fwww.nshealth.ca%2F&source_ve_path=MzY4NDIsMjg2NjY]about how the YourHealthNS app gives patients access to their health data. Learn more about Nova Scotia’s new pathways for integrating internationally-trained medical graduates [https://news.novascotia.ca/en/2025/02/26/new-centre-internationally-trained-physicians-now-open] and the new Cape Breton Medical Campus [https://medicine.dal.ca/departments/core-units/admissions/education-equity/rural-applicant-pathway.html] training rural family doctors. Dive into the research on virtual care [https://www.cmaj.ca/content/197/37/E1230] in Canada. MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise [https://www.cfpc.ca/en/education-professional-development/cpd-at-cfpc/linking-learning-exercises].  More about Primary Focus: Subscribe to our Substack newsletter [https://primaryfocus.substack.com/] Visit our website at primaryfocus.ca [http://primaryfocus.ca] Learn about the OurCare Standard [https://www.ourcare.ca/] Do you have an idea for an episode? Email primary.focus@unityhealth.to [primary.focus@unityhealth.to] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ [https://maphealth.ca/kiran/]  Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com [https://primaryfocus.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

In Costa Rica: integrating public health and primary care

In Part Two of our Costa Rica series, Dr. Tara Kiran takes you inside an EBAIS (Equipos Básicos de Atención Integral de Salud) clinic on the Nicoya Peninsula in Costa Rica to see what it actually looks like to deliver primary care beyond clinic walls. Costa Rica organizes primary care around geography. Each clinic is accountable for a defined population — and community health workers play a central role in making sure no one is missed. They visit households, provide education on prevention and chronic condition management, deliver vaccines, identify risks early, and act as a bridge between public health and clinical care. It isn’t a perfect system. But it is an ambitious one. And it offers a powerful contrast to Canada’s often fragmented approach to primary care and public health — reminding us that building a system where everyone has care is not just a matter of funding, but of design. Further reading: Listen to Part 1 [https://primaryfocus.substack.com/p/in-costa-rica-health-as-a-human-right] of our series on Costa Rica with Dr. Madeline Pesec Take a look at the research article [https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.1319] that first introduced me to Madeline (co-authored by Dr. Atul Gawande)  Explore this brief Commonwealth Fund case study [https://www.commonwealthfund.org/publications/case-study/2021/mar/community-oriented-primary-care-lessons-costa-rica] on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs [https://www.ariadnelabs.org/wp-content/uploads/2017/12/CostaRica-Report-12-19-2017.pdf]  Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret [https://www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret]?” in the New Yorker magazine by Dr. Atul Gawande Read the BBC article Tara mentioned [https://www.bbc.com/worklife/article/20200429-nicoya-the-costa-rican-peninsula-where-centenarians-thrive]about how Nicoya Peninsula is home to a large number of centenarians Learn more about rising violence in Costa Rica related to femicide [https://ticotimes.net/2025/11/27/costa-rica-faces-escalating-gender-violence-crisis-ombudsman-warns] and gang violence [https://ticotimes.net/2025/07/29/costa-rica-surpasses-500-homicides-as-gang-violence-escalates] MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise [https://www.cfpc.ca/en/education-professional-development/cpd-at-cfpc/linking-learning-exercises].  More about Primary Focus: Subscribe to our Substack newsletter [https://primaryfocus.substack.com/] Visit our website at primaryfocus.ca [http://primaryfocus.ca] Learn about the OurCare Standard [https://www.ourcare.ca/] Do you have an idea for an episode? Email primary.focus@unityhealth.to [primary.focus@unityhealth.to] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ [https://maphealth.ca/kiran/]  Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com [https://primaryfocus.substack.com?utm_medium=podcast&utm_campaign=CTA_1]