Gracing many a headline across the country as of late revolves around the lack of family physicians in Canada. CBC News recently reported how Canadians are frustrated with this widespread issue, as evidenced by the results of a national survey performed by a Toronto-based research team led by Dr. Tara Kiran, family physician and scientist with the MAP Centre for Urban Health Solutions at Toronto’s St. Michael’s Hospital. CBC stated that this report is “one of the most comprehensive surveys ever conducted on Canadians' views of the health system and it provides crucial data on the poor state of primary care access in a growing and aging country.”

The survey, which included 10,000 respondents from across the country, concluded that 22% of respondents, or about 6.5 million Canadians do not have a family physician or nurse practitioner they can see regularly. However, upon closer inspection, this “national survey” collected data from only the following provinces: Quebec, Ontario, BC, and lumping together the Prairies and Atlantic provinces as two separate categories. Conspicuously missing are data from Nunavut (NvT), the Yukon Territory (YT), and the Northwest Territories (NWT).

Data from Statistics Canada from 2021 details the percentages of Canadians aged 12 and over who report having a regular healthcare provider. Of those surveyed, 78.8% in YT, 37.3% in NWT, and 13.9% in NvT reported having a regular healthcare provider. In comparison, other provinces such as Ontario reported 89.7%, and New Brunswick, who had the highest percentage at 89.8%. On average in Canada, 85.5% report having access to a regular healthcare provider. It doesn’t take a statistician to appreciate the difference between 13.9% of a population versus 89.9%.

In reviewing the physician to population ratio from 2021, the Canadian Institute for Health Research reports six physicians per 10,000 population in NvT, 12 physicians per 10,000 population in NWT, and 20 per 10,000 in YT. Comparisons between provinces and territories are complicated as all other provinces are broken down into separate regions with their own distinct number of physicians, however, in Calgary alone there are 29 physicians per 10,000 population. In essence, each province reports a significantly greater number as compared to the current availability in the Territories. To expand this idea of accessing care even further, there are 18 long-term care beds available across all of Nunavut, in comparison to provinces from the south, such as Saskatchewan who reports 47 beds per 1,000 population. This isn’t “new” news, either.

A recent article in Healthcare Papers discusses the concept of ‘underserved’ populations, and how this term is often used interchangeably with the words ‘marginalized’ or ‘vulnerable.’ There is a negative connotation underpinning these words, a form of labeling really, implying perhaps there is an inherent deficit of sorts related to this particular population, or that they are somehow at fault for being ‘underserved.’ And yet, when we unpack the word ‘underserved’ we come to see that what this really means is the system isn’t doing its job; the system is not serving these populations. Instead, the word ‘underserved’ should be prefaced with ‘structurally,’ offering a new reality of what this actually means: that these underserved populations in Northern Canada receive an unequal distribution of services due to how the system is structured. Our system. Further, they are at a higher risk for negative health outcomes because of these structural inequities. This also isn’t new, yet, because healthcare in the south is facing issues with accessing care, somehow this is a crisis. Who is really being underserved here?

In thinking about the construct of the Canadian healthcare system, the Canada Health Act stipulates that provinces and territories have jurisdiction over the delivery of healthcare services, which must align with the five principles of the Act in order to receive federal funding through the Canada Health Transfer. These five principles include accessibility, public administration, portability, comprehensiveness, and universality. The Act states that provincial and territorial governments must cover the cost of all ‘medically necessary’ healthcare, and, due to the demographic and geographic differences between them (among other factors), what is considered ‘medically necessary’ varies between provinces/territories. At the core of this debate over access to primary care is whether the provinces and territories are able to uphold the principle of ‘accessibility,’ which states that “The provincial and territorial plans must provide all residents reasonable access to medically necessary services.” Comparing the data between Northern and Southern Canada, I would argue whether six physicians per 10,000 residents truly constitutes as “reasonable access.”

Canada boasts the world’s second largest landmass. Clearly there will be logistical challenges in ensuring all Canadians have equal access to care, particularly when factoring in the variance of climate and geography. However, I would argue that Northern Canada is often all but forgotten in these discussions over accessing primary healthcare. Data gathered from Dr. Kiran’s OurCare survey neglected to even include data from the Territories. Yes, territorial health is governed slightly differently than provincial health, mostly because it falls under federal jurisdiction, however this should not equate to an inequitable access to healthcare. And yet it does.
In sum, there is no denying that accessing primary care in Canada is greatly problematic, and it will continue to be problematic for some time yet to come. There is no easy solution either, such as simply hiring more healthcare professionals. This is a systemic issue involving many factors; however, I ask those living in Southern Canada to spend some time reflecting on whether 29 physicians per 10,000 population in Calgary truly is a “crisis” when compared to the experience of those living in our Northern territories.
 

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