Jane Philpott is a former Liberal MP and health minister. That’s why many were surprised when, in October, she was named by Premier Doug Ford as the chair of a new task force with a mandate to connect as many Ontarians as possible to a family doctor.
Philpott was a family physician before entering politics. She spoke with TVO Today about her new role, crossing the political aisle, and the task ahead.
Matt Gurney: Before we get into what you will be doing here, can you briefly explain the state of primary care in Ontario?
Jane Philpott: The reality is that primary care is in trouble in Ontario and across the country. The numbers differ depending on your source, but there are likely at least 2 million people in Ontario who do not have a family doctor or any other access to primary care. That means they don’t have a front door to get into the health-care system, and that’s a huge problem.
Gurney: What is the different outcome for someone who has that front door versus someone who does not, if they’re both experiencing the same alarming symptom? Can you walk me through a hypothetical use case?
Philpott: Let’s take an example of somebody who’s got abdominal symptoms, bowel disruptions, and they’re not sure whether it’s just because they’re under stress or because there’s something more ominous going on. If you have a family doctor, you’ll see them early on, tell them that something doesn’t seem quite right, and they will arrange for appropriate testing or screening. But if you don’t have a family doctor, you might wait and say, “You know what? It’s probably not serious. I don’t think I should bother anyone in the emergency department.”
If you wait too long, and you happen to have something like advanced colon cancer, it can get to the point where it’s not treatable. That’s the sad reality: some people leave their symptoms too long because they don’t have anywhere to go — they don’t have a front door to the health-care system. No one’s been ensuring that they’ve had their proper screening tests done. Sometimes it costs people their lives, not to mention costing a lot more money to fix problems that are further advanced than they need to be.
Gurney: Yeah, I think that’s a key point, right? If we catch things relatively early, the solution may be relatively quick and minor. If we wait until it’s a four-alarm catastrophe, it could be a spectacularly intensive and expensive process: difficult for the patient and costly for the system.
Philpott: Exactly. Every intelligent person can realize that’s no way to run a health-care system, and, thankfully, we’re going to try to do something about it in Ontario.
Gurney: You’re probably going to hate this question because it’s a big one. Why is the primary-care system in trouble? Like, in the simplest way possible, what went wrong for us here?
Philpott: Yeah, it is a tough question because the answer is so multifactorial, but let me try to nail down a few of the key issues. Essentially, we did not do proper maintenance to our health system over the decades. The structures of universal health insurance that ensured every Canadian had access to doctor care and hospital care made sense in the ’60s, ’70s, and ’80s and set us up pretty well to have decent access to medical care. But we haven’t really done anything to maintain that. Care has been delivered by more than just doctors and in places other than hospitals, but no one was ensuring we built a health system that ensured everyone had access to a family doctor in their community. And, of course, the pandemic struck a serious blow to the entire system. And, suddenly, in the last two or three years, people have awoken and realized that we weren’t taking care of health care — and hadn’t built it for the needs of the 21st century.
Gurney: What are you going to try to do in your new role? What are the actual nuts and bolts of the work that lies ahead?
Philpott: The overarching mandate is pretty straightforward. I’ve been asked to work with people across the province to ensure that 100 per cent of people in Ontario have access to a primary-care clinician. This will usually be a family doctor but might also be a primary-care nurse practitioner who works in a publicly funded team. We’re building the system to ensure people have that person or team and that they can see them in a timely way. So it sounds pretty straightforward, but it’s going to take a bit of work. It’s not impossible, and I’m really delighted to have been given this mandate.
Gurney: One concern I have — and I’m not saying this in any way as an accusation — but I’ve seen Canadian governments at work before. Getting every Ontarian on a list where they’re nominally assigned to a primary-health-care provider is one thing; making sure the wait times and personnel are kept at sustainable levels strikes me as a harder challenge. How can we balance the system in a way where it can function?
Philpott: I’m glad you asked that, because some provinces have tried to address this by, for example, suggesting every family doctor should take on several hundred more patients, which isn’t realistic. The people working in the system are already overburdened and can’t see more patients or see them faster without additional support. So we’re going to need to add more supports to the system, which means helping people with more funding for primary-care teams so that family doctors can share their load with nurses and nurse practitioners. That approach makes for a more efficient system and better access to care. We’re not simply going to ask people to work longer; we’ll find out what’s needed and invest in new primary-care teams across the province.
Gurney: You and I had spoken a couple of months ago when your book was newly out, about totally different models of delivering health care. Can you just briefly recap what you discussed in your book about the postal-code allocation?
Philpott: Yeah. So this is why I feel confident that we can be successful in this collective goal we have — because other countries around the world have done this and have been doing it for decades. In fact, they think it’s natural and normal that every person is attached to a primary-care team, in the same way that we think it’s natural and normal for every child to have access to a public school in their neighbourhood. And they tend to do this by neighbourhood. The United Kingdom is one example, but most Scandinavian countries are examples, too, as is the Netherlands, where people are guaranteed access to care within their neighbourhood, often based on their postal code. There’s a neighbourhood primary-care team, and mechanisms are in place for choice and change if, for some reason, the local team isn’t convenient. For instance, you can apply to be assigned to a different primary-care team closer to your workplace. Shockingly, we’ve never tried to do this in Canada, so we’ll be looking to models like that for inspiration.
Gurney: Do you get the sense that we’re ready for something quite that revolutionary? Or do you think there would be more of a preference for incremental changes? And I don’t just mean necessarily from the perspective of the government. Health care in Canada can be a pretty conservative institution.
Philpott: I actually think this is an idea whose time has come. The public is absolutely seized with this issue. You and I probably both hear every day from people frustrated by the inability to access care in a timely way. And providers — health professionals — are also frustrated and feel beyond ready for change. I’ve been overwhelmed with supportive and enthusiastic messages from just about every health stakeholder you can imagine across the province. They’re saying they want to help, they realize it’s time for change, and they’re thrilled to hear we’re going to make some fundamental shifts in our expectations of what the people of Ontario should have.
Gurney: Your political career was as a Liberal, and you’ve accepted a position with a Progressive Conservative government. I’m curious about the reaction you’ve gotten — from both Conservatives and Liberals. Co-operation like this should be less rare than it is, but it’s unusual to see.
Philpott: You’re quite right; it should be less rare. And I’m happy to report that the reaction has been overwhelmingly positive. I think it’s hard for even the most partisan individuals to say it’s a bad thing that someone wants to try to improve access to health care. I’ve been encouraged, hearing from people from multiple political parties who are really excited about this role. Many have even said, “What can we do to help?” So let’s hope this opens a window on co-operative approaches to improving one of our most fundamental societal needs.
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