Pre-Budget Submission: Budget 2024

2024-02-23

 

Introduction

Health care in Canada is in crisis. Reports indicate that as many as one in five people in Canada do not have a regular family doctor, with consistent evidence that unattached patients have worse health outcomes and are reliant on more expensive options such as emergency departments. International comparisons show that Canadian physicians are more likely to report a worsening performance of the health care system and indicate less accessibility of services compared to their international counterparts.
 
Family medicine has long served as a foundation of Canadian health care and this foundation is showing cracks, despite the best efforts of hard-working family doctors. More than half of family doctors report being burnt out, in large part due to unmanageable paperwork, while incomes stagnate or decrease, and overhead expenses outpace billing due to inflation. The shift to team-based care, widely recognized as the most effective way to provide primary care, is uneven at best.
 
The need to act is urgent and the College of Family Physicians of Canada (CFPC) developed a roadmap toward improvement: A Prescription for Primary Care, which offers concrete recommendations that bolster family medicine and primary care. A series of evidence-based Family Practice Reform Proposals offer guidance.
 
It is encouraging that the federal government announced a landmark funding agreement with provinces and territories that will distribute $196 billion to enhance health care over the next 10 years, with a particular focus on access to family health services.
 
With the funding announced, it is imperative that action plans address the crisis in family medicine. Immediate deployment of these funds to support frontline family practices is necessary.
 
Practice reform is important and must integrate key components such as enhanced interprofessional collaboration, an appealing and sustainable work environment, ethical international recruitment, and ongoing commitments to truth and reconciliation. Each of these dimensions require attention and investment from the federal government to ensure the health workforce is appropriately trained for the changing needs of Canadian communities.
 

Federal Budget 2024 Recommendations Summary

1. Expedite the distribution and application of federal health funding toward front-line, primary care priorities.
2. Dedicate $4 million over two years to establish a federal task force to assess and simplify federal health/disability forms to ease administrative burden of family physicians.
3. Provide ongoing funding for the National Consortium for Indigenous Medical Education.
4. Support licensing and certification pathways for international medical graduates through Practice-Ready Assessments.
5. Fund team-based primary care training reform based on a consensus across health professions.

 

Federal Budget 2024 Recommendations in Detail

 

Recommendation One: Expedite the distribution and application of the announced federal health funding toward front-line primary care priorities.

Budget 2023 outlined the investment of a landmark $196 billion into health, including funding in priority areas such as family health services. A significant portion of this investment depends on provinces and territories creating accountable action plans to strengthen their respective health systems. To date, fewer than half of provinces and territories have reached agreements with the federal government—Canadians are rapidly losing faith that positive change is coming.

It is imperative that funding continues to be available through Budget 2024.

From the perspective of family medicine, funding needs to focus on:

Fair and equitable remuneration for family physicians reflecting the value they bring to the health care system and the complexity of care provided. Initiatives that enhance the appeal and sustainability of family medicine through appropriate remuneration (such as changes introduced in British Columbia’s new Physician Service Agreement) should be supported through federal investments.

Reduced administrative burden reflected in projects to assess and reduce the volume of administrative work expected of family physicians, or investment into team members (such as medical scribes) to shift the administrative tasks away from doctors.

Improved team supports. Primary care involves many health professionals who contribute to effective and efficient care, as outlined in the CFPC’s Patient’s Medical Home vision. Consistent investments in team-based care (such as those in Prince Edward Island) should be supported and enhanced through federal funding.

The Canadian Medical Association recently released a series of measurable targets for provincial health investments. The CFPC strongly supports these targets.

 

Recommendation Two: Dedicate $4 million over two years to establish a federal task force to assess and simplify federal health/disability forms to ease administrative burden of family physicians.

Administrative burden consistently ranks as a top concern for family physicians. Studies estimate between 10 and 19 hours per week are spent on administrative tasks, time that would be better spent on providing direct patient care.

This time is often unpaid (or poorly remunerated), introducing further stresses on hard-working family doctors.

One of the significant sources of administrative burden for family physicians is federal agency forms. Based on feedback from the CFPC’s members, these forms are often excessively long and unnecessarily complex.

Examples include the Disability Tax Credit form, Canada Pension Plan disability credit form, and Veterans Affairs disability benefits. As these forms are within direct influence of the federal government and its agencies, the CFPC calls on the federal government to institute a task force and dedicate $4 million over two years for its operations, to review the most frequently used federal forms and to identify opportunities, in concert with family physicians, to simplify these forms; to re-evaluate available remuneration for filling out these forms; and to work with the relevant agencies to apply these adjustments.

Such a project would demonstrate federal leadership in an area that directly benefits front-line health care workers and their patients. Family physicians, in turn, would benefit from reduced administrative burden, making comprehensive family medicine a more appealing career option, increasing the number of family physicians, and freeing more family physician time for patient care.

While the initial focus should be on streamlining the forms and fair remuneration, we urge the federal government to work toward a long-term solution that shifts the responsibility for filling out these forms away from community family practices and toward a centralized federal pool of professionals (not necessarily physicians) who would be qualified to handle these forms.

 

Recommendation Three: Provide ongoing funding for the National Consortium for Indigenous Medical Education.

The National Consortium for Indigenous Medical Education (NCIME) was established in 2020 through the Indigenous Physicians Association of Canada, the CFPC, the Association of Faculties of Medicine of Canada, the Medical Council of Canada and the Royal College of Physicians and Surgeons of Canada. NCIME responded to recommendations of the Truth and Reconciliation Commission of Canada as well as the Minister of Health Mandate Letter.

To date, NCIME has established connections and structures to make meaningful change possible. It has enabled the development, publication, and availability to family medicine programs of a first-ever National Curriculum Renewal Guide in Indigenous Health to prepare family doctors in Canada to provide culturally safe care to Indigenous Peoples and their communities. Ongoing federal investment to continue the work of NCIME is necessary to maintain the momentum it established and to build on it.

Ongoing funding for the work of NCIME is a part of the collective responsibility to ensure the best possible health outcomes for Indigenous patients.

 

Recommendation Four: Support licensing and certification pathways for international medical graduates through Practice-Ready Assessments (PRA)

International medical graduates (IMGs) experience significant challenges and delays becoming licensed practitioners despite playing a significant role in augmenting the health workforce labour supply. Many of these delays are due to the limited capacity of systems assessing their readiness to practice in Canada. The government has a role in addressing these obstacles and can leverage the $196 billion commitment to provinces and territories to increase the supply of family doctors by supporting expedited pathways to licensure and practice for IMGs wishing to pursue careers in Canada.

Of the IMGs who apply for family medicine examination, only 15 per cent have gone through a PRA. This number must be increased.

Increasing Canada’s health workforce is critical, but it cannot be done at the expense of lowering standards of care. The licensing/certification quality controls currently in place must be maintained as alternate approaches are explored; that is, certification must remain part of a high Canadian national standard for licensing. Dedicated capacity is required to adjust the existing certification process so that certification can be achieved by IMGs in a timelier manner.

• Support provinces and territories with sufficient resources to 1) increase opportunities for experienced IMGs to complete PRAs and 2) expand PRA availability to all provinces and territories to accelerate the path to practice.
• Ensure the time commitment from existing health professionals who are required to participate in PRA is considered in capacity planning and that they are remunerated appropriately as part of this investment.
• Fund the necessary work to adjust the existing certification process to reduce time to certification while maintaining the current high standards of care.

 

Recommendation five: Fund team-based primary care training reform based on a consensus across health professions.

Team-based care is the future of primary care. The team-based approach is best taught in an environment where multiple health professionals are trained to work collaboratively to optimize scopes and achieve the best results together. Equipping Canada’s workforce for effective team-based care will ensure access to high-quality, comprehensive care. To enable primary health care professionals to practice teamwork ,and understand each other’s roles and capabilities, it is crucial to reform their training. Creating interprofessional primary care tables within and across jurisdictions would inform and empower this reform.

This is necessary amidst increasing supply/retention challenges in family medicine and the growing demand for primary care due to Canada’s aging population and growth through immigration. This recommendation directly aligns with the government’s priority to improve access to care for all in Canada and will build on work advanced by the Employment and Social Development Canada-funded Team Primary Care initiative. Consensus on the path forward is needed across professions to effectively implement team-based primary care and enhanced funding for team-based clinical teaching sites are needed to prepare the primary care workforce.

The federal government must leverage the $196 billion increase in health funding to provinces and territories to invest in team-based primary care training.

• Provide funding and incentives toward expansion of clinical faculty across professions working in primary care to support increased training enrolment and include expanded reimbursement available to family practices serving as training sites.
• Facilitate the expansion of distributed community-engaged team-based family practices to prepare the primary care workforce in underserviced communities. Support should include administration costs, stipends, and distributed research. This approach will also facilitate diverse training opportunities in underserved communities.
• Support intra- and inter-jurisdictional forums for those involved in reforming team-based primary care training to establish best practices, standards, and shared resources.

 

About the CFPC

The voice of family medicine in Canada
The CFPC is the professional organization that represents more than 44,000 members across the country. The College establishes the standards for and accredits postgraduate family medicine training in Canada's 17 medical schools. It reviews and certifies continuing professional development programs and materials that enable family physicians to meet certification and licensing requirements. The CFPC provides high-quality services, supports family medicine teaching and research, and advocates on behalf of the specialty of family medicine, family physicians, and the patients they serve.
 
Contact
Artem Safarov
Director, Health Policy and Government Relations
College of Family Physicians of Canada
905-629-0900, ext.249; 1-800-387-6197, ext. 249
[email protected]