Pre-Budget Submission: Budget 2024
IntroductionHealth care in Canada is in crisis. Reports indicate that as many as 20 per cent of people in Canada do not have a regular family doctor, with consistent evidence that unattached patients have worse health outcomes and are more 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 starting to show 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, as 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) outlined a roadmap toward improvement: a Prescription for Primary Care, which relies on a series of changes that would support and bolster family medicine and primary care. In particular, a series of evidence-based Family Practice Reform Proposals offer explicit guidance.
It is encouraging that the federal government has announced a landmark funding agreement with the provinces that will see $196 billion distributed to the provinces to enhance health care over 10 years, with a particular focus on access to family health services.
With the funding announced, it is imperative that any action plans address the crisis in family medicine and the consequences to health care if action is not taken. Immediate deployment of these funds to support the work of practising family physicians is necessary.
While practice reform is important, it is imperative to integrate key components into it, such as the strengthening of physician education, international recruitment, and medical research to inform the evolution of primary care and family medicine. Each of these dimensions is developing and requires 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
- Expedite the distribution and application of the announced federal health funding toward front-line, primary care priorities
- Provide funding to create a federal task force to assess and simplify federal health/disability forms to ease administrative burden on family physicians
- Strengthen physician training and education infrastructure
- Support licensing and certification pathways for international graduates through Practice Ready Assessments
- Enhance dedicated funding for family medicine and primary care through Canadian Institutes for Health Research (CIHR)
Federal Budget 2024 Recommendations In Detail
Recommendation One: Expedite the distribution and application of the announced federal health funding toward front-line, primary care prioritiesBudget 2023 outlined the investment of a landmark $196 billion into health, including funding in priority areas such as family health services.
It is imperative that the funding for this announced set of priorities continues to be available through Budget 2024.
From the perspective of family medicine these needs 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 family doctors.
Improved team supports. Primary care involves many health professionals who contribute to an 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 adherence to these targets to ensure effective application of this critical funding.
Recommendation Two: Provide funding to create a federal task force to assess and simplify federal health/disability forms to ease administrative burden on family physiciansAdministrative 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 of these forms include the disability tax credit, Canada Pension Plan disability benefit, 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; 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 more appealing, increasing the number of family physicians, and freeing more family physician time for patient care.
Recommendation Three: Strengthen physician training and education infrastructureThe post-pandemic pressures have exacerbated supply/retention challenges in the family physician profession, which will further increase in the coming years due to growing demand (aging population and growth through immigration).
The federal government must leverage the $196 billion increase in health funding to provinces and territories to increase the supply of family doctors, which will also require investment in training and education infrastructure (e.g., faculty capacity, reimbursing teachers, training sites, etc.).
This recommendation directly aligns with the government’s priority to improve access to care for all in Canada. This must be done through increases in number of seats in existing medical and nursing schools.
While the increase in the number of training seats is important, it cannot be done in a vacuum. Family medicine must be an appealing, sustainable career for this profession to be a viable choice for medical graduates. Addressing fair remuneration, reduced paperwork, and enhanced team support, as outlined in Recommendation One, would achieve this. The team-based enhancement must be done in an environment where multiple health professionals are purposefully trained to work collaboratively to optimize scopes and achieve best results together, as advanced by the Team Primary Care program.
- Create a new targeted and time-limited program that would be available to any jurisdiction seeking to expand existing medical and nursing school capacity, building on existing infrastructure
- Provide funding and incentives dedicated toward expansion of clinical faculty capacity to support increased training enrolment, including expanded reimbursement available to family practices serving as training sites
- Facilitate the expansion of distributed community-engaged learning sites (including administration costs, stipends, distributed research), which additionally facilitates specialized training opportunities in underserved communities
- Dedicate funding to empower the expansion and strengthening of family medicine residency training (and expansion to three years) in alignment with the Outcomes of Training Project beginning in 2027
Recommendation Four: Support licensing and certification pathways for international graduates through Practice Ready AssessmentsInternational medical graduates (IMGs) experience significant challenges and delays becoming licensed practitioners despite playing a significant role in augmenting the health workforce labour supply. Much of these delays are due to the limited capacity of the systems dedicated to assessing their readiness to practice in Canada. The government has a role in addressing these obstacles and must 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.
Nationally, about 250 family physicians are assessed in Practice Ready Assessments (PRAs). Of the IMGs who apply annually to sit the CFPC’s family medicine examination, roughly 15 per cent have gone through a PRA assessment.
Support provinces and territories to1) increase opportunities for experienced foreign-trained IMGs to complete PRAs and 2) expand PRA availability to all provinces and territories to accelerate the path to practice. Sufficient resources are also required to achieve success. Be mindful about the time commitment from existing health professionals who are required to participate in PRA and ensure that is considered in capacity planning and they are remunerated appropriately as part of this investment.
While increasing Canada’s health workforce is critical, it cannot be done at the expense of lowering standards of care available to people in Canada and so 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. Ethical recruitment is also imperative as Canada seeks to recruit internationally from countries also struggling with health workforce supply.
Recommendation Five: Enhance dedicated funding for family medicine and primary care through CIHREvidence-based primary care planning and decision making needs to be informed by research conducted at the interface of the community and the health care system. To achieve this, Canada needs to support family medicine and primary care research, including studies carried out through the practice-based research and learning networks (PBRLNs). The federal government must invest $60 million over five years into a dedicated fund disbursed through CIHR focused on family medicine research, including PBRLNs.
This investment will help collect, link, and analyze data on the structure, processes, and outcomes of primary care.
In Canada, there are 15 PBRLNs across seven provinces and one territory, affecting 1,189 family physicians and interprofessional primary care teams at 217 sites and more than 1.5 million patients. However, without exception, they lack the funding and infrastructure that would allow them to reach their full potential.
Currently, only 2.39 per cent of grant funds available through the CIHR is spent on primary care research (despite family physicians accounting for the majority of medical services in Canada). In order to continue to serve as a robust foundation for Canadian health care, appropriate funding must be available for primary care and family medicine research.
An addition of $12 million per year dedicated to primary care/family medicine research, with a particular focus on the PBRLNs, would lead to evidence-based planning and projects that support and improve health care that the people of Canada use most – family medicine and primary care.
About the CFPC
The voice of family medicine in Canada
The CFPC is the professional organization that represents more than 43,000 members across the country. The CFPC 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.
Director, Health Policy and Government Relations
College of Family Physicians of Canada
905-629-0900, ext.249; 1-800-387-6197, ext. 249