Pre-Budget Submission: Budget 2025

2024-08-07

Introduction

Family medicine is the cornerstone of Canadian health care, but this foundation is showing cracks, despite the best efforts of hard-working family doctors. More than half of family doctors in Canada report being burnt out, which is compounded by unmanageable paperwork, stagnant or decreasing incomes, and excessive overhead costs. These challenges are prompting early retirements among family physicians and resulting in many family physicians leaving primary care.

As a result, reports indicate as many as six million Canadians are without a regular family doctor, with consistent evidence showing that unattached patients have worse health outcomes and rely on more expensive options such as emergency departments. International comparisons show that Canada ranks poorly in terms of access to primary care among high-income countries. Increasing reliance on walk-in services (including virtual care) prioritizes episodic care over continuity of care rooted in a long-term patient-family physician partnership.

Despite these challenging circumstances, family physicians continue to provide high-quality care. Canadians who do have access to a primary care provider are positive about the care they receive. But family doctors can only do so much in the face of a system that is letting them down. Ultimately, they need the support of governments to make primary care a priority.

We must not only increase funding but also allocate resources differently to get different results. Reducing paperwork on family physicians is essential to prevent burnout and make sure they can focus on providing patient care. Providing financial supports such as loan forgiveness programs will help attract and retain future family physicians. Funding innovative projects to develop new certification pathways for international medical graduates will bolster the workforce, while retaining Canada’s high-quality standards in medical education and training. The federal government must prioritize and invest in these areas to strengthen family medicine across Canada.
 

Federal Budget 2025 Recommendations Summary

1. Fund the reassessment and reform of the Disability Tax Credit (DTC) program by: 1) eliminating the legislative requirement for family doctors to complete the DTC form; and 2) providing the Canada Revenue Agency with necessary resources to create a citizen-focused process for completing the DTC form that is supported by an auditing system.
2. Delay the repayment of federal medical student loans to five years post-residency and dedicate resources to develop an integrated federal, provincial and territorial loan repayment system to ease the financial burden on new family physicians.
3. Fund innovative family medicine pathways to expedite recognition of international medical graduates.
4. Invest in front-line family medicine by enabling fair remuneration and bolstering teams' availability.

Federal Budget 2025 Recommendations in Detail

Recommendation One: Fund the reassessment and reform of the Disability Tax Credit (DTC) program by: 1) eliminating the legislative requirement for family doctors to complete the DTC form; and 2) providing the Canada Revenue Agency with necessary resources to create a citizen-focused process for completing the DTC form that is supported by an auditing system.

At a time when six million Canadians are without a family physician every effort must be made to reduce paperwork to allow family doctors more time to provide patient care.

The DTC form is completed by 97 per cent of family physicians in Canada. It requires family physicians to police access to critically important social supports and then doesn’t pay them to do it. We’ve heard directly from family physicians about the frustrations they encounter completing the DTC form and how damaging the process can be to the physician-patient relationship. Furthermore, the 16-page form can take up to an hour to complete. Approximately 250,000 DTC forms were processed in 2022 Estimates suggest the time to fill out these forms would accommodate up to one million patient visits.

Family doctors should not be the gatekeepers of this critical support system. As the DTC is within direct influence of the federal government, the CFPC calls on the federal government to eliminate the requirement for family doctors to complete the DTC form by revising the Income Tax Act, Section 118.3, relieving medical practitioners of this obligation.

Our call to action for legislative change would benefit patients, as family doctors would have time for more patient care. It would also result in improved appeal and sustainability of family medicine, attracting more graduates to the specialty.

Beyond the legislative change, it is vital that the federal government provide the Canada Revenue Agency with necessary resources to create a convenient, simplified, citizen-focused process to enable applicants to complete and submit DTC forms. These changes would align with the recommendations proposed by the CRA’s own Disability Advisory Committee. There are immediate changes that can be made prior to applying these overarching reforms to the DTC form. The DTC form should be streamlined and, as per Budget 2024’s commitment, family physicians should be appropriately compensated for completing the form. But an ideal future state would see this responsibility shifted completely away from community-based family doctors so they can do what they do best: provide care to patients.

Rather than costing the federal government, this could serve as a savings over the long term.
 

Recommendation Two: Delay the repayment of federal medical student loans to five years post-residency and dedicate resources to develop an integrated federal, provincial and territorial loan repayment system to ease the financial burden on new family physicians.

Family medicine students and residents face substantial financial challenges due to the cost of their medical education and training. The high cost of medical school often results in significant student loan debt. Prior to even starting their residency training, the debt load for many medical graduates can range from $100,000 to over $200,000​ in Canada. As the Canadian Medical Association (CMA) points out, the proposed increase to the capital gains inclusion rate tax adds an additional financial burden on physicians throughout their careers, exacerbating the challenges they face as they strive to repay their debt, save for retirement, and achieve long-term financial stability.

The federal government, through Employment and Social Development Canada, can build further on this financial support by delaying the repayment status of federal medical student loans until after completion of residency.

In addition, the current system of separate federal, provincial and territorial loan repayment plans should be integrated and streamlined. The CFPC calls on the federal government to work with provincial and territorial governments to develop an integrated federal/provincial/territorial loan repayment system. This would streamline the process, making sure that deferral or repayment adjustments at the provincial/territorial level automatically trigger corresponding actions at the federal level. Moreover, this would reduce the administrative burden on new family physicians and help them manage their overall debt more effectively.

By implementing these recommendations, the federal government can alleviate the financial stress on new family physicians and encourage more residents to pursue careers in family medicine.
 

Recommendation Three: Fund innovative family medicine pathways to expedite recognition of international medical graduates.

International medical graduates (IMGs) experience significant challenges, variable requirements, and delays becoming licenced, despite playing a significant role in augmenting the health workforce labour supply. Many of these delays are due to the limited capacity and scope of systems assessing their readiness to practice in Canada. The federal government has an opportunity to increase the supply of family doctors by supporting projects that expedite pathways to practice for IMGs wishing to pursue careers in Canada. This includes innovative credentialling and new approaches to certification.

The CFPC oversees the certification of family physicians and conducts assessments to guarantee that IMGs meet Canada’s rigorous training standards. Therefore, it is in an excellent position to work with key stakeholders to broaden and accelerate the recognition of foreign credentials. The CFPC is considering several innovative projects that will, as a starting point, require a comprehensive review of foreign medical training programs, to speed up credentialling pathways into Canada.

The background work required to realize these various efforts will be significant, ranging from comprehensive reviews of medical training standards of countries to determine comparability to Canada, coordination among various stakeholders such as the Medical Council of Canada and medical regulatory authorities, and the development and implementation of new processes. The CFPC calls on the federal government to provide the necessary funding to expedite family medicine pathways for IMGs.

The CFPC is keen to work with the federal government to increase Canada’s health care workforce, while maintaining standards that make certain that Canadians receive high quality care.
 

Recommendation Four: Invest in front-line family medicine by enabling fair remuneration and bolstering teams' availability.

Budget 2024 did not feature significant new investments in primary care priorities. To guarantee progress, it is crucial that funding remains accessible and directed to family practices.

The CFPC echoes the CMA’s recommendations that the federal government leverage the Canada Health Transfer to provide funding to achieve specific goals in primary care. These goals include:

• A total of 7,500 net-new family physicians within five years, and 15,000 within 10 years.
• Interprofessional primary care teams for 50 per cent of Canadians within five years, and 80 per cent within 10 years.

These measurable goals can be addressed in several ways, including targeted investments in:

• Fair remuneration For family physicians, reflecting the value they bring to the health care system and the complexity of care provided. In addition to increased access and more efficient use of resources, alternative payment models have shown to attract physicians to the primary care sector. For instance, British Columbia’s move to an alternative payment model saw an increase of 708 family physicians providing longitudinal care in 2023. While the federal government does not directly affect physician payment structures, provision of funds for provincial initiatives will serve as a key enabler of this crucially important reform.
• Improved team supports To strengthen team-based primary care, by investing in the multidisciplinary approach outlined in the CFPC’s Patient’s Medical Home vision. Federal funding should bolster and expand successful models of team-based care, such as those in Prince Edward Island.
• National licensure The Council of the Federation has recently committed to work toward a common streamlined national licensing process for physicians across Canada. The federal government must provide funding to make sure the national licensure system is in place, reducing administrative hurdles for physicians and making it easier to provide care in underserved communities.

These and other recommendations are summarized in a joint report released with the Canadian Nurses Association (CNA) and the CMA to help alleviate the health workforce crisis.
 

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]