Revisiting the Canadian primary care crisis: What exactly are we advocating for-values or outcomes?

Last month’s issue of Canadian Family Physician (June 2025) was a compelling one. From overwhelmed providers, disengaged medical trainees, unattached patients, and solutions that sometimes felt too rigid to fit our increasingly complex realities, one could feel the urgency of the challenges Canada is facing with primary care. As I read through it, I found myself reflecting not just as a clinician or researcher, but as someone who believes deeply in the relational heart of family medicine. I imagined that this primary care crisis wasn’t just about the numbers or metrics, it might be more about the erosion of trust, and meaning in our everyday work, and the growing disconnect between our idealized vs realized primary care policies.

Yes, Canada’s primary care system is in crises. Nearly 6.5 million Canadians lack a regular provider. In British Columbia and Quebec, the numbers are even worse.¹ Emergency rooms are overflowing, continuity is fragmented, physicians are burning out, with many spending up to 38% of their time on paperwork.¹ Team-based care (TBC) is often floated as a solution, but it’s unevenly applied and poorly supported. Payment models are under scrutiny with the fee-for-service (FFS) model (still dominant in most provinces) rewarding volume over quality, challenging team-based care, and disincentivizing comprehensive, longitudinal care.^1,2

So, what are we really advocating for? More measurable outcomes, or better, shared values? I argue that a distinction between both matters. Outcomes-driven advocacy may seek system efficiencies (e.g., more attached patients, reduced ER visits, lower costs). But values-driven advocacy focuses on the core needs and lived realities of both patients and providers, prioritizing how care is delivered just as much as what is delivered. Drs. Orkin and Oandasan’s piece on task sharing rightly highlighted role clarity and relational trust as essential for effective team-based care.³ Similarly, the piece by McCracken et al. warned that provider payment reforms (no matter how well intended) risked token compliance or failure when applied universally without centering provider voices and contextual realities.⁴ There are value-based advocacies that should be centered front.

When values are centred, the voices of those most affected (underserved patients, and overwhelmed providers) are not only heard but co-author the design and delivery of care. I argue that values trump outcomes in most of our advocacy efforts because they ensure that the processes of reform are collaborative, inclusive, and sustainable; and because they recognize that   “one-size-fits-all” solution often privileges dominant voices and minimizes complex, localized needs.  Gilfoyle et al., also echoed similar sentiment in their piece which proposed a “Living Lab” model (i.e., an innovation space where primary care teams co-design administrative processes to reduce documentation burden and increase workflow satisfaction).⁵ In the end, true reform won’t come from hitting better numbers, but from answering the questions like: are we building a system that people want to work in and be cared by? Are we creating spaces where values are not just stated but lived? Because when we centre values, we don’t just fix a broken system, we co-create a better one.

Dr. Udoka Okpalauwaekwe is a family physician and participatory primary care researcher with the Department of Academic Family Medicine at the University of Saskatchewan. He holds a Bachelor of Medicine, Bachelor of Surgery (MBBS) from the University of Nigeria, as well as a Master of Public Health (MPH) and a PhD in Health Sciences (Primary Care/Family Medicine) from the University of Saskatchewan, and a primary care fellowship from Western University. His work focuses on health system strengthening, equity-oriented primary care, participatory research, international medical graduate (IMG) integration, and values-based health reforms. 

References:

1. Statistics Canada (2025). Health of Canadians: Access to healthcare. Available from: https://www150.statcan.gc.ca/n1/pub/82-570-x/2024001/section4-eng.htm 
2. CIHI (2025). Access to primary care: Many Canadian face challenges. Available from: https://www.cihi.ca/en/primary-and-virtual-care-access-emergency-department-visits-for-primary-care-conditions/access-to-primary-care-many-canadians-face-challenges 
3. Orkin AM, Oandasan IF. Task sharing, community health workers, and Canada's primary care crisis. Can Fam Physician. 2025;71(6):e98-e100. doi:10.46747/cfp.7106e98
4. McCracken RK, Lavergne MR, Hedden L. Will blended family physician payment models revive primary care in Canada?. Can Fam Physician. 2025;71(6):377-379. doi:10.46747/cfp.7106377
5. Gilfoyle M, Pearce S, Ha E, et al. Navigating Canada's primary care crisis: Living Lab approach to reduce administrative burden. Can Fam Physician. 2025;71(6):e101-e104. doi:10.46747/cfp.7106e101