Health Care Innovators
No.1: Alika Lafontaine
People often describe the calamity in Canadian health care in the same way a clinician might diagnose a bone or lung: fractured, broken, on the verge of total collapse. It’s also a story told largely from patients’ points of view. They lack access to GPs, contend with ER closures and interminable surgical backlogs—and sometimes die while watching the clock in the waiting area. But on the other side of the curtain, doctors are dealing with their own health problems and standing by helplessly as their personal lives are swallowed up by the sinkhole their profession has become. Alika Lafontaine, the Canadian Medical Association’s current (and first Indigenous) president knows this; they’ve confided in him.
Since 2022, the veteran anesthesiologist, based in Grande Prairie, Alberta, has consulted with politicians, policymakers and the roughly 70,000 physicians and trainees who belong to the CMA, the largest advocacy group for Canadian doctors. He’s pushing for a streamlined licensing protocol, one that allows physicians to more easily cross provincial borders, to practise where they’re most needed. He’s also trying to revive his colleagues’ morale, hollowed out by thousands-deep patient rosters and months-long stints without so much as a vacation day. It’s a good thing anesthesiologists are known for their steady hands.
There’s an ongoing MYTH that national physician licensure will lead to a mass exodus of physicians from rural and remote communities to cities. Let me take you through the logic to explain why this is VERY UNLIKELY to happen.
A thread 🧵
— Dr. Alika Lafontaine MD (@AlikaMD) February 19, 2023
Lafontaine has always calmly unravelled obstacles that, to others, appear intractable. Born and raised in southern Saskatchewan, he was diagnosed with a developmental delay in elementary school. His mother (who immigrated from Tonga) and his father (who is Métis, with a master’s in education administration) were told their son would never earn a high school diploma. Medicine, then, seemed entirely out of the question. But thanks to homeschooling by his devoted parents, at just 16, Lafontaine became one of the youngest-ever recipients of an undergraduate NSERC research grant through the University of Regina, where he graduated with a major in chemistry. Later, with the support of an entry program tailored to Indigenous students, Lafontaine was admitted to the University of Saskatchewan. He was the only Indigenous student there at the time.
Being the “first and only” can be a badge of honour or a crushing weight, depending on how you carry it. Lafontaine used his singular perspective to raise serious questions about a deeply entrenched crisis in Canadian health care: why were Indigenous people in his home province of Saskatchewan, particularly those living on reserves, so sick compared to everyone else? In 2016, Keeseekoose, Cote and Key First Nations declared a state of emergency. It was rare that a week went by without a death attributed to opioids, and funeral processions filled their band halls. Through 2017, Lafontaine co-led a national strategy with organizations representing 150 First Nations, forming the Indigenous Health Alliance, which sought to bridge the cultural gap in care by bolstering patient-doctor trust and, of course, funding. But the stories he heard about Northern Ontario nursing stations without resuscitation equipment and people leaving hospitals with improperly casted broken legs—all of them tragically commonplace events in Indigenous communities—were harbingers of the very same problems that now exist country-wide. Forget sporadic fires: the entire forest is burning.
We can’t invite historically excluded folks to the table, make it intolerable to sit there, then wonder why they still feel excluded.
This is a general issue across all levels of political service, from school boards to legislatures.
— Dr. Alika Lafontaine MD (@AlikaMD) February 24, 2023
Lafontaine’s ability to consider the greater whole was his biggest asset when he assumed the CMA’s top job. The issue that’s led Canadian health care into such a deep state of disrepair is, he believes, fragmentation. Private clinics, imported nurses—they’re just new manifestations of Canada’s very old piecemeal mindset, one that’s resulted in a network of medical facilities where providers can’t even keep track of the equipment between them, and where hospitals in one province, like B.C., can have an oversupply of anesthesiologists while Canada somehow grapples with a national deficit.
Lafontaine’s main priority as CMA head honcho will be pushing for pan-Canadian licensure, an overhaul that would allow doctors to transcend provincial and territorial borders without enduring time-consuming recertifications that can, in the current system, run docs up to $3,000 a pop. He sees promise in the federal government’s proposed $196-billion funding boost, a financial band-aid that also includes commitments to support regional movement. He’ll also be doubling down on team-based care, a model that allows patients to be referred to physicians who may not be in their jurisdiction but have more bandwidth to help them, if their current doc is strapped. (And they probably are.)
The way Lafontaine sees it, the future of Canadian health care doesn’t hinge on eerily precise robotics or state-of-the-art facilities but on our ability to bring his fellow doctors back from the brink. Part of that involves holding firm at policy tables. Another part is helping physicians help us. His sector may be facing one of the worst HR problems in Canadian history, but like any skilled care expert would, Lafontaine is there to provide a listening ear (and steady hands) as its bones are reset.