Need a Family Doctor? Jane Philpott Can Help.

Tommy Douglas wouldn’t be too pleased if he could see the state of Canadian health care today: warlike wound-dressing in ER hallways, creeping privatization, scattershot definitions of “medically necessary” and more than six million of his fellow citizens without a family doctor. Like Douglas, Jane Philpott—a trained family doctor herself—is big on radical reforms. Canada’s former health minister outlined her own plan to bust through the system’s discombobulation in this year’s bestseller, Health for All. One proposal is the creation of primary-care “homes,” teeming with nurse practitioners, therapists, housing workers, dieticians, tax experts (!) and, of course, family physicians. Ones we can actually get in to see.

For the moment, Philpott is forced to narrow her focus. She exited the toxic (her word) political milieu after the Liberals’ cabinet-shattering SNC-Lavalin debacle in 2019, then took a directorship at Queen’s med school in Kingston. Recently, she accepted Doug Ford’s offer to lead a brand-new primary-care “action team”—a gig that officially begins next month—with the goal of hooking up every single person in Ontario to care by 2029. Pulling the ripcord and paying for private, she says, isn’t the panacea you think it is.

In Health for All, you say the Canadian health-care system has “stagnated under the weight of cowardice.” As someone who’s devoted her entire life to medicine, did that hurt to admit?

I don’t know if it hurt me personally, but it’s a jolt to the Canadian identity. So much of that is wrapped up in having the best health-care system in the world; I’m not sure that was ever true. To be clear, the fact that we have universal health coverage for doctor and hospital care is phenomenal— something to be proud of—but the full vision of medicare was never quite realized. And you can’t fix something you don’t acknowledge is at least partially broken.

One-fifth of the country not having family doctors is a glaring shortcoming. What are the others?

If you read the works of Tommy Douglas or the more recent Romanow Report (also known as the Royal Commission on the Future of Health Care in Canada), medicare was supposed to include home care as a national guarantee, plus mental health care, dental care and pharmacare. Instead, we narrowly defined “medically necessary care” and gave provinces leeway to determine what else would be in their basket of insured services. We also never said that, once you did have a family doctor, you’d be able to see them within a reasonable time frame. Those cracks are being revealed right now.

Back in October, you were tapped to head up Ontario’s new Avengers-esque primary-care action team. Your assignment: to connect each Ontarian to a family doc the same way kids are assigned to schools. That’s probably a lot more complicated than it sounds. How do you plan to pull it off?

It’s early days, but we’re thinking about two streams. Where people have providers, we’ll add capacity. That might mean asking doctors what it would take to help them extend their hours or raise their caseload from, say, 4,000 patients to 5,000; maybe it’s a nurse practitioner. In communities where 70,000 people are without a doctor, we’re going to need to establish brand-new primary-care “homes,” as I call them. If you can’t get in to see your GP, you might be seen by a nurse practitioner, a dietician or a social worker, depending on your needs. And we may need hundreds of these teams across the province. The good news is patients love this model. Young physicians do, too.

That’s good, because there’s no way all of these teams are going to be in exciting urban centres—or even suburbs. How will you attract young docs to remote places when you’re bleeding out staff everywhere?

It’s chicken-egg, right? Right now, family doctors are checking hundreds of emails and lab results on their holidays. That’s a horrible, horrible way to work. Still, we can’t create satisfactory conditions without keeping people in the system. Ideally, both of those things happen in concert. Once young trainees are a year or two out from graduating as MDs, I’ll be saying, “I want all”—or almost all—“of you to stay in general comprehensive practice. What are you looking for?” Maybe they want someone to delegate their inbox to.

Given how desperate Canadians are for care, have any emailed you their medical horror stories? Anyone asked you to look at their weird skin thing at a party?

All the time. You should see my inbox. The other day I was talking to a psychiatrist who was asked to renew somebody’s diabetes prescriptions. The person said, “I know I need to stay on these medications and I have nobody else to go to.”

I have friends who get maybe 30 minutes of GP face time a year. Others’ doctors have seen them through their first bout of strep throat, their first periods and pregnancies, all the way up to caregiving for aging parents. Should Canadians still expect that level of doctor-patient closeness in 2024?

We know that when people have long-term primary-care relationships, they live longer and they’re generally healthier and happier. They may not have it now, but most Canadians have, at some point, had that person. Somebody with whom they didn’t always have to start from scratch.

Who was that person for you?

I have sentimental memories of my childhood doctor, Ray Middleton—a Queen’s med school alumnus, actually! He looked like he stepped out of a Norman Rockwell painting. Baggy pants. Wholesome. He saw my family from the time we moved to Hespeler (now part of Cambridge), Ontario, when I was six—a year after my brother died from complications of the flu—to when I went off to university. My mom was reassured by his house calls. She probably worried that, if we got the flu, what happened to my brother would happen again. I shadowed Dr. Middleton in my last year of high school. He used some of his income to hire an amazing nurse practitioner named Arlene. Hespeler was a relatively small town back then, so working at the clinic gave me some insight into what it’s like to know so much about people’s private lives—in this case, my neighbours’.

What is your sick-person personality? On a scale of one to giant baby?

I’ve never taken a sick day. Touch wood.

What?!

Maybe as a child. I don’t remember ever spending a day sick in bed. (My husband might be able to remember, but I can’t.) There were times I probably should have, but I plowed through.

Do you lean on any remedies to help you maintain that stamina? Tea?

I don’t know. Perspective? Like, I might not be feeling well, but I’ve got work to do. Someday, that’ll probably come back to bite me.

On the subject of work: back in 2019, you resigned from the Liberal cabinet over its handling of the SNC-Lavalin affair, which you described as an affront to your ethics. Between its toe-dipping into private health care, the Greenbelt—I could go on—Doug Ford’s government is not exactly scandal-free. What convinced you to try politics again?

In medicine, you help people stay well one by one. I loved politics because I could do things that could improve the health of hundreds or thousands of people in a single swoop. Of course, there’s risk involved. Will there be follow-through? This primary-care plan is going to take a lot of resources, a lot of continued political will. But if it works, it’ll change the face of health care in this province, and maybe even beyond it. It was too great an opportunity to say no.

Did (or do) you have any misgivings about aligning yourself with an administration that has been accused of intentionally tanking the province’s beloved public system? (I’m thinking of the passage of the Your Health Act in 2023, which allowed for-profit clinics to conduct more OHIP-covered surgeries.)

I want to emphasize that this new job is non-partisan; my official role is with the public service. But my views about the importance of medicare are well-known: I believe firmly that we have to preserve access to medically necessary care that’s based on need and not someone’s ability to pay. I will always fight for that. I’m sure the Ontario government knows I will, too. I suspect that some of the public’s fears and accusations aren’t always founded.

The Ontario Health Coalition released a report last February that showed some privately owned facilities are receiving dramatically higher payments than public hospitals for the exact same procedures. I think it’s fair to be worried about that.

There certainly are breaches of the spirit of the Canada Health Act, where people are paying out of pocket for insured services. I don’t blame them. People will often do anything necessary to get care for themselves or their loved ones. But that points to a system failure. I think any government is just trying to solve problems for its people—and the sooner the better. In this country, about 30 per cent of health care is delivered privately, which is a higher percentage than many countries. But you can’t possibly cover everything. There’s not a public benefit to providing cosmetic surgery to everybody, for example.

Have you ever used a private service?

I’ve never paid privately for a publicly insured service. I’ve been to the dentist—and a physiotherapist once or twice. But I had insurance for both.

Do you personally know anyone who has resorted to medical tourism—say, flying to Turkey for a knee replacement—rather than floundering in the public system? 

Nobody in my immediate family. My mom’s on the list for hip surgery now. She’ll wait her time in the queue, as she should. 

You’ve said that you feel like we’ve tried to run health care without a soul. How so?

We put a lot of emphasis on fitness and diet, but we don’t talk much about how to make sure the deepest core of who we are as humans is protected and cared for. I’m also a person of faith—my husband and I are members of Community Mennonite Church in Stouffville, Ontario. That gives me a set of values for what’s expected of me. That said, I haven’t been a church regular since the pandemic. 

You had some profound medical experiences in Niger and Ethiopia—areas with significantly fewer resources than here. Did any of their approaches inspire your work in Canada?

Ethiopia comes to mind immediately. When I was there in 2008 establishing the country’s first family-medicine training program, the minister of health was Tedros Adhanom Ghebreyesus, who’s now director-general for the World Health Organization. He knew not everybody would have a family doctor but, in his mind, they could at least have community health workers. He mapped the whole country, right down to the village level, and figured they needed to train 30,000 of them in a short time period. I think it was five years. 

Sounds... familiar.

I think Tedros actually went slightly over his target. We’ve never done anything that ambitious in Canada. We’ve never said: We need to set big, hairy, audacious goals, as some like to say. Let’s turn the crank because our people are depending on us.

Your daughter, Bethany, earned her medical degree in 2017. How did you persuade her to get into the game?

She made up her own mind, but I did give her some unsolicited advice. Around the time she started med school, late one night, I wrote her a letter that I ended up publishing on a blog: “30 things I’ve learned in 30 years as a doctor.” She’s now a GP in Belleville. I’m super proud of her. 

Would you ever return to practice?

Oh, there’s a big part of me that misses dealing with patients. Having my daughter and lots of friends in it helps keep me connected to it. 

What part do you miss the most?

Seeing people through. An emerg doc sees somebody at one point in time; you might never know what became of them. That would be so frustrating for me! Family medicine is like an ongoing novel—and you’re in the novel of 1,000 people’s lives. I love knowing how it all turned out.

Are you a big reader? 

I “read” a lot of audiobooks—lots of biographies. Let me pull up my Audible and see what my last 25 books are...

Did any have an outsize impact on you?

How Big Things Get Done by Bent Flyvbjerg and Dan Gardner. I just finished it. For the second time.

This interview has been edited for length and clarity.