Primary Focus with Dr. Tara Kiran

In this episode, Tara speaks with Dr. Nicole Boutilier, Executive Vice President of Medicine and Clinical Operations at the Nova Scotia Health Authority —  a family doctor leading primary care transformation from within the government. Dr. Boutilier walks Tara through Nova Scotia’s multi-pronged plan to improve primary care access: transforming the province’s centralized waitlist into an active patient management tool, building and strengthening Health Homes (team-based primary care clinics), creating pathways for people without a family doctor to access care while they wait, and modernizing how data flows — so patients can access and share their own health information through the YourHealthNS app.

Research and programs mentioned in this episode

Read the OurCare reports from the Provincial Priorities Panels (including Nova Scotia’s).

Find out more about Nova Scotia’s Need a Family Practice Registry and Health Homes model.

Get more info on Nova Scotia’s Longitudinal Family Medicine (LFM) physician payment model.

Watch a video about how the YourHealthNS app gives patients access to their health data.

Learn more about Nova Scotia’s new pathways for integrating internationally-trained medical graduates and the new Cape Breton Medical Campus training rural family doctors.

Dive into the research on virtual care in Canada.

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In Part Two of our Costa Rica series, Dr. Tara Kiran takes you inside an EBAIS (Equipos Básicos de Atención Integral de Salud) clinic on the Nicoya Peninsula in Costa Rica to see what it actually looks like to deliver primary care beyond clinic walls. Costa Rica organizes primary care around geography. Each clinic is accountable for a defined population — and community health workers play a central role in making sure no one is missed. They visit households, provide education on prevention and chronic condition management, deliver vaccines, identify risks early, and act as a bridge between public health and clinical care. It isn’t a perfect system. But it is an ambitious one. And it offers a powerful contrast to Canada’s often fragmented approach to primary care and public health — reminding us that building a system where everyone has care is not just a matter of funding, but of design.

Further reading:

Listen to Part 1 of our series on Costa Rica with Dr. Madeline Pesec

Take a look at the research article that first introduced me to Madeline (co-authored by Dr. Atul Gawande) 

Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs 

Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul Gawande

Read the BBC article Tara mentioned about how Nicoya Peninsula is home to a large number of centenarians

Learn more about rising violence in Costa Rica related to femicide and gang violence

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

This episode is the first in a two-part series on the primary care system in Costa Rica. Dr.Tara Kiran sits down with Dr. Madeline Pesec, an internal medicine physician and pediatrician, to explore Costa Rica’s ambitious primary health care system. They talk about how Costa Rica's commitment to health as a human right and its community-oriented primary care have led to significant improvements in health outcomes. From the concept of "Hospital Without Walls" to the role of community health workers, Madeline shares insights from her extensive research and personal experiences in Costa Rica. Then, join us in our next episode where Tara goes on a tour of a Costa Rican clinic and speaks to members of the EBAIS (Equipos Básicos de Atención Integral de Salud) about both how and why they do their work. 

Further reading:

Take a look at the research article that first introduced me to Madeline

Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs 

Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul Gawande

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode, we take you to Saint-Hyacinthe to see how a team in Quebec is transforming timely access to primary care. Quebec has more interprofessional primary care teams than anywhere else in Canada — yet it remains one of the provinces struggling most with access. So how do you turn a team into one that actually works? Dr. Kiran sits down with Dr. Isabelle Gaboury, a researcher and QI leader who, alongside colleague Mylaine Breton, has modernized the “advanced access” model for today’s interprofessional clinics. Together, they’ve coached more than 40 practices to redesign workflows, clarify roles, and use data to constantly iterate. Then I take you inside GMFU Richelieu-Yamaska, where waits dropped from 14–16 days to just 3. You’ll hear how receptionists learned to triage using a symptom-based algorithm, how nurses and social workers took on new responsibilities, and how the whole clinic shifted from working harder to working differently. It’s a story about change management, team-based care, and what it really takes to deliver timely, patient-centred access — in Quebec and across Canada.

Resources mentioned in the episode:

An article on why it’s so hard to find a family doctor in Quebec

Isabelle and Mylaine’s contemporary advanced access model

How Canada compares to peer countries when it comes to timely care

An older commentary from Tara that delves into why timely access is such a problem in Canada

A summary of Quebec’s data from the OurCare survey

Explore Quebec data from the 2022 OurCare National Survey at data.ourcare.ca or read this article

Visit the website for GMFU Richlieu-Yamaska

Listen to our 4-part series on The Netherlands (mentioned in this episode when discussing training for primary care nurses

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this episode of Primary Focus, Dr. Tara Kiran travels to Renfrew County, Ontario, where an innovative team is tackling the family doctor shortage with a new kind of hybrid care - where your doctor is virtual, but your team is on-site. At the Petawawa Centennial Family Health Centre, Dr. Jonathan Fitzsimon shows Tara how patients are matched with virtual family physicians who work alongside local nurses, pharmacists, and other health professionals to provide full-service, ongoing care. The result? More than 6,000 people who once had no family doctor are now receiving comprehensive, team-based care. It’s a story about creativity, access, and what’s possible when rural communities rethink how primary care can be delivered.

Further reading:

Explore more about the Petawawa Centennial Family Health Centre Read a report summarizing Renfrew’s Integrated Virtual Care model 

Dive into research on the Integrated Virtual Care model including papers on early patient outcomes, patient experience, and staff experience. 

See some photos of Petawawa Centennial Family Health Centre (link to post)

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by the St. Michael’s Foundation and the MAP Centre for Urban Health Solutions. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

This season, we’re diving into innovative primary care practices across Canada—starting in Alberta, where one family practice is making timely, high-quality care a reality for more than 25,000 patients within a fully capitated model. In this episode, Tara visits Crowfoot Family Practice in Calgary—a clinic that’s getting team-based care right. Physicians here manage patient panels about 30 percent larger than their peers, thanks to a model where 35–40 percent of care is delivered by non-physicians. Executive Director Shauna Thome gives us a tour of the clinic, and then she and medical director Dr. Janet Reynolds join Tara in conversation. They talk about how the role of the physician on the team is different, how the team is piloting new ways to attach patients without a family doctor, and how continuous quality improvement—with patients as partners—shapes the clinic’s culture.

Research mentioned in this episode

Explore more about the Crowfoot Village Family PracticeTake a look at the case study evaluation Health Quality Alberta published on CrowfootRead more about the Calgary Foothills Primary Care Network Dr. Janey Reynolds leadsRead the final report from the Modernizing Alberta’s Primary Care System (MAPS) processCheck out this article that talks about how teams are our hope for the future and can theoretically help doctors care for more patientsSee some photos of Crowfoot Village Family Practice

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

As Canada faces a family doctor shortage, Tara calls up her friend Dr. Ruth Lavergne, a primary care researcher at Dalhousie University, to ask how we ended up an estimated 23,000 doctors short — despite training more in recent years. Together they explore how the work of family doctors has grown more complex, why more are choosing focused practice or shorter hours, and how payment reforms are shaping — but not necessarily solving — the challenge. Along the way, they reflect on the moral and emotional strain of family medicine, the choices doctors make to preserve balance and meaning, and what it would take to make family medicine not just better paid, but a better job. Stay tuned to the end, when several family doctors sound off about their own practice choices — whether full-service or something different — and what led them there.

Research mentioned in this episode

The federal report estimating Canada is 23,000 family doctors short

Tara’s research on the shift away from full-service family medicine

Ruth’s research on career choices and administrative burden in primary care

Dive into the commentary on physician payment that was a Ruth-Tara platonic meet-cute

Here's the cross-country comparisons on physician payment mentioned in the episode

MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. 

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

In this special episode, host Dr. Tara Kiran reflects on the passage of Ontario’s new Primary Care Act—the first legislation of its kind in Canada. Joined by Peter MacLeod, founder of MASS LBP and co-lead of the OurCare initiative, Tara and Peter take you behind the scenes of a national public dialogue that helped shape the new law. Nearly 10,000 Canadians participated in the OurCare process and what they said they wanted from the primary care system is now reflected in Ontario’s legislation. This episode is a story of civic imagination, moral beauty—and a hopeful step toward primary care that works for everyone.

Resources mentioned in the episode:

Read more about OurCare and OurCare Standard: OurCare.ca

Meet some of the OurCare panelists: https://www.youtube.com/watch?v=ShkxhIJBCh8&t=25s

Review Ontario’s Primary Care Act: https://www.ontario.ca/laws/statute/s25008 

Watch the press conference where Ontario’s Minister of Health, Sylvia Jones, announces the Primary Care Act: https://www.youtube.com/watch?v=RFYZOosIZngRelated articles you might like:

Results from the OurCare provincial priority panels

Dr. Tara Kiran’s Opinion piece in the Toronto Star

More about Primary Focus:

Subscribe to our Substack newsletter

Visit our website at primaryfocus.ca

Learn about the OurCare Standard

Take the OurCare national survey to share your experiences with primary care.

Do you have an idea for an episode? Email [email protected] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

How do you design a system that delivers timely primary care — not by chance, but by design? In this final episode in the Netherlands, Tara visits a health insurance company and reflects with her travel companion, Rosemary Hannam on what stood out from their trip to the Netherlands. They discuss how features like standardized GP contracts, clear access guarantees, strong physician leadership and a customer-orientation help keep primary care timely and organized — and consider what Canada can learn from the Dutch approach.

If you missed Part 1,  Part 2 or Part 3, click to catch up. 

See a gallery of Dr. Kiran’s photos from her trip to the Netherlands.

Hear Dr. Kiran speaking about her trip on CBC’s White Coat, Black Art

Read Dr. Kiran’s 4-part series for the Medical Post on her trip

Subscribe to our Substack newsletter to get bonus content.

Take the OurCare national survey to share your experiences with primary care.

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.

Emergency departments in Canada are overcrowded — but what if they didn’t have to be? In Part Three of her audio documentary series from the Netherlands, Dr. Tara Kiran takes listeners behind the scenes at two Dutch after-hours clinics: one in the university town of Nijmegen, and another in bustling Amsterdam. She follows Dr. Tim Olde Hartman into a modern after-hours centre that serves over 400,000 people — and learns how Dutch GPs came together to fix a broken model. Rather than being on call alone, GPs in the Netherlands now work together in large regional cooperatives to provide care 24/7. Patients call one number, speak with a specially trained practice assistant, and are guided to the right level of care — whether that’s phone advice, an in-person visit, or a doctor dispatched directly to their home.

It’s a system built on trust, triage, and teamwork — and it results in emergency rooms that are calm, efficient, and often… empty.

Stay tuned for Part Four, where Tara reflects on the trip with colleague Rosemary Hannam, who joined her in the Netherlands just before becoming Strategic Advisor on Primary Care at Ontario Health.

If you missed Part 1 and Part 2, click to catch up. 

See a gallery of Dr. Kiran’s photos from her trip to the Netherlands.

Hear Dr. Kiran speaking about her trip on CBC’s White Coat, Black Art

Read Dr. Kiran’s 4-part series for the Canadian Health Network on her trip

Read an article on after hours care in the Netherlands called "Quality of after-hours care in the Netherlands: a narrative review"

Subscribe to our Substack newsletter to get bonus content.

Take the OurCare national survey to share your experiences with primary care.

Do you have an idea for an episode? Email [email protected]

Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ 

Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto.