Les Grands et Petits Moments de la Dernière Année : Revue de publications récentes et de nouveaux médicaments (French only)

Primary Care Under Pressure

Canada's primary care system is straining under a confluence of workforce shortages and demographic pressures. In 2025, the number of family physicians per capita rose in most provinces, yet access deteriorated due to an aging population with complex health needs. By early 2026, estimates suggest 5.9 million Canadians lack a family doctor, down slightly from prior years but still alarmingly high. This mismatch arises as more physicians opt for specialized niches like emergency medicine or psychiatry, reducing the pool available for comprehensive community care.

Recent drug approvals amplify the urgency. In October 2025, Health Canada greenlit lecanemab, the first treatment to slow Alzheimer's progression, targeting early-stage patients with specific biomarkers. Other notable additions include Alyftrek for cystic fibrosis in those aged six and older, and various oncology and dermatology therapies like lazertinib for lung cancer. These advancements promise better outcomes but require family physicians to weigh risks, such as lecanemab's potential side effects, against benefits in resource-constrained settings.

Real-world impacts are profound. Without prompt primary care, chronic conditions like diabetes or hypertension escalate, leading to higher hospitalization rates and costs exceeding $10 billion annually in avoidable emergency visits. In Ontario alone, projections indicate 4.4 million without a doctor by 2026, exacerbating inequities in rural and Indigenous communities where wait times already stretch months. Urban areas fare little better, with Toronto anticipating nearly one million unattached patients.

Stakes involve tight deadlines and financial burdens. The Canada Health Act's new services policy, effective April 2026, mandates provinces cover medically necessary services by nurse practitioners if equivalent to physician-delivered care, with non-compliance risking federal transfer deductions starting December 2028. Immigration reforms reserving 5,000 spots for doctors aim to infuse 1,000 new practitioners yearly, but integration lags could cost $500 million in training and credentialing. Inaction risks burnout, with 52% of Ontario family doctors eyeing retirement within five years, potentially collapsing ERs already at 120% capacity.

Non-obvious angles include trade-offs in care models. Expanding non-physician roles eases immediate pressures but may fragment continuity, as patients bounce between providers. Surprising data shows administrative burdens consume 19 hours weekly per doctor, diverting time from patient care. Tensions simmer between fee-for-service payments, which incentivize volume over complexity, and team-based approaches that demand upfront investments but yield long-term savings. Counterarguments highlight that while more specialists address acute needs, they undercut preventive care foundational to family medicine.