“Access to a family doctor is a fundamental right”: A physician on how Ontario health care fails underserved communities

U of T researcher and associate professor Tara Kiran has been a family physician for more than 20 years with a focus on underserved communities such as immigrants, refugees and people experiencing homelessness. She also headed up OurCare, a recent national initiative on primary care that had close to 10,000 participants. We spoke to her about barriers to health care and what doctors can—and sometimes don’t—do to help new Canadians.

Related: Dispatches from Ontario’s broken health care system

You get a lot of new Canadians at your practice within St. Michael’s Hospital. What challenges do they face in navigating their way to you? It’s pretty difficult for them to find primary care to begin with. Some of my patients came to Canada as refugees and were referred to me from social services. They’re often suffering from post-traumatic stress disorder from the events that drove them out of their country, sometimes compounded and exacerbated by current stresses like children and other family members who were left behind. And then there’s the pressure of adjusting to an unfamiliar new place where you have to worry about finding employment and a place to live—frequently without a network of support. Immigrants often have family here, which makes it easier to integrate, but this frequently isn’t the case for refugees. All of this is on top of any medical issues they may have.

Which can be addressed only if they find a family doctor. Definitely—but our system doesn’t make that easy. The official mechanism to find a family doctor in Ontario is Health Care Connect, but most people don’t know about it. And even if they do, there are so few doctors taking on patients. One of my patients is a refugee from Uganda who connected with me through his sister, another patient of mine. Had that not happened, I think it’s likely he would never have found care—and he needed it. He came to Canada in his late 40s, and he had been persecuted for being gay. When he saw me, he was suffering from many symptoms of PTSD. Often, people like this are anxious and worried that someone is out to get them. That might have been a rational thought to have in their country, but generally doesn’t fit with reality here. Still, their nervous systems are on high alert, which can lead to difficulty sleeping, difficulty concentrating and mood problems. Part of my work is to make a connection with these types of patients so they feel that they can trust me.

Are there factors that impede family doctors from providing care to newcomers? For one thing, newcomers often don’t know that primary care is an option. They may be satisfied going to a walk-in clinic and not know that they aren’t getting the ongoing, sustained treatment with a family doctor that they’re entitled to. There are also language barriers. I have access to language interpretation services through St. Mike’s, but that’s not something most family practices have. And then there’s the paperwork. Refugees come in with a different kind of health coverage. While they’re waiting for their claims to be accepted, they’re on the Interim Federal Health Program rather than OHIP. Treating people on that plan requires an extra administrative layer, and what we heard during the OurCare initiative was that some doctors won’t accept patients based on that alone.

What are newcomers most surprised by when it comes to Canadian health care? Based on the OurCare feedback, the most surprising part of our system for newcomers is all the things that aren’t covered, like dental care, prescriptions and ambulance services. Don’t get me wrong—they are grateful for what they do have. But they generally expect more given Canada’s reputation for free, universal health care.

What else came up during your surveys on difficulties underserved communities face while accessing health care? One of the groups was held in the Durham region. It focused on Afro-Caribbean and Black communities, in partnership with the Black Physicians Association of Ontario and two of the regions’ community health centres. Not only were many of the participants new to Canada and unfamiliar with the health care system when they arrived, but they were also Francophone. They struggled to receive care in French even though it’s one of our official languages. On top of that, they felt discriminated against for being Black. Research has shown that Black patients aren’t taken as seriously when it comes to pain—in some cases, they’re even expected to have higher pain tolerance. Historically, there’s a bias in our medical school curriculum, which often uses a 60-kilogram white man as its standard patient.

What’s the solution to that? The people at that roundtable really appreciated how the staff working at their local health centre came from similar backgrounds as them. But they questioned why so many people who were doctors in their home countries can’t use their skills here. We really need to accelerate and improve the training to make that happen.

And what needs to happen to fix health care in Canada more generally? When we did our initiative, everyone across the country agreed that access to primary care is a fundamental right, regardless of a person’s background or their ability to pay. And yet everyone also knows that the current system isn’t living up to those values. We need to do better, and the only way to accomplish that is for people to speak up to those in power.

This interview has been edited for length and clarity.