Canadian governments have outlined ambitious visions for team-based care and interprofessional collaboration to deal with a workforce crisis in primary care, with 6.5 million people lacking access to a regular family doctor. Yet, a fundamental policy contradiction undermines these efforts: while family medicine is exploring how to prepare doctors for team-based primary care, other health professions lack equivalent training requirements.
Since 2010, the College of Family Physicians of Canada has built a strong case through its education policy levers in accreditation and certification, aligned with their Patient’s Medical Home vision and Prescription Primary Care 2.0 to support family medicine residents to acquire competence in the Can-MEDS-FM Expert Role and the Can-MEDS-FM Collaborator Role working in interprofessional teams across the contexts in which family physicians work, particularly in primary care.
Nursing, pharmacy, physiotherapy, occupational therapy and other health professions operate under general interprofessional education requirements but have no specific mandates to learn within primary care contexts with other primary care health professional learners to provide comprehensive, continuous and coordinated primary care. The interprofessional primary care health workforce is not being intentionally prepared for team-based practice.
The federally-funded Team Primary Care initiative – involving 40 teams, more than 20 health professions and more than 100 partner organizations – revealed that most health professions lack pre-existing primary care curricula, despite expectations that they function effectively in primary care teams.
Health Canada’s January 2025 workforce study validates these concerns, explicitly recommending that “health professional education and training should be structured from a perspective of required competencies for primary care.”
The 2002 Romanow Commission presciently warned of today’s workforce crisis and prescribed a solution: train health-care providers to work together effectively. Following this, the federal government launched the Interprofessional Education for Collaborative Patient Centred Practice Initiative, recognizing that team-based care delivers superior patient outcomes.
Primary care has unique requirements that demand specific interprofessional preparation. Barbara Starfield’s foundational work identified four defining characteristics – the “4 C’s” – distinguishing primary care from other health-care settings:
- First Contact: Primary care serves as the health system entry point, requiring providers to assess undifferentiated health problems and coordinate appropriate care pathways.
- Comprehensiveness: Primary care addresses the full spectrum of health needs across the lifespan, integrating prevention, acute care, chronic disease management and health promotion.
- Coordination: Primary health professionals must integrate all aspects of care, ensuring seamless transitions while maintaining oversight of total patient care.
- Continuity: Primary care involves sustained relationships over time, building therapeutic partnerships that enhance care effectiveness.
The current training gap creates fragmented care, underutilized team members and overwhelmed family doctors. Despite increasing team-based practice models, many health-care professionals lack primary care preparation and interprofessional training in primary care contexts.
The current training gap creates fragmented care, underutilized team members and overwhelmed family doctors.
We need systematic reform across health professional education:
Develop primary care competencies for all health professions working in primary care, adapting existing interprofessional frameworks to include Starfield’s 4 C’s.
Align accreditation requirements so health professional accreditation bodies require demonstration of primary care competencies, not just general teamwork skills.
Create funding incentives that reward programs preparing graduates for primary care practice, with enhanced support for interprofessional primary care education.
Mandate primary care exposure so all health professions working in primary care demonstrate core understanding through curriculum requirements.
The infrastructure for change exists: interprofessional education frameworks, accreditation bodies, health professional schools and policy momentum. What’s missing is coordinated action extending primary care training requirements beyond family medicine.
This requires collaboration across sectors. Health professional programs must integrate primary care competencies into curricula with interprofessional approaches. Accreditation bodies need to require primary care preparation for professions working in primary care settings. Government funders should prioritize innovative funding for primary care team preparation. Health system leaders must recognize that effective primary care teams require all members to understand primary care contexts.
Canada cannot solve the primary care crisis without considering the needs to prepare all healthcare professionals envisioned to work in the primary care context in team-based care. True interprofessional primary care requires symmetric preparation – all team members must develop primary care competencies to deliver the comprehensive, coordinated, community-oriented care that primary care demands. They must have intentional learning provided in primary care contexts learning about, from and with other health professional learners.
The vision exists. The need is urgent. The solution requires extending primary care training requirements beyond family medicine to create truly prepared primary care teams.
Ivy Oandasan, MD MHSC EMBA CCFP FCFP, is a Professor in the Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto.
www.linkedin.com/in/oandasan
Thank you Ivy for posting this important issue regarding health professions education. I wholeheartedly agree that this is critical if primary care and integrated care teams are to function to provide best care to patients. In addition to theories of interprofessional, integrated and primary care, health profession students (and I would argue current health care practitioners) need opportunities to learn in primary care team settings. I suggest creating innovative placement opportunities for all health professions students where they can be exposed to working within teams and across healthcare settings to support patients along the continuum of care. This cannot happen in isolation of course, we need education and practice sectors to work together to create these opportunities for our current and future healthcare professionals.
Just because the infrastructure exists doesn’t mean that allied health professional associations and colleges understand what primary care actually is. They don’t know the training, knowledge base and skill set that goes into making a primary care physician. Do they even want to listen to those that do know? Until they have a firm grasp of the breadth and depth of primary care…of the gap between what a family physician does and how they do it and the skill set and knowledge base of their own profession, they can’t possibly train their profession to work in primary care teams with family physicians.
Allied health professionals are also receiving mixed messages from provincial governments. Scope expansion without training how to work in primary care teams leads to more isolation, more silos, more confusion for the populace and more work for family physicians. It also leads to gaps in communication that can put patients at risk for poor outcomes. Allied health professionals are being told, in so many ways, that they can do the work of a family physician and they and the public are being told that they can do it as well or better for cheaper. They are being legislated to do more all in the name of convenience.
Who can blame associations and colleges of allied health professionals if they are confused…one the one hand they are being told that they can replace us and on the other hand they hear that inter professional primary care teams are the future. I would argue that it is easier to plan to replace primary care physicians in isolation than it is to come together with primary care physicians and other health care professionals and create a coherent education plan to prepare to work together in interprofessional primary care teams.
Important perspective Paul. I would first question if we all have the same definition of primary care and primary healthcare and argue that family physicians who are trained to do intrapartum care, in office surgical procedures emergency medicine, in hospital care plus cradle to grave care do more than primary care. Working in primary care as the foundation of the healthcare system requires a diverse health workforce who understands the 4Cs of primary care with an infrastructure that supports practicing these behaviors. As educators, government, healthcare professionals and the public let us be clear on the context and then who works within, across and integrated with primary care and those who work in all healthcare settings. The competencies of a family physician or nurse practitioner or primary care pharmacist or social worker are not the same. Contributions to primary care delivery are offered by different health professionals. Therein is the challenge when we lump everyone in as the same.