Primary care’s real problem isn’t the system—it’s us

These are exciting and challenging times in primary care. On one hand, more attention has been paid to the primary care crisis over the past three years than in the past three decades. Across Ontario and Canada, more recognize the foundational value of primary care in our healthcare system. The importance of an interdisciplinary team-based model has been highlighted like never before with investment and support at various levels; Ontario’s Primary Care Action Plan is just one example. From an optimistic perspective, we’re making progress, but is it enough? On the other hand, system-level challenges and how they impact primary care teams are also drawing attention. We need adequate health human resource funding, digital integration of health information systems, legislation to ensure health professionals are able to practice to their full scope, and reduced administrative burden so that they can focus on patient care and not paper work. These are all real issues that need to be addressed because they affect our day-to-day practice and our ability to provide patient care. What doesn’t seem to get as much attention are the challenges with collaboration, the actual substance of building interprofessional relationships and finding ways to work together effectively. Human relationships are at the root of everything we do in healthcare, but they are fragile, heavily influenced by the attitudes and behaviours of people. In this case, we have a wide variety of health professionals with different agendas, biases and perspectives. Trust and respect among health professionals are essential to functional interprofessional collaboration; when it’s lacking at the individual and professional group level, collaboration suffers. Maybe we started off on the wrong foot? When the first Family Health Teams (FHTs) were formed in Ontario in 2007, interprofessional education (IPE) in undergraduate health professional programs was still in it’s infancy. Sure, we talked about roles and collaboration, but we weren’t learning how we were actually supposed to work together. And let’s face it, it’s far from intuitive especially when you consider historical context. Without that foundation in training, were we bound to fail? It’s been said many times: you can’t just throw people together and expect them to form an effective team. Taking it one step further, do professional programs need to assess some measure of willingness to collaborate when selecting candidates? Should a collaborative mindset become just as important as academic aptitude and critical thinking skills when we are choosing our health professionals of the future?More than anything, I would argue that the primary driver of success in collaboration would seem to be intention, open-mindedness, and a willingness to share the responsibility of care with others. I vividly recall much of the language used in the early days of FHTs sold interdisciplinary health professionals (IHPs) as “helpers,” “supporters,” and “extenders” of physicians. Well, 20 years have passed. Has anything changed? The art of true collaboration still eludes us, IHPs often remain under-used, and systems ensure patient care remains stuck in physician bottlenecks. The subtext of this persisting messaging about teams is clear: a hierarchy still exists in healthcare, with physicians at the top and IHPs as subordinates. Team-based care was new back then and the evidence was not as robust, so perhaps some struggled with the view that IHPs are valuable health professionals in their own right, with knowledge and skills unique to their disciplines, and real potential to have measurable impact on patient outcomes. Can we not conceive of the value of IHP care unless it is tied to reducing physician workload or increasing patient attachment to a physician? Maybe we set ourselves up for failure by framing IHPs as support staff as opposed to equitable partners in patient care? In my mind, true collaboration is impossible until we address this inequity in the perceived value of care provided by different health professionals. So, perhaps our foundation is weak due to a lack of IPE and the propagation of hierarchies when teams were forming, but why does it still feel like a struggle today? Part of the problem, in my opinion, is that interprofessional trust, respect, and empathy can be hard to come by when for a long time it has felt like various professional associations are more interested in positioning their members as essential above all others. Most of them pay lip service to the broad concept of collaboration in primary care through statements, policies, endorsements and social media posts while simultaneously (and subtly) attacking progress by taking aim at other professionals.The recent discourse around federal legislation to fund “physician-equivalent services” (problematic language, I agree) conducted by nurse practitioners and pharmacists is just one example. But every few years, there is negative chatter as IHPs simply seek a seat at the primary care table, not to replace anyone, but to contribute to primary care with equitable footing in the way we're trained. It's immensely frustrating to see this type of discourse rear its head again and again given the dire need for us to work together to fix the system. Ultimately, it feels foolish for a drowning man to slap away a lifeline. This antagonism between professions is often subtle and I don’t want to believe that it’s malicious; we all know that change is hard, especially when it involves dismantling power structures and hierarchies that have existed for decades. That being said, anyone who has worked in a team should be able to appreciate the value of different viewpoints, different areas of expertise and different backgrounds. There are so many personal, professional and systemic benefits to embracing collaboration, but we need to abandon the us vs. them narrative and focus on getting the work done. To put it bluntly, the call is coming from inside the house: we're the problem. In general, most health professionals are well-meaning people who are providing the best care they can, doing their best to work effectively within the team. We also absolutely have leaders from various professions who were early adopters of collaborative team-based care and still champion the model. I also understand that professional associations have their mandates. But we shouldn’t lose sight of the oaths we take to put patients first. Are our patients being served by in-fighting, whether it be open or passive-aggressive, about who gets to do what? With the approaching tsunami of an aging population and an ever-growing burden of chronic disease, what are we actually accomplishing by arguing over role and scope?We’ve lost the plot. As much as we need system-level change, we also need an attitude adjustment and it would be great if the professional association leaders could find a way to support their members without counterproductively dismantling collaborative spirit. The way we present ourselves as a group has a way of trickling down and influencing our individual attitudes and behaviours; when our leaders negatively speak about other professionals, it can have a huge detrimental impact on interprofessional relationships. In 2026, it’s time to be honest with ourselves: there is not a single one of us who can be all things to all patients. Not at 100%. Not with the complexity of medicine and the complexity of the biopsychosocial context that our patients exist in. We need all hands on deck. But can we actually change? We can build team-based infrastructure and throw money at the problem all day, but I’m not confident that will get us anywhere unless we address the underlying interprofessional conflicts and shift to a truly collaborative mindset. I’m just one pharmacist venting my frustration; one with 15 years of team-based primary care experience, but just one nonetheless. I genuinely love working in primary care and can’t imaging working in any other sector, but I also can’t believe that I’m alone in this frustration around meaningfully moving the needle on collaboration; we’ve been squabbling about who does it best and who should get to be involved for decades and it’s enough already. Maybe we all need to do some reflecting and be a little more critical about our role in improving collaboration. Are we walking the walk or just talking the talk? In particular, I'd love to see all the professional associations and leaders in positions of power, those who have real influence to effect change, strongly reflect on how the current approach is serving patients and take action on a better way to advocate for team-based primary care in a way that keeps the focus on patients and where we are working on progress together rather than in our professional silos. Our patients deserve it. Jay Reaume is a clinical pharmacist at the Elliot Lake Family Health Team in Elliot Lake, Ont.

Primary care’s real problem isn’t the system—it’s us

Register for free access or login.

Related Topics