Where is primary care access worst? New survey highlights discrepancies among Canadian jurisdictions

Insufficient access to primary care permeates the country, but some areas have it far worse than others. That is among the findings from a new pan-Canadian survey of nearly 17,000 participants conducted between April and November 2025 in partnership with the Canadian Medical Association (CMA) and OurCare, a research initiative based out of St. Michael’s Hospital in Toronto.Across Canada, 82.8% of respondents reported having access to a family doctor, nurse practitioner or primary care setting of some kind, but this figure vastly varied among provinces and territories. In some provinces, nearly 90% of respondents said they had access to primary care, while in much of the territories and Atlantic Canada, the percentages were as low as 62.6%.Part of this has to do with geography, particularly in places like Nunavut and the Northwest Territories that have a small population living in a vast and remote region. But family physician and researcher Dr. Tara Kiran, who led the study, says these discrepancies are also reflective of the different policy decisions that all of the provinces and territories have made around family medicine and team-based care.“Over decades, provinces and territories have developed different policies when it comes to primary care,” Dr. Kiran, who also founded OurCare, said in an interview with the Medical Post. “Doctors are paid differently in different provinces. Their investment into primary care infrastructure, how primary care is organized, the accountability that's required of primary care—all of that varies by province and territory, and I think ultimately, those policy choices are driving what we're seeing in terms of these differences.”Three provinces in particular—Manitoba, Ontario and Alberta—had primary care attachment rates of 88.8%, 88.5% and 87.4%, respectively. Dr. Kiran says part of this has to do with the fact that the pay discrepancy between family doctors and other specialists in Alberta and Ontario, in particular, is not as great compared to other provinces, with funding models like capitation enabling better compensation than what fee-for-service can offer. Dr. Kiran also noted that these three provinces have invested heavily into team-based medicine.“All three are provinces have invested in teams in different ways, but I suspect that's one factor. However, it's not an explaining factor in its own, because we see one of the provinces where people are struggling to get access to care is Quebec,” Dr. Kiran said.Indeed, only 72.5% of Quebec respondents reported access to primary care. Quebec also leads the country paying out-of-pocket to access primary care. In the survey, 19.6% unattached Quebec patients reported paying out-of-pocket, which is almost twice as high as the national average of 11.3%.“That's consistent with the policy context. We know in Quebec, it's one of the provinces where fewer people have access to primary care, and it's also one of the provinces where the legal landscape is different and there is more prevalence of private pay clinics,” Dr. Kiran said.And even in the provinces where nearly 90% of residents are attached to a primary care provider, the work isn’t finished. Ontario, for instance, still has more than 1.53 million residents without access to primary care, Dr. Kiran noted.“The job is far from over, that's still far too many people who whose health is suffering, as a result of not having access to the care that they need,” she said.Access to health records was another aspect that had wide variance across provinces and territories. Less than 30% of residents in Manitoba, Prince Edward Island and the territories said they had access to their vaccination history, medication records, lab test results or other records online. However, in B.C., Alberta and Saskatchewan, it was 78%-to-86%. In these provinces, Dr. Kiran notes there is a province-wide patient-facing healthcare app, while no such app exists in most of the other jurisdictions.Despite these variations, the percentage of respondents who were satisfied with their primary care doctor or nurse practitioner was generally consistent across the country, with most provinces hovering around the national average of 67.3% (P.E.I. was the exception, with satisfaction a rate of 81.1%).Dr. Kiran says she hopes the findings of the survey can enable policymakers have a better understanding of what’s working and not working in other jurisdictions.“I do think there's a lot that we need to be learning from each other in order to get to better for everybody,” she said. “Unfortunately, that reality is . . . where you live matters in Canada, and if you live in some provinces, you're just much more likely to get high quality primary care than you are in others, and that shouldn't be the case.”The full report can be read online through the OurCare website.

Where is primary care access worst? New survey highlights discrepancies among Canadian jurisdictions

Register for free access or login.

Related Topics