Primary Focus with Dr. Tara Kiran

• In Costa Rica: How a middle-income country built a world-class primary care system

  This episode is the first in a two-part series on the primary care system in Costa Rica. Dr.Tara Kiran sits down with Dr. Madeline Pesec, an internal medicine physician and pediatrician, to explore Costa Rica’s ambitious primary health care system. They talk about how Costa Rica's commitment to health as a human right and its community-oriented primary care have led to significant improvements in health outcomes. From the concept of "Hospital Without Walls" to the role of community health workers, Madeline shares insights from her extensive research and personal experiences in Costa Rica. Then, join us in our next episode where Tara goes on a tour of a Costa Rican clinic and speaks to members of the EBAIS (Equipos Básicos de Atención Integral de Salud) about both how and why they do their work. Further reading:Take a look at the research article that first introduced me to Madeline (co-authored by Dr. Atul Gawande) Explore this brief Commonwealth Fund case study on the Costa Rican primary care system or dive deeper into this more detailed case study from Ariadne Labs Read the article “Costa Ricans Live Longer Than We Do. What’s the Secret?” in the New Yorker magazine by Dr. Atul GawandeMAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardDo you have an idea for an episode? Email [email protected] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

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• In Quebec: Improving timely access one clinic at a time

  In this episode, we take you to Saint-Hyacinthe to see how a team in Quebec is transforming timely access to primary care. Quebec has more interprofessional primary care teams than anywhere else in Canada — yet it remains one of the provinces struggling most with access. So how do you turn a team into one that actually works? Dr. Kiran sits down with Dr. Isabelle Gaboury, a researcher and QI leader who, alongside colleague Mylaine Breton, has modernized the “advanced access” model for today’s interprofessional clinics. Together, they’ve coached more than 40 practices to redesign workflows, clarify roles, and use data to constantly iterate. Then I take you inside GMFU Richelieu-Yamaska, where waits dropped from 14–16 days to just 3. You’ll hear how receptionists learned to triage using a symptom-based algorithm, how nurses and social workers took on new responsibilities, and how the whole clinic shifted from working harder to working differently. It’s a story about change management, team-based care, and what it really takes to deliver timely, patient-centred access — in Quebec and across Canada.Resources mentioned in the episode:An article on why it’s so hard to find a family doctor in QuebecIsabelle and Mylaine’s contemporary advanced access modelHow Canada compares to peer countries when it comes to timely careAn older commentary from Tara that delves into why timely access is such a problem in CanadaA summary of Quebec’s data from the OurCare surveyExplore Quebec data from the 2022 OurCare National Survey at data.ourcare.ca or read this articleVisit the website for GMFU Richlieu-YamaskaListen to our 4-part series on The Netherlands (mentioned in this episode when discussing training for primary care nursesMAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardDo you have an idea for an episode? Email [email protected] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ Primary Focus is supported by the MAP Centre for Urban Health Solutions, St. Michael’s Foundation and the Max Bell Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

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• In Renfrew County: A hybrid solution to the rural family doctor shortage

  In this episode of Primary Focus, Dr. Tara Kiran travels to Renfrew County, Ontario, where an innovative team is tackling the family doctor shortage with a new kind of hybrid care - where your doctor is virtual, but your team is on-site. At the Petawawa Centennial Family Health Centre, Dr. Jonathan Fitzsimon shows Tara how patients are matched with virtual family physicians who work alongside local nurses, pharmacists, and other health professionals to provide full-service, ongoing care. The result? More than 6,000 people who once had no family doctor are now receiving comprehensive, team-based care. It’s a story about creativity, access, and what’s possible when rural communities rethink how primary care can be delivered.Further reading:Explore more about the Petawawa Centennial Family Health Centre Read a report summarizing Renfrew’s Integrated Virtual Care model Dive into research on the Integrated Virtual Care model including papers on early patient outcomes, patient experience, and staff experience. See some photos of Petawawa Centennial Family Health Centre (link to post)MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardDo you have an idea for an episode? Email [email protected] Dr. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ Primary Focus is supported by the St. Michael’s Foundation and the MAP Centre for Urban Health Solutions. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

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• How One Calgary Clinic Gets Team-Based Care Right

  This season, we’re diving into innovative primary care practices across Canada—starting in Alberta, where one family practice is making timely, high-quality care a reality for more than 25,000 patients within a fully capitated model. In this episode, Tara visits Crowfoot Family Practice in Calgary—a clinic that’s getting team-based care right. Physicians here manage patient panels about 30 percent larger than their peers, thanks to a model where 35–40 percent of care is delivered by non-physicians. Executive Director Shauna Thome gives us a tour of the clinic, and then she and medical director Dr. Janet Reynolds join Tara in conversation. They talk about how the role of the physician on the team is different, how the team is piloting new ways to attach patients without a family doctor, and how continuous quality improvement—with patients as partners—shapes the clinic’s culture.Research mentioned in this episodeExplore more about the Crowfoot Village Family PracticeTake a look at the case study evaluation Health Quality Alberta published on CrowfootRead more about the Calgary Foothills Primary Care Network Dr. Janey Reynolds leadsRead the final report from the Modernizing Alberta’s Primary Care System (MAPS) processCheck out this article that talks about how teams are our hope for the future and can theoretically help doctors care for more patientsSee some photos of Crowfoot Village Family PracticeMAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardDo you have an idea for an episode? Email [email protected]. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

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• Why don’t we have enough family doctors? with Dr. Ruth Lavergne

  As Canada faces a family doctor shortage, Tara calls up her friend Dr. Ruth Lavergne, a primary care researcher at Dalhousie University, to ask how we ended up an estimated 23,000 doctors short — despite training more in recent years. Together they explore how the work of family doctors has grown more complex, why more are choosing focused practice or shorter hours, and how payment reforms are shaping — but not necessarily solving — the challenge. Along the way, they reflect on the moral and emotional strain of family medicine, the choices doctors make to preserve balance and meaning, and what it would take to make family medicine not just better paid, but a better job. Stay tuned to the end, when several family doctors sound off about their own practice choices — whether full-service or something different — and what led them there.Research mentioned in this episodeThe federal report estimating Canada is 23,000 family doctors shortTara’s research on the shift away from full-service family medicineRuth’s research on career choices and administrative burden in primary careDive into the commentary on physician payment that was a Ruth-Tara platonic meet-cuteHere's the cross-country comparisons on physician payment mentioned in the episodeMAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardDo you have an idea for an episode? Email [email protected]. Tara Kiran is a family physician and researcher who is passionate about building a stronger, more equitable primary care system in Canada. She practices at St. Michael’s Hospital, Unity Health Toronto where she is also a scientist at MAP Centre for Urban Health Solutions. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. You can learn more about Dr. Kiran’s research here: https://maphealth.ca/kiran/ Primary Focus is supported by a grant from the St. Michael’s Foundation. Dr. Tara Kiran is supported as the Fidani Chair in Improvement and Innovation at the University of Toronto and a Scientist in the Departments of Family and Community Medicine at St. Michael’s Hospital and the University of Toronto. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit primaryfocus.substack.com

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