Beyond Headcount: Four Dimensions of Canada's Primary Care Access Crisis and a Three-Level Agenda for Ac@on

Maisam Najafizada^*

• Memorial University of Newfoundland Faculty of Medicine, St. John's, Canada

Public debate in Canada often diagnoses a simple "shortage of family physicians," yet system indicators point to a more complex access problem. In 2023, 17% of adults reported no regular primary care provider, only 26% obtained same/next-day appointments, and about 15% of emergency department visits were potentially primary-care-manageable—over half potentially manageable virtually. Meanwhile, average weekly physician work hours have declined by 6.9 hours since the late 1980s and the average number of patients seen per family physician fell from 1,746 (2013) to 1,353 (2021), alongside a shift away from comprehensive community practice. Drawing on comparative evidence that stronger primary care architecture is associated with better performance and that primary health care averages ~13% of current health spending across OECD countries, this Perspective reframes Canada's challenge across four dimensions: effective capacity (not just headcount); demand—complexity, time, and continuity; maldistribution and loss of comprehensive care; and system entry-point design. We then organize solutions in three groups: system-level (investment floors, enrollment/rostering and after-hours obligations, payment aligned to continuity and team-based comprehensiveness), organizational-level (interdisciplinary teams, task-sharing with NPs/pharmacists/PAs, operationalized continuity), and data & research (effective-FTE and continuity metrics, complexity-adjusted panel targets, rigorous evaluation of entry-point and scope reforms). Recasting the problem from headcount to capacity-and-design clarifies actionable levers for timely attachment and sustained relational continuity.