How Nova Scotia Is Expanding Access to Primary Care with Dr. Nicole Boutilier
In this episode, Tara speaks with Dr. Nicole Boutilier, Executive Vice President of Medicine and Clinical Operations at the Nova Scotia Health Authority — a family doctor leading primary care transformation from within the government. Dr. Boutilier walks Tara through Nova Scotia’s multi-pronged plan to improve primary care access: transforming the province’s centralized waitlist into an active patient management tool, building and strengthening Health Homes (team-based primary care clinics), creating pathways for people without a family doctor to access care while they wait, and modernizing how data flows — so patients can access and share their own health information through the YourHealthNS app.
Research and programs mentioned in this episode
Read the OurCare reports from the Provincial Priorities Panels (including Nova Scotia’s).
Find out more about Nova Scotia’s Need a Family Practice Registry and Health Homes model.
Get more info on Nova Scotia’s Longitudinal Family Medicine (LFM) physician payment model.
Watch a video about how the YourHealthNS app gives patients access to their health data.
Learn more about Nova Scotia’s new pathways for integrating internationally-trained medical graduates and the new Cape Breton Medical Campus training rural family doctors.
Dive into the research on virtual care in Canada.
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.
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How Nova Scotia Is Expanding Access to Primary Care with Dr. Nicole Boutilier
Primary Focus Podcast
Introduction
Dr. Tara Kiran (00:01) I think any researcher will tell you that one of the best parts of our job is when you get to see your research translate into actual change. I was lucky to have that happen to me in a big way back in June of 2025, when the province of Ontario passed the Primary Care Act into law — a set of six priorities for primary care that directly reflect the six elements of the Our Care standard. That standard was a distillation of everything we heard from people across the country about what they wanted to see and expected from a primary care system.
And it's been great to see that even just this month, Ontario's health minister announced the government is on track to increase access to primary care to all residents of the province by 2029.
Now, the best part I talked about also came up a few months ago when I heard Nova Scotia's Dr. Nicole Boutilier reference in a presentation how they've used the Our Care report from their province to centre the patient voice in their provincial primary care reforms.
In our last two episodes, I took you on a journey to Costa Rica to see how that country is integrating primary care and public health and really using a community-based approach to deliver care with geographic impanelment and community health workers who are really leading the way. We're going to talk more about community-based primary care in a couple of future episodes — we'll take you to clinics in BC and Ontario to talk about the innovative work they're doing in this area. But after hearing Dr. Boutilier talk about Our Care's impact on Nova Scotia's primary care policies, I thought we'd better take a brief detour to talk about how that province's primary care transformation has Our Care at the centre. And so today I talked to Dr. Boutilier about how they're building new pathways for patient access, all with the patient voice at the centre.
Introduction
Dr. Tara Kiran (02:03) Welcome to Primary Focus, a launching point for a national conversation we really need to have about the current primary care crisis in Canada and how we're going to solve it. I'm Dr. Tara Kiran, a family doctor, researcher, and an advocate for a better primary care system in this country. I believe in creating a primary care system that's inclusive, comprehensive, and that truly works for everyone. But to do that, we're going to have to make primary care our primary focus.
Today on the show: Dr. Nicole Boudreau, the Executive Vice President of Medicine and Clinical Operations for the Nova Scotia Health Authority.
Dr. Nicole Boutilier I am a family doctor by training and did my residency in Calgary. I've done a variety of things. When I lived in Alberta, I did full-scope family medicine in a very rural setting — about 3,000 people with a local hospital, and I did emergency medicine, inpatient and office care, and obstetrics. I also did some work at [uncertain: Siksika] First Nation at the time and did some outreach clinics there.
I have three children, and I started having children and got the call to come back home and be closer to family. When I moved back here, I started doing full-time emergency medicine, and did that for a number of years. And then as I started to weave back more towards leadership experiences, I started doing some locums in collaborative settings and also working at youth health centres. That's been kind of how I've kept my feet in the door with family medicine through the years.
Dr. Tara Kiran Nicole is a family doctor leading primary care transformation in a government role — which is more rare than you might think. In this conversation, we cover a lot of ground. We talk about how Nova Scotia has reformed their Need a Family Practice Registry: a centralized waiting list of people who need primary care, managed by the central health authority. She details how they're connecting people to new primary care teams called health homes, and supporting those teams to work effectively together. We also dive into the options they've built for people who don't have a family doctor, so those people can access care while they're still waiting for one.
And how a new physician payment model called the Longitudinal Family Medicine payment model, or LFM, is making family medicine more attractive. We also talk about how Nova Scotia is training the next generation of family doctors through a unique new medical school focused on training rural family doctors who commit to practicing in the province. And importantly, how they're empowering people in Nova Scotia to have access to their own records through a new app, Your Health Nova Scotia.
Here's my conversation with Nicole.
Conversation with Dr. Nicole Boutilier
Dr. Tara Kiran (05:02) Welcome to Primary Focus. It's so wonderful to have you here.
Dr. Nicole Boutilier I'm excited to be here. Thanks for having me.
Dr. Tara Kiran I invited you on this podcast because of a presentation I heard you give a few months ago. I was really struck because you and I had actually never met before, but you started and ended the presentation talking about how the patient voice was so central to the work you're doing in Nova Scotia around primary care transformation. And you specifically cited the Nova Scotia Our Care report — which I was delighted to hear.
I was wondering if you could go into a little bit more about how that Our Care report has influenced the direction of your work in Nova Scotia.
Dr. Nicole Boutilier I should say that I didn't know you were going to be in the room, and I wouldn't have even connected it probably. So it was totally a coincidence. That is genuinely where we started.
We had this wonderful opportunity to make investments and changes in primary healthcare. And we already had something that told us all we needed to know. And we were very aligned as a leadership group with the Our Care standards — with what we'd heard, and with what we'd felt from working in the system. So it was not even a second thought that we kind of put that up as: this is what we want to try to achieve. We might not achieve everything in there, but we're going to start working towards it and making sure we're focused on what patients and providers told us.
When do you have an opportunity to have a national survey, and then all the focus groups, right down to groups that were important to us in Nova Scotia — like our patient and family advisors, our leaders — who all took part in it? So it connected us right from the start. And we continue to update our thinking as that evolves as well, making sure we're still aligning. And when you can bring anything you're doing — any kind of changes, both for providers and the community — when you can ground it in what they want and what they've told you, and make sure that's coming first, it's hard to misstep if you keep that as your main focus.
Dr. Tara Kiran (07:25) That's so wonderful to hear. I have to say our Nova Scotia group was among the most engaged — the patients and public we worked with. They created their own Facebook group after to try and stay in touch. And it had a very family-oriented feel — everyone is very friendly in Nova Scotia. It's a stereotype, but I think it's also true. And I know that some of them will be listening, and I'm sure they're going to be heartened to hear how the real hard work they put in as volunteers has made a difference, and that you have heard their voices and continue to go back to them.
I was wondering if you could give some examples of decisions your team has made as a result of the Our Care consultations or the Our Care report.
Dr. Nicole Boutilier I think pretty much everything we've done connects back to it somehow. But when you think about attachment — when we started to really dig into our attachment rate, there was about 16% of the population here unattached. The numbers are off the press now. We're getting under seven percent and we're still going, still doing that.
There were many things around that that we needed to do differently. We had the fortune or misfortune — depending on how you look at it — of knowing the numbers and knowing the people on the list, but that's all we knew. We did not know what they were waiting for. We did not know what their access was otherwise. We did not know the state of it — had they just had a doctor, or had it been ten years? There was nothing we knew.
So we set out to actually redefine that and create a tool with the Need a Family Practice Registry that would be more of an interactive tool — where we would gather information around age, demographics, and preferences, their current health status. We also have a kind of emergency category, so if people were pregnant, or in need of regular care because of a new diagnosis, there was a way they could step into that.
So part of it was to promote attachment. The other piece is really to promote stabilization — working with providers in their offices to either add care team members, add resources that would help new practitioners onboard, or just provide the support that people are missing when they're out in the community and feeling like, I'm walking away from family medicine because this isn't working for me. So we created a physician hotline and kind of set out to make it so that no one would ever leave. It didn't mean that they necessarily won't move on to other things, but they weren't going to leave unsupported and with their patients unsupported.
The other piece is that we really focused on: attachment is important, and access is important. And we know that even some people with attachment didn't necessarily have great access. So we've created about a million appointments in different types of access — whether virtual, whether through mobile clinics, whether in pharmacy offices, or just an expansion of some of the services that we already had. That piece, to give patients access while they're waiting for attachment, is really critical to what we were doing because we needed to know that people were getting care.
The other piece we have is called Primary Care Clinics — an in-person solution for people who don't have attachment. For instance, if you access Virtual Care Nova Scotia — which is provided by Nova Scotia providers — they can refer to an in-person appointment if needed through our Primary Care Clinics. And then the person stays with the Primary Care Clinic as long as they need to after that point.
It also covers things that are typically only done by family doctors in their offices: maybe allergy testing, or maybe they need a workers' compensation form filled out, or a physical for a job. So we've created pathways that even while we wait for attachment — because we knew we weren't going to go from 16% to zero overnight — we needed a path to get there. We were trying to look at all the ways we could have primary care access as robust as possible.
And again, that also touches back to the Our Care report, because patients were telling us about their need for virtual appointments.
Dr. Tara Kiran (12:09) What I'm hearing you say is that your overall goal is to have everybody in Nova Scotia have access to ongoing primary care, but that it's going to take a bit of time to get to 100%. And as we get there, you've tried to put in other methods or other ways for people to access some care until they have that ongoing relationship — what you describe as attachment. That's often what we in the healthcare world call attachment: that ongoing, named family doctor, clinic, or nurse practitioner who's going to be able to see you on an ongoing basis.
So maybe I'll just start with your drive for getting everybody a family doctor, nurse practitioner, or clinic. What are some of the strategies you've taken to try and get that attachment? You mentioned some of it is stabilizing the workforce, but I think there have been other strategies you've used as well.
Dr. Nicole Boutilier Yeah, so there's stabilizing the workforce by providing support, but it's also enhancing that workforce and really looking at how other providers can all work as a team together — really embracing the health home model that the College of Family Physicians of Canada and others have advocated for in creating team-based care.
And what we did learn is that just because you put people together doesn't mean you have a way of doing team-based care. So we've been really intentional about how these clinics will be monitored, run, and assessed — and the kinds of things we would like to see happening in all the health homes — really creating an environment where the team and their skill sets, everyone in that skill set, is working to their full scope. A lot of work done on people and full scope, on being able to practice full scope, and really on the relationships between team members and how they best serve patients. And I think that's been another good strategy.
The other one is about space — physical space — creating health home environments through physical space that is conducive for group appointments or for multiple team members being co-located. And one of our newer ones actually has a purpose-built primary healthcare simulation space where people can learn from the interprofessional team for different skills and learn together. That was really exciting for us to even push the limit on what we can create in these "layered learning environments" — where you have lots of students, lots of professions, and lots of patients all working together to get the best care possible.
Dr. Tara Kiran (14:31) Yeah, I love that. Physical space really is important. The literature shows, and my own experience is the same, that when people are co-located and the specific structure is designed so there's an ability to interact among team members, it can really enhance the way a team works.
I'm curious if you could expand a little bit more on the teams you describe. What portion of the Nova Scotia population do you think has access to that kind of team-based care?
Dr. Nicole Boutilier There's a variety of setups. We've kind of had core team members — we've defined core team members for optimization that you need to have. And then on top of that, we've listened to the individual community as to what that community needs. What are they missing in their community? So there are optimal team members, and then additions. So not every health home looks the same. Not everyone has all the members. And they're always kind of asking: we're working really well at this phase, we can serve our patients well. Or they're saying, wow, would it ever be great to have a pharmacist here one day a week? Would it ever be great to have mental health come in? How can we collaborate a little better with some of our community resources?
That's really what we want — creating those health homes that then start to become a health neighbourhood for the communities they're in. Nova Scotia has rural communities, so this is about rural medicine as much as anything, because creating full-functioning spaces for people in a community — especially a rural community — to access other services they might not otherwise have had is also critical.
Dr. Tara Kiran I love that there's standardization but with the flexibility to meet community needs. I'm curious what your core team members are — what have you decided on for that?
Dr. Nicole Boutilier (16:56) Yeah, so we do have a few different iterations depending on what we're starting with. There are physician-and-physician interchangeable models, and physician-and-NP models, family practice nursing, admin support for the clinic, and what we call a Primary Healthcare Lead — who might support more than one clinic but is actually helping them achieve their goals.
We have supports from external teams for those teams — like the onboarding team, which is also like a group of some nurses and some nurse practitioners that would come to the clinics and work on onboarding. We also have a practice support team. If there are issues that need improvement — like one project I really loved was around the EMR, where they came in with some basic things that allowed the team to flourish and practice faster.
Dr. Tara Kiran One of the recent episodes we did this season was with [uncertain: Isabel Gaboury] in Quebec, and she talked a lot about the supports that teams need in order to be high-functioning and work well together. You can't just throw people together and expect them to work as a team. I think you've already talked about some of the implementation supports you've put in place to support these 117 teams in Nova Scotia. I wonder if you could tell us a little more about what those implementation supports look like.
Dr. Nicole Boutilier Well, there are leadership supports, and there's also clinical co-leadership in the clinics. And then we have what we call QI collaboratives. Really, that's about: if they sign on to be part of a collaborative, they get support on how to do quality improvement. We have a well-prescribed program they go through, with support from teams that coach them through it — part of the quality team. And it's really also about spreading that, so that we don't just create a one-and-done type of thing — people keep learning and they can become coaches after they've gone through the collaborative.
Dr. Tara Kiran (19:12) I also remember you telling me that you have people who actually come into the clinics to observe and understand the efficiency in the clinic and the different roles people are taking. Tell me a little bit more about that.
Dr. Nicole Boutilier Yeah. So we had transformation teams — again, this was for transformation broadly — and some of the people on that team would be data analysts, industrial engineers, people from professional practice and learning, maybe research and innovation. And we would assemble whatever that team was and go into a clinic and watch the flow, try to optimize the space, and make suggestions about space changes or process changes that could really benefit that clinic.
Dr. Tara Kiran Yeah, I think that's really important. As we think about accelerating team-based care as a way to improve primary care, there are a few different rationales. Of course, patients love to have access to different healthcare professionals — for more holistic care that looks after the different parts of themselves in a more comprehensive way. I think many clinicians love it because it adds support to their day. But I think one of the main reasons we need to move to team-based care in Canada is that we just don't have enough doctors and nurse practitioners to go around — not given the way we've worked traditionally.
What we need to unlock as a country is how teams can support doctors and nurse practitioners to actually care for more patients. And I think one contentious area is: when a doctor works in a team, should there be a minimum number of patients they're expected to care for, given that they do have access to other health professionals? I'm curious what your approach in Nova Scotia has been. Are there roster targets? And if so, how were those set?
Dr. Nicole Boutilier How we've done this is in collaboration with Doctors Nova Scotia and the Department of Health and Wellness. Basically, when we negotiated the last contract, we had all these conversations and there was a co-design of what we call Longitudinal Family Medicine — LFM. So we have target panels, but people don't have to do a target panel practice. If you want to do 60% of your time in your office, you can also do hospitalist work or other types of work that rural communities need. It doesn't prescribe that you must do this, but there's a certain salary associated with a full scope of office practice. People are doing really, really well, and people are choosing it. We've seen —
Dr. Tara Kiran So it's been a really big success.
Virtual Care and Continuity
Dr. Tara Kiran You mentioned Virtual Care Nova Scotia — which is something else you've put forward as a way to enable access for people while they're waiting for that permanent attachment. And I was wondering how you're approaching that. I think people want access to virtual care, but my understanding from talking to patients is that ideally they want it integrated with in-person care — and with continuity of information. Some of our research has pointed out that when people are using virtual-only platforms, there can be downstream consequences for the health system, with more use of the emergency department, for example. We think some of that might be related to not having informational continuity — access to people's records when you're seeing them, and not being able to follow up on an ongoing basis.
I'm curious what thinking you've done around continuity and preventing fragmentation — which I think is a big risk when it comes to one-off virtual care.
Dr. Nicole Boutilier Yeah, so there are kind of two answers to this. One is the fact that we've grounded virtual care in Nova Scotia in both people who don't have access to regular care and also Nova Scotia practitioners. So they have a direct path to in-person care if they need it. And then they would get the continuity of — if it was a diagnosis or a problem — and they can stay there until they have a doctor. So that's one way of connecting them to in-person care when needed. We have pretty steady results that about 30% of people need that.
Dr. Tara Kiran (24:01) So 30% of people accessing these virtual appointments are eventually also referred to these Primary Care Clinics that then follow them on an ongoing basis.
Dr. Nicole Boutilier Yes. Then the second piece is about having patients have autonomy over their data.
Dr. Tara Kiran Yeah, let's talk about that.
Your Health Nova Scotia
Dr. Nicole Boutilier So we also have something digital called Your Health NS. It's an app. People can find their patient summary there. They can find their test results, appointments, ways to access like women's clinics or other community supports, mental health supports. There's also a bit of an AI chat tool where they can ask things like: where's the best option for my issue in my area? Is there a pharmacy open today? So it kind of helps patients navigate the system.
And it also helps them be the owners of their data. They can share it — they can actually share what they see with a provider when they're in front of them. So they actually can share their records with a provider they want to share with.
Dr. Tara Kiran It's amazing. When we talk to patients and the public across the country, one of the things we heard over and over again is how frustrated people were that they didn't have access to their own health records. It has huge implications for patient safety, for being able to get care across provincial boundaries — or even within the same province — for being able to share important diagnoses if you go to the emergency department, for providers to know what medications you're on. We heard so many examples of how not having access to your own record can really detrimentally affect your healthcare.
So it's amazing to see that you guys have launched Your Health Nova Scotia. For those of you who aren't familiar with it — it's an app, something you can access on your phone, and possibly online as well, though I've only seen the phone-based interface. It looks like you can access a lot of different parts of your health record. I was wondering if you could go over what parts of the health record you can access through it, and whether primary care records are included.
Dr. Nicole Boutilier I looked at mine, because everybody wants to see what yours looks like. So it had a few hospital visits I'd had. It had all my immunizations. It had any blood work I'd had done. It had X-rays and any imaging. It had kind of a summary of the facilities I'd visited, and just the overall — like what you would see on the first page of a chart, with the demographic pieces as well. Medications and your medication history — what you started and stopped. Allergies. There was a lot on there.
And when you see a patient in an emergency setting, sometimes you're going to the trauma room and by the time somebody gets the paper chart and things like that — well, this had all that. And I did all this from the community as well. While it doesn't have your family doctor's notes on there, it has all the appointments and things you've had recently. And it was a fairly decent summary for just coming online — lengthwise, it went back far enough that you get the sense of how somebody's health has been over the last while.
So I think it's a useful tool for a patient to be able to provide to their doctor in any setting, not just a virtual care setting — emergency or otherwise. It's very helpful. Because how many times have I had to call for the chart, call the family doctor's office, call the pharmacy, call another imaging department, to try to get those things quickly?
Dr. Tara Kiran Absolutely. I mean, the medications alone are a huge piece, because people are on a lot of medications these days and can have different prescribers. It's important, for example, as a family doctor, that I know what medications were prescribed in the emergency room or by a specialist. And I don't always have that information in a timely and accurate way. That can be a big issue from both a patient safety and a disease treatment perspective. So absolutely so important to have that information and have patients have ownership over it.
I'm curious how you did it though. What you describe is actually an aberration when we think about Canada as a whole and what's happening in every province and territory. What Nova Scotians have in an app is not the standard across the country. So how did you make it happen? And who were the people who were potentially opposed to it — if you can say — and how did you get them on board?
Dr. Nicole Boutilier Really, it was about data and what you could accumulate and put on a cloud and figure out what it was. So it was a lot of working with government around what that looked like from their perspective. There was lots of engagement and consultation with Doctors Nova Scotia around data points and things like that. Change is always hard no matter what it is. But when people start to see the power of things and how it works —
And we were really cautious. There was a pilot done around giving test results out, and there's a lag in the test results so family doctors have time to review them and things like that. And really working with the different providers to do it. It was challenging — those things are challenging. And it's really about bringing everybody to the table and working through those problems.
There's lots of other things that Your Health NS could do that it isn't doing right now. And to get to every stage of that plan, it'll have to keep being about engaging, engaging, engaging — and then good implementation, evaluations afterwards, seeing how it's working, and being willing to be nimble around changes. I think that's one of the things we've really learned how to do.
New Medical School and IMG Assessment
Dr. Tara Kiran Yeah, I love that. We've talked about a lot of the initiatives. I think a couple of things we haven't touched on yet — that you guys have pushed forward — are a new medical school, and I think you also have a pretty unique International Medical Graduate assessment clinic. Could you speak to those?
Dr. Nicole Boutilier Yeah, those two things are great examples. The new medical school opened up in August in Cape Breton, and it's being delivered at Cape Breton University, associated with Dalhousie University's Medical School. They have thirty students coming in every year, and these thirty students are going to be family doctors — they're going to do family medicine residency, and they're going to be committed to the province of Nova Scotia.
A lot of people said it couldn't be done; it's been done really quickly. And I was fortunate enough to attend the Rising Tide ceremony, which was their opening ceremony. Jennifer Hall was there — she's been working as a senior dean for the medical school, but she's also a family doctor. And she talked about the principles of family medicine. You know, as a family doctor you have to recite them, know your competencies, all that. But hearing her be able to talk to these students in a way that acknowledged that this was going to be their purpose in the community — I felt like it was so powerful. To know that they're dedicated to that path in medicine.
A lot of people say, well, maybe they would want to do something else. Maybe they do. But I think — and I talked to a lot of them afterwards — it's very exciting for them to be in medical school and know that they have this path and to be part of this new program. So it's a big lift, and there are a lot of people who need to be committed to training these folks across our province and for rural areas: Dalhousie, Cape Breton University, the department, the government, Nova Scotia Health, IWK — everybody has to have a part. So really, this is future-proofing family medicine for rural areas. It's really exciting.
Dr. Tara Kiran Are they specifically training to be rural family doctors, or family doctors, or are they training to be any kind of doctor?
Dr. Nicole Boutilier Family doctors. Specifically family medicine. So the medical school itself will be the same in that there's nothing specific in medical school other than they are attached to a practice — but the intention is that they'll go into a family medicine residency afterwards and practice as family doctors. Yes.
Dr. Tara Kiran And I think this is only one of two schools currently where that's the case — yourselves and I think Simon Fraser University was also opened with that intention. So very unique. And this is also in a rural part of the province, and we know that training in rural areas can help with rural retention. Wonderful to see and to follow along over the next few years.
Measuring Impact
Dr. Tara Kiran (33:30) So we've talked about a lot of different initiatives you've done to try to get to that vision of everybody having access to primary care — and not just primary care, but primary care that's consistent with the Our Care standard. I wonder: do you have any data you can share with us around how things are going? You mentioned a little bit about the decrease in the number of people waiting on the Need a Family Practice Registry, but are there other things you're tracking or other evaluations you have planned?
Dr. Nicole Boutilier Yeah. Some of the metrics take a while to move. Eventually, our goal would be outcome measures — health outcomes — rather than process-type outcomes. So certainly the decrease from 16% to under seven percent of the population, moving down every month, is one of our key metrics that we watch.
As I mentioned before, we are starting those evaluation processes — more local-level collection of data to know how those clinics are doing against the standard we're setting for the health home. So that's more of a qualitative evaluation.
We monitor everything from how many patients we've stabilized, to how many patients are coming into the province population-wise, to the Need a Family Practice Registry. We monitor the number of appointments, the number of missed appointments. We also look at how much of 811 ends up in the emergency room — how could we change that? So many data points, and we try to focus in on the ones that we need. And one of the key ones we'll be looking at is ongoing access challenges for patients that are already attached, and making sure we're addressing those as well.
And we're starting to see a bit of a shift with specialty care too, because primary healthcare is the foundation. You need to have the foundation fixed before you can start doing other things. By creating this primary healthcare foundation, it's going to enable improvements in specialty care as well, because so many specialists have been bogged down having to provide not only specialty care but regular care to their patients. And we hear that from specialists a lot.
The other thing is about community in general. We've been in Canada — and I don't think I'm wrong to say this — a very acute care-focused country where we focus on hospitals and hospital care. We don't really talk about healthcare and wellness and other things we do. And I think our overall push would be: as many things as we can treat in health homes, health neighbourhoods connected for chronic disease management and other things that keep people unwell — how we look after our seniors in the community, how we keep people out of hospital. Primary healthcare is just one piece of the larger work of keeping people healthy in the community.
That's really the type of things we want to see — people being actually treated at home and staying at home, staying healthy in the communities they're in. We've had other initiatives going on with cancer care, for instance, providing cancer care closer to home. I'm starting to see all the dots start to coalesce as we have initiatives in every angle. And we're monitoring all that data. We're starting to get into: what are our targets for health outcomes?
Dr. Tara Kiran Wonderful. In the Our Care consultations, again, we heard from people how important it was to have a wellness-oriented system. So I think that's exactly what you're talking about — how can we bring care to people where they need it, in the ways that they want it?
Do you have any other advice for other provinces who are on this same journey?
Dr. Nicole Boutilier (38:16) Well, I think we've waited a long time in healthcare until we're a hundred percent sure something is perfect. And we've kind of then taken the attitude of, okay, wait until we're at 80%. So we've kind of taken the philosophy of: if we're 60% there, let's go. Let's try — and stop talking about pilots, having them forever, restarting them, doing the analysis. That kind of analysis paralysis. And really focus on actions. What are the actions we can do to get us to a new place?
And there will be bumps. You have to go into it knowing there are going to be bumps, and things that might fail — but fail fast, change, and make it better. And you need the people behind you doing it. We needed the leadership of the health system, the leadership in the government, and everybody to be supportive. Because that's how you actually get somewhere.
I can go right back to the very first time the Premier actually came to Nova Scotia Health when he took over. He told us a story about seeing a gentleman out on the campaign trail who said to him: "Do good for Nova Scotians. That's the only advice I have for you." And we've shared that over and over again. And that is really where we're grounded: doing good for Nova Scotians. That's the purpose. And everybody's aligned with it. And I think if I tell the story of our transformation, that's what people want to do.
Dr. Tara Kiran Well, thank you so much, Nicole, for graciously agreeing to be on my podcast today, despite your very busy schedule and all the transformation work you're leading in Nova Scotia. Really appreciate it.
Dr. Nicole Boutilier Thank you, Tara. Good luck.
Closing Reflections
Dr. Tara Kiran (40:09) It's clear that Nicole and her team are trying to do better for Nova Scotians, and they're determined to achieve their goal of everyone having access to primary care — a direction that's come directly from the Premier. I'm really impressed that they keep the Our Care standard and the patient voice at the centre of their work, and that they've put in place a multi-pronged strategy to achieve their vision.
So — will all this work actually result in everybody in Nova Scotia having access to high-quality primary care that's in line with the Our Care standard? I don't know, but I am very hopeful. Change takes time. And my hope is that we can learn from how the reforms in Nova Scotia are really impacting care. That's going to take transparent evaluation that answers questions that are relevant to people leading change all across the country.
For example, I want to know: are the physicians practicing in these new teams actually able to care for more patients as a result of having those team members? And if so, what's the secret ingredient that really makes that happen? And how about all those access points that Nova Scotia put in for people without primary care? To what degree are we trading off convenient access for increased fragmentation, maybe unneeded health use, and more costs?
These are important questions that need to be answered if we really want to build a great primary care system — not just in Nova Scotia, but across the country. I get the sense that Nicole and her team have a commitment not just to do the work, but also to learn and improve. And I look forward to learning more to really understand the impact of their reforms on care in the province.
One thing we touched on but didn't explore a lot is how primary care reforms in Nova Scotia aren't being done in isolation — they have reforms underway to also help Nova Scotians stay well through community initiatives. And as we heard in our episodes on Costa Rica, it's really powerful when primary care is connected to the community.
Dr. Tara Kiran (42:23) We'll be diving more deeply into the concept of supporting people to stay well in our upcoming episodes, where we'll be visiting two innovative teams in Canada — teams who recognize that primary care needs to be grounded in the needs of community.
Credits and Closing
Primary Focus was created by Dr. Tara Kiran and is made possible by funding from the MAP Centre for Urban Health Solutions, the St. Michael's Foundation, and the Max Bell Foundation. Maryam Danesh is our research assistant. Seema Marwaha and Emily Holton are our creative advisors. Our producer is Avery Moore Kloss.
If you'd like to read more content from Dr. Kiran about Canada's primary care system, join the Substack newsletter at primaryfocus.substack.com, or visit primaryfocus.ca. For more information on the Our Care standard and the public's vision for a better primary care system, visit ourcare.ca.
Family doctors in Canada who are listening to this episode can claim Mainpro+ credits by completing a Linking Learning exercise. See the show notes for more information.
And finally, if you're enjoying this podcast, please share it in your networks. It's only through enlarging the conversation about primary care in this country that we'll ever really affect system change. If you have ideas for topics or places to visit and feature, please reach out at primaryfocus@unityhealth.to.
The information shared in this podcast is for educational and informational purposes only. It is not intended as medical advice and should not be used as a substitute for professional medical care, diagnosis, or treatment. Always consult with a qualified healthcare professional before making any medical decisions or changes to your health routine. Views expressed in this podcast are those of the speakers and do not necessarily reflect the views of any organizations the speakers may be affiliated with.
Side effects of listening to this podcast may include: a strong impulse to help fix the primary care crisis in Canada; a feeling of anger over how many Canadians do not have access to primary care; increased feelings of empathy toward primary care professionals who are just trying to make it work; and intermittent visions of hope that we can find a better way.