Primary Focus with Dr. Tara Kiran

In this episode, Dr. Tara Kiran travels to Vancouver, British Columbia, to visit the Umbrella Multicultural Health Co-op Clinic — a clinic built by and for newcomer communities. Umbrella pairs physicians and nurse practitioners with cross-cultural health brokers who act as language and cultural interpreters, helping bridge gaps not just in communication, but in navigating the healthcare system itself. Tara tours the clinic with Naomi Armstrong, Director of Integrated Health Programs, and then sits down with Dr. Mei-Ling Weidmeyer, family physician and clinical lead. Together, they discuss Umbrella’s origins as a mobile clinic for migrant farm workers, its cooperative governance model, and how culturally safe, community-accountable primary care can have a meaningful impact on people’s lives.Donate to UmbrellaUmbrella relies on donations from the public to continue offering services to newcomers–especially for those without insurance coverage. To donate to Umbrella Multicultural Health Co-op, head to their website umbrellacoop.ca Research and programs mentioned in this episodeLearn about the OurCare Standard and how it was developedWatch this 3-minute video about UmbrellaRead a research paper or short report on how Umbrella is integrating cross-cultural health brokers in primary careFind out more about national efforts to bring cross-cultural health brokers to primary careMAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise. More about Primary Focus:Subscribe to our Substack newsletterHave an idea for an episode? Email primary.focus@unityhealth.to 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 receives financial support from 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

In Part Two of our Costa Rica series, Dr. Tara Kiran takes you inside an EBAIS (Equipos Básicos de Atención Integral de Salud) clinic on the Nicoya Peninsula in Costa Rica to see what it actually looks like to deliver primary care beyond clinic walls. Costa Rica organizes primary care around geography. Each clinic is accountable for a defined population — and community health workers play a central role in making sure no one is missed. They visit households, provide education on prevention and chronic condition management, deliver vaccines, identify risks early, and act as a bridge between public health and clinical care. It isn’t a perfect system. But it is an ambitious one. And it offers a powerful contrast to Canada’s often fragmented approach to primary care and public health — reminding us that building a system where everyone has care is not just a matter of funding, but of design.Further reading:Listen to Part 1 of our series on Costa Rica with Dr. Madeline PesecTake 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 GawandeRead the BBC article Tara mentioned about how Nicoya Peninsula is home to a large number of centenariansLearn more about rising violence in Costa Rica related to femicide and gang violenceMAINPRO 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 primary.focus@unityhealth.to 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

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 primary.focus@unityhealth.to 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

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 primary.focus@unityhealth.toDr. 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

In this special episode, host Dr. Tara Kiran reflects on the passage of Ontario’s new Primary Care Act—the first legislation of its kind in Canada. Joined by Peter MacLeod, founder of MASS LBP and co-lead of the OurCare initiative, Tara and Peter take you behind the scenes of a national public dialogue that helped shape the new law. Nearly 10,000 Canadians participated in the OurCare process and what they said they wanted from the primary care system is now reflected in Ontario’s legislation. This episode is a story of civic imagination, moral beauty—and a hopeful step toward primary care that works for everyone.Resources mentioned in the episode:Read more about OurCare and OurCare Standard: OurCare.caMeet some of the OurCare panelists: https://www.youtube.com/watch?v=ShkxhIJBCh8&t=25sReview Ontario’s Primary Care Act: https://www.ontario.ca/laws/statute/s25008 Watch the press conference where Ontario’s Minister of Health, Sylvia Jones, announces the Primary Care Act: https://www.youtube.com/watch?v=RFYZOosIZngRelated articles you might like:Results from the OurCare provincial priority panelsDr. Tara Kiran’s Opinion piece in the Toronto StarMore about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caLearn about the OurCare StandardTake the OurCare national survey to share your experiences with primary care.Do you have an idea for an episode? Email primary.focus@unityhealth.to 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 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

Emergency departments in Canada are overcrowded — but what if they didn’t have to be? In Part Three of her audio documentary series from the Netherlands, Dr. Tara Kiran takes listeners behind the scenes at two Dutch after-hours clinics: one in the university town of Nijmegen, and another in bustling Amsterdam. She follows Dr. Tim Olde Hartman into a modern after-hours centre that serves over 400,000 people — and learns how Dutch GPs came together to fix a broken model. Rather than being on call alone, GPs in the Netherlands now work together in large regional cooperatives to provide care 24/7. Patients call one number, speak with a specially trained practice assistant, and are guided to the right level of care — whether that’s phone advice, an in-person visit, or a doctor dispatched directly to their home.It’s a system built on trust, triage, and teamwork — and it results in emergency rooms that are calm, efficient, and often… empty.Stay tuned for Part Four, where Tara reflects on the trip with colleague Rosemary Hannam, who joined her in the Netherlands just before becoming Strategic Advisor on Primary Care at Ontario Health.If you missed Part 1 and Part 2, click to catch up. See a gallery of Dr. Kiran’s photos from her trip to the Netherlands.Hear Dr. Kiran speaking about her trip on CBC’s White Coat, Black ArtRead Dr. Kiran’s 4-part series for the Canadian Health Network on her tripRead an article on after hours care in the Netherlands called "Quality of after-hours care in the Netherlands: a narrative review"Subscribe to our Substack newsletter to get bonus content.Take the OurCare national survey to share your experiences with primary care.Do you have an idea for an episode? Email primary.focus@unityhealth.toDr. 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

How is it that 99% of people in the Netherlands have access to primary care? How can Dutch doctors look after large numbers of patients while still providing primary care? Those are some of the questions Dr. Kiran is set on answering when she visits the Netherlands to learn more about their primary care system. In the first of this four part series, Dr. Kiran brings you with her as she visits a GP practice in Nijmegen. She shadows Dr. Tim Olde Hartmen and Dr. Suzanne Ligthart to understand a typical work day. She meets key members of their team and unpacks how they all work together. In Part Two, Dr. Kiran introduces you to what she called “the secret sauce” of the Dutch primary care system. Stay tuned!See a gallery of Dr. Kiran’s photos from her trip to the Netherlands.Read Dr. Kiran’s 4-part series on the Netherlands published in the Medical Post and the insights she shared with Andre Picard at the Globe and Mail.Listen to Dr. Kiran speaking about her trip on CBC’s White Coat, Black ArtRead an article about Tara’s host, Dr. Tim Olde Hartman: A Giant Standing on the Shoulders of GiantsSubscribe to our Substack newsletter to get bonus content.Take the OurCare national survey to share your experiences with primary care.Do you have an idea for an episode? Email primary.focus@unityhealth.to 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 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

Join Dr. Tara Kiran as she learns about how the Northern Connections Medical Centre in Winnipeg is revolutionizing primary care for Indigenous communities. Dr. Kiran tours the facility and interviews Dr. Mandy Buss, who highlights the clinic’s culturally inclusive and trauma-informed practices, and the critical need for increased Indigenous representation in the medical field. Through real-life stories and discussions on systemic racism and historical barriers, this episode examines how a patient-centred and culturally competent healthcare system that honours Indigenous traditions can help address the significant health inequities and barriers to care experienced by First Nations, Métis, and Inuit people.Resources mentioned in the episode:The Truth and Reconciliation Commission Health Calls to ActionRelated articles you might like:CMAJ Commentary: Ensuring incoming cohorts of medical students better represent the diversity of Indigenous communities in CanadaResearch study: Changes in health indicator gaps between First Nations and other residents of ManitobaReports from the OurCare Community Roundtables“The Unforgotten” - a five part film from the Canadian Medical Association about Indigenous Health in CanadaMore about Primary Focus:Subscribe to our Substack newsletterVisit our website at primaryfocus.caTake the OurCare national survey to share your experiences with primary careDo you have an idea for an episode? Email primary.focus@unityhealth.to About Dr. Tara Kiran: 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/ Funding: 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

Why do 6.5 million people in Canada lack a family doctor or access to primary care—and what can be done about it?In this podcast, Dr. Tara Kiran unpacks the root causes of Canada’s primary care crisis and, more importantly, explores solutions. The podcast is centred on the OurCare Standard—six simple statements that define what every person in Canada should expect from the primary care system:1. Everyone has a relationship with a primary care clinician who works with other health professionals in a publicly funded team.2. Everyone receives ongoing care from their primary care team and can access them in a timely way.3. Everyone’s primary care team is connected to community and social services that together support their physical, mental, and social well-being.4. Everyone can access their health record online and share it with their clinicians.5. Everyone receives culturally safe care that meets their needs from clinicians that represent the diversity of the communities they serve.6. Everyone receives care from a primary care system that is accountable to the communities it serves.To explore how we can achieve this vision, Dr. Kiran travels across Canada and around the world, uncovering what’s working in places like the Netherlands, Costa Rica, and Denmark—countries known for high-quality primary care. She also takes listeners inside innovative clinics across Canada that are rethinking how care is delivered.Join Dr. Kiran as she dives deep into the challenges, innovations, and possibilities for building a better primary care system for all.About Dr. Tara Kiran: 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 the MAP Centre for Urban Health Solutions. She is the Fidani Chair in Improvement and Innovation at the University of Toronto, an Associate Professor in the Faculty of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto, and a Senior Adjunct Scientist at ICES. In her research and practice, she finds and tests solutions to make healthcare more inclusive and effective. In 2022, Dr. Kiran launched OurCare, a national initiative to engage the public in shaping the future of primary care in Canada. Important Links:Visit primaryfocus.ca to learn more. Read about the OurCare Standard at ourcare.caSubscribe to our Substack newsletterLearn more about Dr. Kiran's research: and work to improve practice in Canada. 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