Family Physicians In Action

More than 334,000 Ontarians are living with Alzheimer’s disease or other forms of dementia, according to the Alzheimer Society of Ontario. With an aging population, by 2050 that figure is expected to triple. These numbers are staggering not only because of the pressure they place on Ontario’s health care system, but also because of what they mean for patients, and for the caregivers and health care professionals who support them.

Early in her career, Dr. Linda Lee, a family physician from Kitchener, witnessed firsthand the impact dementia had on her patients and their families, who often face grief, frustration, and uncertainty. That experience inspired her to dedicate her career to improving care and support for those living with Alzheimer’s disease and other forms of dementia. Over the past twenty years, she has supported patients and their caregivers as they navigate the mental, physical, and emotional challenges that come with these diagnoses.

“Many of my patients value nothing more than their intellect,” she said. “To see them lose part of their identity as professors, lawyers, and doctors has had a big impact on me.”

At the time, Dr. Lee was caring for more than 20, 30, at times even 40 patients a day without the support of a team. Despite her commitment to learning everything she could, Dr. Lee recognized that on her own she could not provide the level of care she wanted for her patients.

“All family physicians work hard to provide the care their patients need, but there are system issues,” she said. “So, the solution was a system change.”

That change began in 2006, when Dr. Lee helped establish one of Ontario’s first family health teams and launched MINT Memory Clinics, a multidisciplinary, inter-professional approach to providing early diagnosis and treatment for people living with dementia and other memory disorders.

For the first time, her patients could access the support of social workers, nurses, occupational therapists, and pharmacists. Working with her new team, she developed an evidence-based model of dementia care, leveraging the strengths of each profession and improving care for patients. As the impact of their work became clear, Dr. Lee saw the opportunity to share what she and her team had developed with others.

Over the past 15 years, with project-specific funding from national health charities, the Government of Ontario, the Public Health Agency of Canada, and support from organizations including the Ontario College of Family Physicians, Dr. Lee and her team have trained more than 500 family physicians and 1500 allied health team members. They have also guided the development of new memory clinics in over 130 primary care settings across seven Canadian provinces.

Across the system, patients cared for by these teams have been found to experience a 38 per cent reduction in overall care costs and a 90 per cent decrease in specialist referrals.

Dr. Lee’s impact extends far beyond numbers. For people living with dementia, accessing support early can be transformative, helping them maintain independence longer and navigate their condition with dignity. Dr. Lee’s innovation and deep commitment to improving the lives of her patients and their caregivers has transformed the experience of dementia care for thousands of families and will continue to do so for generations to come.

Throughout the month of January, many will be reminded of the challenges faced by friends, family members, and neighbours living with Alzheimer’s disease and other forms of dementia. The OCFP is proud to recognize the leadership of family physicians like Dr. Lee, who are caring for patients today while reshaping the system to deliver better care for the future.

According to the Canadian Medical Association, less than one per cent of Canadian physicians identify as Indigenous. In response to the Truth and Reconciliation Commission’s calls to action, medical schools across the country, including those in Ontario, have pledged to increase enrollment of Indigenous students.  

Dr. Chase McMurren is a Michif (Métis) family physician leader, recently transitioning from his role as Theme Lead for Indigenous Health in the MD program at the University of Toronto (UofT). In his role at UofT, he had curricular oversight for Indigenous health content for the entire medical program, supported current Indigenous medical learners and chaired the Indigenous Student Application Program (ISAP).  

It was during a geriatric medicine rotation during residency that Dr. McMurran first heard the saying, ‘nothing about us without us.’ At its core, this means recognizing that individuals have the deepest understanding of their own needs and those of their communities. Their lived experience and insights should inform the design of community services, rather than being overshadowed by decisions made without their involvement. 

Dr. McMurran emphasizes that this same commitment must be made to Indigenous people, who are directly affected by the health-care programs and services being created, and the curriculums being taught.  When Indigenous voices are heard and their perspectives are valued, it leads to more relevant and effective solutions and ensures they can actively participate in shaping the supports designed for their communities.  

For Dr. McMurren, a powerful way to support Indigenous patients in primary care is to add Indigenous Patient Navigators to team-based care models and hospitals. Integrating Indigenous Navigators into care teams strengthens cultural safety and improves care for Indigenous patients. Their knowledge of both the health-care system and Indigenous traditions such as talking circles, and other important practices, allows them to guide, advocate, and shape services that truly reflect the needs of the communities they serve. 

It is through this lens that Dr. McMurren mentors, teaches, and creates curriculum for the next generation of family physicians who are deeply attuned to the needs of the communities they serve.  

 Throughout her 18-year career as a family physician in southwestern Ontario, Dr. Briana Yee-Providence’s patients have struggled with long wait times, difficulties accessing specialists and diagnostic services, and other barriers that have led to poor outcomes and impacted their quality of life.  

After years of caring for her patients and seeing them face the same recurring challenges in Ontario’s health-care system and knowing that patients across the province faced the same challenges, Dr. Yee-Providence joined her local Ontario Health Team (OHT) with the goal of leading meaningful change, improving access to care and to advocate for all Ontarians. 

As a physician Co-chair for the Chatham-Kent Ontario Health Team (OHT) for over four years, Dr. Yee-Providence has been a part of her local OHT since its inception.  

Part of her work is ensuring that the initiatives the OHT prioritizes reflect the needs of both patients and physicians. This includes working to improve system integration, advocating for policies that increase access to care and making a tangible difference in the way that care is delivered by physicians and experienced by patients. Her leadership in her local OHT led to a successful application for funding and creation of an unattached clinic that provides comprehensive care to the over 35,000 patients in Chatham-Kent who previously were without primary care. 

In addition, Dr. Yee-Providence is the Co-chair of the Physician Leadership and Engagement Table, a trilateral table comprised of the Ministry of Health, Ontario Health and the Ontario Medical Association. This role ensures that family physicians have an avenue to provide feedback and insights from working directly with patients and collaborate with the government on the evolution of OHTs and Primary Care Networks (PCNs). Dr. Yee-Providence believes that PCNs are essential in bringing together the primary care sector in local areas and providing  them with a collective voice to improve the health care in their region. 

Because family physicians provide care from birth to end of life, manage chronic and acute illnesses and work across multiple health-care settings, they are best positioned to ensure their patients’ needs are considered during decision-making. By having a seat at the table, family physicians can help shape a system that is patient-centered, sustainable, and effective for both those that work in the system and patients. 

As we come to the end of our lives, many of us would prefer to be at home, surrounded by family, receiving care from someone we know and trust. 

Inspired by mentors like Cyndi Fagan, a nurse navigator from the Palliative Care Team in Scarborough, and his own experiences, Dr. Aleem Hussain views the provision of end-of-life care as both a privilege and a natural extension of family medicine.  

For over a decade he has practised family medicine in Scarborough and Markham, and five years ago he decided to take that one step further by providing palliative care in Scarborough where he sees an opportunity to ensure his patients receive the home-based care, they need at the end of their lives.  

For Dr. Hussain, providing this personalized care for his patients in a comfortable and familiar space is a foundational part of his practice. 

By listening to their patients and understanding their needs, family physicians like Dr. Hussain gain an understanding of how to provide the best end-of-life care possible. This experience also uniquely positions family doctors to advocate for their communities to ensure that patients can experience dignity at the end of their lives.  

Looking ahead, Dr. Hussain hopes to see increased recognition of the vital role family doctors play in shaping a more accessible and equitable health-care system. His work in palliative care highlights the critical role family physicians play in supporting patients through every stage of life. 

In Northern Ontario, accessing specialist care often means patients traveling hundreds of kilometers—sometimes in dangerous winter conditions – and with a financial cost. Dr. Lorraine Sharp, a dedicated family physician in Sault Ste. Marie, sees the challenge this presents to patients every day. To address the need for access in her community, she now focuses her work in geriatric rehabilitation, and palliative and long-term care.  

Although Dr. Sharp has a focused practice, she believes that comprehensive family medicine is the pillar of patient-centered care. Family physicians know their patients deeply—not just their medical histories, but the details of their daily lives. Just like Dr. Sharp, all family physicians have a breadth of experience caring for patients, which uniquely positions them to advocate for a health-care system that meets their patients’ needs. 

In addition, Dr. Sharp recognizes that everyone needs a family physician, regardless of the complexity of the care they require, or the specialists they see. No matter the situation, a family doctor should be a part of a patients’ care team.  

Her hope for the future? That governments and healthcare systems continue to invest in and support family medicine—ensuring that every patient, no matter where they live, has access to a trusted family doctor.