Primary Focus with Dr. Tara Kiran

Dr. Tara Kiran
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  • MEDICINE
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Patients, politicians and clinicians agree: it’s high time to fix primary care in Canada. But, what could a stronger, more inclusive, more efficient public system look like? In this smart, engaging podcast, family doc and researcher Dr. Tara Kiran brings together the voices of frontline healthcare workers, patients, researchers and policymakers from around the world to unpack the issues and innovations that could—and should—transform primary care in Canada. With a focus on actionable insights and real-world solutions, episodes will take you behind the scenes to understand how different health systems and clinics are solving access problems, stretching healthcare dollars and ensuring quality care for all. At the heart of each conversation is a shared commitment to a better public healthcare system—one that not only serves every person in Canada, but leads the world. primaryfocus.substack.com

  1. 6H AGO

    In Vancouver: A Clinic Accountable to the Community It Serves

    For many newcomers to Canada, accessing healthcare isn’t just about finding a doctor. It’s about navigating an unfamiliar system, in a new language, often without the safety net of family or community. Appointments, referrals, and forms can become barriers rather than pathways. Too often, people fall through the cracks not because they don’t need care – but because the system isn’t built with them in mind. Today on Primary Focus, I take you on a tour of the Umbrella Multicultural Health Co-op Clinic in Vancouver, BC. At Umbrella, primary care didn’t start with a funding envelope or a policy directive… it started with community members (many of them newcomers to Canada) organizing around a simple truth: the system wasn’t meeting their needs. They started with a mobile clinic for migrant farm workers, and eventually expanded into a community health centre that now provides longitudinal primary care, mental health support, and help with social needs — all grounded in a cooperative model where community members have real governance power. In this episode, we are focusing on their use of a unique role: the cross-cultural health broker. What is a cross-cultural health broker? A cross-cultural health broker is a member of a primary care team at Umbrella who helps bridge the gap between patients and the healthcare system by combining language interpretation, cultural understanding, and system navigation. Unlike an interpreter, a cross-cultural health broker: 🌐 Shares language and cultural background with the patient (currently Umbrella has brokers who speak Spanish, Arabic, Tigrinya and Farsi/Dari/Pashto)📋 Helps patients prepare for appointments, understand diagnoses and treatment plans, and follow through on next steps🧭 Supports navigation outside the clinic; labs, pharmacies, referrals, transportation, benefits, and paperwork⁉️ Flags cultural misunderstandings that could affect care and helps clinicians adjust how questions are asked or care is delivered In short, a cross-cultural health broker doesn’t just translate words… they translate context, helping patients feel understood and helping care actually happen. A conversation about equity — and trade-offs In this episode, I sit down with Dr. Mei-ling Wiedmeyer, a family physician and Umbrella’s clinical lead. We talk honestly about what it takes to make this model work — including the very real tension around resources. Here’s a sneak peak of Mei-ling’s powerful response to my question about whether this model they’ve created is scalable: Why this episode matters Umbrella is a powerful example of what can happen when primary care is built with community and truly accountable to meeting the community’s needs. It’s an inspiring model of how we can close gaps in health equity through high-quality health care for those too often left behind. Here are some photos I took of the Umbrella clinic during my visit: A small ask (that really helps) If you are enjoying Primary Focus and think the ideas we discuss are worth sharing, here are 4 ways you can support the podcast: * Forward this email to one person who cares about improving our primary care system * Share your favourite episode with a friend or colleague * Hit follow on your favourite podcast app so new episodes show up automatically * Leave us a review on Apple Podcasts - it truly does help us get more exposure. Thank you for listening. With gratitude,Tara 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

    55 min

  2. JAN 29

    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.  More about Primary Focus: Subscribe to our Substack newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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

    45 min

  3. 12/19/2025

    In Costa Rica: integrating public health and primary care

    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 Pesec 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 Gawande Read the BBC article Tara mentioned about how Nicoya Peninsula is home to a large number of centenarians Learn more about rising violence in Costa Rica related to femicide and gang violence MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.  More about Primary Focus: Subscribe to our Substack newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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 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

    34 min

  4. 12/04/2025

    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 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 Gawande MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.  More about Primary Focus: Subscribe to our Substack newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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 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

    56 min

  5. 11/21/2025

    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 Quebec Isabelle and Mylaine’s contemporary advanced access model How Canada compares to peer countries when it comes to timely care An older commentary from Tara that delves into why timely access is such a problem in Canada A summary of Quebec’s data from the OurCare survey Explore Quebec data from the 2022 OurCare National Survey at data.ourcare.ca or read this article Visit the website for GMFU Richlieu-Yamaska Listen to our 4-part series on The Netherlands (mentioned in this episode when discussing training for primary care nurses MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.  More about Primary Focus: Subscribe to our Substack newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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 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

    1 hr

  6. 10/30/2025

    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 newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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 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

    59 min

  7. 10/16/2025

    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 episode Explore 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 Practice MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.  More about Primary Focus: Subscribe to our Substack newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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

    51 min

  8. 10/02/2025

    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 episode The federal report estimating Canada is 23,000 family doctors short Tara’s research on the shift away from full-service family medicine Ruth’s research on career choices and administrative burden in primary care Dive into the commentary on physician payment that was a Ruth-Tara platonic meet-cute Here's the cross-country comparisons on physician payment mentioned in the episode MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.  More about Primary Focus: Subscribe to our Substack newsletter Visit our website at primaryfocus.ca Learn about the OurCare Standard 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

    51 min
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Patients, politicians and clinicians agree: it’s high time to fix primary care in Canada. But, what could a stronger, more inclusive, more efficient public system look like? In this smart, engaging podcast, family doc and researcher Dr. Tara Kiran brings together the voices of frontline healthcare workers, patients, researchers and policymakers from around the world to unpack the issues and innovations that could—and should—transform primary care in Canada. With a focus on actionable insights and real-world solutions, episodes will take you behind the scenes to understand how different health systems and clinics are solving access problems, stretching healthcare dollars and ensuring quality care for all. At the heart of each conversation is a shared commitment to a better public healthcare system—one that not only serves every person in Canada, but leads the world. primaryfocus.substack.com

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