Optimizing care with teams

Team-based collaboration is widely considered to be the gold standard in Canada’s primary care. Working together with other skilled professionals can be a more satisfying, more efficient way for a family physician to practice. If you can afford to employ a nurse or nurse practitioner, that is, and if everyone on your team is working together smoothly, following the same script.Nova Scotia has a network of more than 100 collaborative family practices, supported by the provincial government and the health authority. There are similar models across Canada.If you work in one of these health authority-run centres, you aren’t worrying right now about having to pay nurses’ salaries—or bricks and mortar, for that matter. (But you may or may not be happy with the amount of input you get in the decision-making and the selection of team members.)To grow team-based practice across Canada and perhaps increase patient attachment, provinces know they need to make team-building more affordable for autonomous private clinics, like Alberta and British Columbia have been doing, and other provinces like Nova Scotia are beginning to do.An evolving patchworkAlberta’s system of Primary Care Networks has been operating since 2005, with the vast majority of private family medicine clinics participating.There are financial incentives for maintaining and increasing capitation. The doctors get to decide what kind of skill is best suited for their team. They do the hiring. Maybe a nurse or an LPN, maybe a dietician or mental health counsellor—it is up to the private clinic to identify what it needs. There is also a unified provincial EHR: Alberta Netcare.These are all strengths that foster team collaboration and efficiency.British Columbia has been developing a Primary Care Network (PCN) initiative since 2018. It’s available to all longitudinal care FPs whether they’re paid on contract, fee-for-service or on B.C.’s new longitudinal care payment plan. But the B.C. program is different from Alberta’s in that the doctors often don’t have a say in the team hiring. It depends on the culture of the particular Division of Family Practice that manages their PCN.The nursing staff generally comes from the health authority—which means those crucial team members are on a health authority career track. If a better job comes along and they get it, the clinic doctors have to spend hours training their new nurse.The provincial government has just introduced a “Nurse in Practice” program that does give doctors the choice of hiring their own nurses.Still, Dr. Vanessa Young, a Victoria family doctor, is not so sure that won’t actually create a different set of problems for the doctors who go for it.“They are then competing with health authority wages and benefits,” she said in an email.Commenting on other aspects of the PCNs, Dr. Young said: “Our (PCN) team is helping our efficiency. We have a 0.5 FTE (full-time equivalent) mental health and substance use social worker, and a 0.25 FTE social worker for accessing financial and social programs, as well as a 0.2 FTE clinical pharmacist. She is excellent with my complex chronic pain patients, and has helped significantly with de-prescribing of sedatives.”The PCN-funded team members access their patients usually by phone, occasionally in person and chart in the clinic’s EMR.“We sadly don’t have space for them in our clinic, nor is the pittance of overhead we receive that is attached to their positions anywhere near sufficient,” she said. “But (we) would happily move into funded space to be co-located with them. Dream on!”Nova ScotiaNova Scotia’s new program supports private family practice clinics that are ready to build teams.“The 2023 contract included funding for a pilot project available to family physicians who hire an allied healthcare provider (AHCP),” said a Doctors NS spokesperson. “The pilot project intends to incentivize innovation in primary care resulting in improved access and attachment.”Participating physicians can bill for the services provided by the AHCP to a maximum of $110,000 per year. All services delivered by the AHCP must be within their scope. Only family physicians in their own practice (not in a health authority-operated facility) may apply to be part of the pilot project.It’s too early to evaluate how well this is working.Meanwhile, do we actually know to what degree collaborative care initiatives boost efficiency and free up doctors to take on new patients?A 2014 Alberta study of four academic FP clinics that employed RNs and LPNs identified, among other things, the importance of clear leadership and defined roles in bringing about improved workflow and patient access.The number of primary care providers accepting new patients on Alberta Find a Doctor reached a four-year high of 462 at the end of March 2025, after three successive years of decreases, it says. That included a total of 418 family doctors and 44 nurse practitioners taking patients, with 20 in the south zone, 251 in the Calgary area, 38 in central zone, 89 in Edmonton and 64 in the north, the website states.It’s important to note that a March 2025 report by the Alberta Auditor General warned that the Alberta Department of Health still needs to make some improvements to its data-gathering on PCNs.A unique approachDrumheller, Alta., family physician Dr. Rithesh Ram will tell you he definitely sees many more patients now through the teamwork he’s established at the clinic he shares with one other doctor. Together, they have a panel of 5,000 patients.Dr. Ram’s collaborative care set-up ticks all the right boxes: He chooses and trains his own staff. He has a full-time LPN, fully funded by Alberta’s PCN. His team (including the pharmacist) collaborates closely, through a customized EMR.He is certain that his team saves him a lot of time by taking care of things he does not need to do himself.The Riverside Clinic has no wait time, Dr. Ram said, with the two physicians and their team available to both booked patients and walk-ins.“We don’t have MOAs (medical office assistants), because an MOA has a very specific scope of practice, and they’re trained in a very certain way. So we developed what we call patient care co-ordinators,” Dr. Ram explained.No MOA, no receptionist. Just four patient care co-ordinators and a fifth who oversees them.Dr. Ram said this looser structure enables his office staff to be nimble in the moment, for example by taking charge of patient questions and answers.He gave the example of a patient calling the clinic for lab test results. If you’re calling in and everything’s normal, in a traditional clinic the person answering the phone would say, “Hold on, I have to go ask somebody,” Dr. Ram said.“But our patient care co-ordinators have the training and the backing of the physicians to say, ‘yeah, that is all normal’ . . . as opposed to wasting everybody’s time,” he said.“The biggest thing is that you pick the right team members, and that it is led by a physician who understands how to leverage and use all of their team to the maximum amount that they are capable of doing,” Dr. Ram said. “Part of that for physicians is actually letting go of the care a little bit, and understanding that the team around you is going to be providing safe care—not equal to what a physician does, but safe care and providing what the patient needs in that moment.“You just need to hire people that are willing to keep learning, keep educating themselves, and keep moving themselves into a level where they’re providing as much of the full scope care that a patient needs in the moment they need it.”Overall, he is seeing about double the number of patients he used to see in a more traditional set up, and on the day of our interview he had just seen 50.Of course, not every doctor wants to see 50 patients a day.

Optimizing care with teams

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