National Day of Action: Medical Student Advocates in Action

The Canadian Federation of Medical Students (CFMS) National Day of Action (NDoA) is an annual event where medical students unite to address critical healthcare issues in Canada. This year’s topic, “Re-Thinking Healthcare Spending in Canada,” brought medical students from across the country to Ottawa for two days of advocacy training, followed by meetings with Parliamentarians to discuss evidence-based policy solutions for creating a more equitable and sustainable healthcare system. 

This collaborative effort was made possible by the remarkable work of the CFMS and the NDoA Research Team [1]. Their dedication to investigating critical healthcare issues and preparing detailed advocacy materials ensured that medical students had the evidence and tools necessary to confidently engage with policymakers, exemplifying the importance of evidence-based discussions in shaping health policy. 

During our meetings with Parliamentarians, we presented three key evidence-based policy asks (of equal importance): 

1. Supporting International Medical Graduates by increasing residency spots and implementing a National Practice Ready Assessment program. 

2. Adjusting the Canada Health Transfer Formula to a needs-based model for equitable funding that accounts for demographics and geography. 

3. Implementing Pan-Canadian Licensure to enhance physician mobility, improve care in underserved areas, and expand virtual healthcare. 

These policy asks are grounded in research, including findings that over 6.5 million Canadians—one in five—do not have access to a regular family doctor or nurse practitioner [2]. International Medical Graduates (IMGs) represent a critical resource to address this gap, but barriers such as limited residency spots and fragmented assessment programs hinder their integration. Only 39% of IMGs secure residency positions, highlighting the need for systemic reform [3]. Expanding IMG residency spots and implementing a national Practice Ready Assessment (PRA) program would streamline the process and ensure consistency across provinces. This approach could add thousands of new family physicians within a decade, improving healthcare access for underserved populations while addressing Canada’s growing primary care crisis [4]. 

In addition to addressing the shortage of healthcare professionals, equitable healthcare funding remains a pressing concern. The Canada Health Transfer (CHT) currently allocates funds on a per capita basis, overlooking key cost drivers like aging populations and geographic disparities. Provinces with older populations, such as those in Atlantic Canada, and rural regions with limited infrastructure face disproportionately higher costs [5, 6]. Adopting a needs-based allocation model, as seen in provinces like British Columbia and Alberta, where budgets account for age and socioeconomic factors, could address these inequities. Adjusting the national CHT

formula to reflect regional healthcare needs would ensure more equitable funding and improved outcomes for underserved populations [5, 7]. 

Finally, addressing physician mobility through licensure reform presents another key opportunity for improving healthcare delivery across Canada. A 2022 survey of CMA members revealed that 95% of respondents supported pan-Canadian licensure, with 70-75% agreeing it would improve access to rural and remote communities, primary care, and specialist care, and better facilitate virtual services. Additionally, 67% indicated it would incentivize them to seek inter-provincial locums, while 69% said it would encourage them to pursue part-time practice in retirement [8]. Drawing comparisons, Australia adopted all-jurisdiction licensure for healthcare professionals, including physicians, in 2010 [9]. This system has since improved patient safety, physician mobility, and facilitated workforce planning [10]. During discussions, practical steps to implement pan-Canadian licensure were highlighted, emphasizing its feasibility and transformative potential for healthcare delivery in Canada [11]. 

Ali’s Perspective: 

Advocacy like this serves as a powerful reminder that, as future physicians, we possess both the privilege and responsibility to use our voices to inspire and drive meaningful change. Witnessing how physicians in government bridge medicine and policymaking is a powerful reminder of the ways physicians can lead beyond the bedside to create change. This experience reaffirmed the importance of physician voices in shaping policy. One key takeaway from the weekend advocacy workshops was the powerful message shared by Dr. Dominik Nowak: to be "tough on the issue but kind to the person," when advocating. This resonated deeply with me as it underscores the importance of advocating respectfully while fostering constructive dialogue, promoting understanding, and prioritizing humanity in all advocacy efforts. 

Palak’s Perspective: 

Having the opportunity to engage in collaborative passion and advocacy alongside medical students across Canada at the 2024 National Day of Action in Ottawa allowed me to foster a sense of commitment and action towards meaningful healthcare discourses. This experience sparked the learning of the power of using our voices as medical students to start the conversation on insightful healthcare topics with policymakers as a collective. While embracing compassion and understanding along with advocacy, I hope to continue this journey to shape the future of healthcare. 

Jess Perspective 

The National Day of Action was an insightful experience that highlighted the importance of advocacy in shaping the future of healthcare. Engaging with policymakers and collaborating with peers from across Canada underscored the value of collective action in addressing systemic challenges. Effective advocacy, I learned, requires a thoughtful balance of assertiveness to drive change and empathy to foster understanding and collaboration. This experience reinforced the importance of approaching healthcare reform with both determination and respect, ensuring meaningful and lasting impact.

Acknowledgments - 

Alongside medical student leaders, our discussions focused on the challenges and opportunities within Canada’s healthcare system. Experts such as Dr. Dominik Nowak from the Ontario Medical Association shared strategies for becoming effective change agents, while Dr. Alika Lafontaine inspired us with his insights on how purpose drives success. Anne Dowson of the Canadian Health Coalition and Dr. Haizhen Mou from the University of Saskatchewan unpacked the complexities of the Canada Health Transfer and its real-world impact. Dr. Gus Grant, Registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, addressed multi-jurisdictional licensure, and Dr. Melanie Bechard from Canadian Doctors for Medicare highlighted strategies for meeting policymakers. Dr. Lisa Freeman from the University of Ottawa provided a deep dive into advocating for individuals with disabilities, and Dr. Kathleen Ross, Past-President of the CMA, shared expertise on advocacy and government relations. Artem Safarov from the College of Family Physicians of Canada explored practical solutions to easing the family medicine burden. 

Thank you to the CFMS research team for their efforts in research and putting together a thorough background for the event. 

References: 

1. Wang J, Bauer N, Singh S, et al. Rethinking Healthcare Spending in Canada: Addressing Systemic Gaps for a Better. Canadian Federation of Medical Students. 

https://www.cfms.org/uploads/NDoA/NDoA24_Backgrounder-EN.pdf. Accessed November 15, 2024. 

2. Wright T. Canada facing family doctor shortage: national survey finds 6.5 million without regular physician. National Post. 

https://nationalpost.com/health/canada-family-doctor-shortage#:~:text=According%20to %20a%20national%20survey,other%20%E2%80%9Cminor%E2%80%9D%20health%2 0problem. Published October 6, 2023. Accessed November 15, 2024. 

3. Medical Council of Canada. Pathways for international medical graduates. Medical Council of Canada. 

https://mcc.ca/credentials-and-services/pathways-to-licensure/pathways-for-international medical-gradu ates/. Accessed November 15, 2024. 

4. Imdvar R. International Medical Graduates (IMGs) in Canada: A report on the current landscape and recommendations for change. Ratna Omidvar. 

https://www.ratnaomidvar.ca/wp-content/uploads/2024/10/IMG-Report-Design-EN.pdf. Published October 2024. Accessed November 15, 2024. 

5. Marchildon G, Mou H. A needs-based allocation formula for Canada Health Transfer. Can Public Policy. 2014;40(3):209-223. 

6. Victoria News. RDN suggests federal health transfers should factor in B.C.'s aging population. Victoria News. 

https://www.vicnews.com/news/rdn-suggests-federal-health-transfers-should-factor-in-bc s-aging-population-7314651. Published October 11, 2023. Accessed November 15, 2024. 7. Doctors of BC. Regionalizing health care budgets in BC: A proposal for a more equitable health care system. Doctors of BC. 

https://www.doctorsofbc.ca/sites/default/files/regionalizing_health_care_budgets_in_bc.p df. Published September 2023. Accessed November 15, 2024.

8. Canadian Medical Association. Pan-Canadian licensure. Canadian Medical Association. https://www.cma.ca/our-focus/pan-canadian-licensure. Accessed November 15, 2024 9. Australian Government Department of Health. National Registration and Accreditation Scheme. Australian Government Department of Health. 

https://www.health.gov.au/our-work/national-registration-and-accreditation-scheme. Accessed November 15, 2024. 

10. Healthy Debate. A pan-Canadian licensure model: Addressing the physician workforce crisis. Healthy Debate. 

https://healthydebate.ca/2023/07/topic/pan-canadian-licensure-model/. Published July 12, 2023. Accessed November 15, 2024. 

11. Ma H, Fenn D, Knott J, et al. An assessment of the effectiveness of international medical graduate (IMG) assessment in Canada: A scoping review. BMC Health Serv Res. 2022;22(1):950. doi:10.1186/s12913-022-08134-1