Primary care has long been the backbone of a strong health-care system that people turn to for everyday concerns, preventive care and ongoing support. Today, that backbone is under strain. Many Ontarians can’t find a family doctor, walk-in clinics are harder to access, emergency rooms are overloaded and private, out-of-pocket services are emerging to fill the gaps.
For Professor Agnes Grudniewicz of the Telfer School of Management, this crisis also presents a rare opportunity.
“Never before have federal, provincial and municipal governments all been working toward the same goal for primary care,” she says.
Indeed, the federal government has said that access to team-based primary care is a priority, the Ontario government has launched a Primary Care Action Plan and, recently, the City of Ottawa approved a plan to attract more primary care providers locally. Other cities are making similar efforts.
A system under pressure
The pandemic didn’t create Ontario’s primary care challenges, but it did expose and intensify them. As clinics closed and many physicians retired early, longstanding service gaps became impossible to ignore.
“We’ve had access problems for years,” Grudniewicz says. “But COVID amplified everything. It made clear that if we don’t fix primary care, the rest of the system can’t function.”
Grudniewicz argues that investing in primary care is one of the most cost-effective ways to strengthen the entire system, preventing crises instead of reacting to them. Universities play a key role in this work by training the health-care workforce and producing evidence that helps decision-makers use new investments wisely.
Research grounded in reality
As a health services researcher, Grudniewicz studies how primary care operates in clinics and communities, not just in datasets. Her work blends policy, management and qualitative approaches, with one principle at its core: involving the people doing the work.
“We always include family physicians, nurse practitioners, clinic managers and patients in our research teams,” she says. “Their insights are essential.”
Grudniewicz conducts her research with three cross-Canada colleagues through the Health Systems Research Lab. One of her recent CIHR-funded projects examines system-level issues that often fly under the radar, such as the administrative burden placed on primary care clinics. Many family physicians are effectively small business owners responsible for leasing office space, hiring staff and overseeing IT — all without formal training in administration.
“We’re funnelling billions into primary care, but not supporting clinic management,” she says. “That’s a huge gap.”
In this newest project, Grudniewicz will map existing supports for administration and management of primary clinics, survey clinic managers in three provinces and conduct case studies to identify scalable ways to strengthen clinic operations. The goal is to ensure new investments improve not only patient “attachment” — having a named provider — but also access and quality.
Findings from Grudniewicz’s other primary care research have already influenced national discussions. Results of a major study on early-career family physicians challenged the assumption that younger doctors are less committed or see fewer patients by choice. Instead, the data showed service levels declining across all career stages as their patients’ cases grow more complex. The team’s qualitative findings helped explain these patterns and informed debate on family medicine residency training.
“You can’t fix the system with numbers alone,” Grudniewicz says. “Quantitative data is powerful, but qualitative research adds the human experience — especially for people that are marginalized or missing from the data.”
Collaboration as a way forward
Collaboration is central to Grudniewicz’s work. At the recent Telfer Health System Conversation, a panel of local leaders — including a nurse practitioner, pharmacist, family physician and public health expert — highlighted how community-level solutions are already emerging in Ottawa.
For example, the Ottawa Nurse Practitioner Clinic, which opened in 2025, includes an on-site pharmacy and partnership with community supports, to attach people from marginalized communities to primary care providers.
“It was inspiring to see how connected they were,” she says. “They collaborate every day to make the system better. It reminded me that local partnerships matter just as much as provincial strategy.”
True collaboration, however, takes time. Interprofessional teams can take up to 10 years to hit their stride, and many current models still isolate physicians from other professionals. Breaking down those silos is essential to building strong, team-based care.
A follow-up event planned for the spring will focus on patient engagement, a theme that surfaced repeatedly from audience questions. For Grudniewicz, incorporating patient voices into research, leadership and service design is critical to a more human-centred system.
Training leaders to transform the system
Education is the other lever Grudniewicz sees for lasting change. She points to Telfer’s health programs — from the Master of Health Administration (MHA) and Executive MHA to the MSc, PhD and undergraduate health analytics programs — as engines for system transformation.
“Our graduates go on to change the world,” she says. “They become leaders who understand policy, system complexity and the importance of collaboration. They give me hope.”
“Our graduates go on to change the world. They become leaders who understand policy, system complexity and the importance of collaboration. They give me hope.”
Agnes Grudniewicz, Phd — Ian Telfer Research Fellowship and Associate Professor at Telfer
Many students arrive with clinical experience and leave prepared to lead organizations, design new primary care models and champion evidence-based reform. Through coursework and applied projects, they learn to navigate policy, analyze data and see the health system as a whole.
Future leaders, she adds, also need more formal training in primary care administration — a gap Telfer is well positioned to address.
“You can’t advance primary care if you don’t understand why things are the way they are,” she says. “Policy shapes everything.”
A realistic, hopeful vision
Grudniewicz avoids idealized visions that ignore Canada’s structural realities. Primary care will remain under provincial jurisdiction, and physicians will continue to have autonomy in how they practise. Within those constraints, though, she imagines a system with fewer hierarchies, stronger teams and a balance between attachment, access and quality.
This could mean teams where physicians work in tandem with interprofessional providers, making the most of everyone’s scope of practice and truly sharing care.
“We have to avoid oversimplified solutions,” she warns. “Blaming physicians or focusing only on one metric won’t help. But if we stay grounded in evidence, listen to the people doing the work and keep collaboration at the centre, we can build something much better.”
Despite the challenges ahead, she is optimistic.
“I truly believe Ontarians will have much better primary care in the years to come,” she says. “This is our moment to get it right.”
