Primary Focus with Dr. Tara Kiran

Is the primary care access problem the cause for ED overcrowding?

Do emergency rooms have to be the safety net in our system - or is there another way?
How can primary care and emergency medicine better collaborate?
While the Primary Focus team takes a brief summer break, we are sharing a special crossover episode from Emergency Medicine Cases. Host Dr. Anton Helman sits down with Dr. Tara Kiran and Dr. Danielle Martin to talk about the place where primary and emergency care meet. Together, they unpack common myths and discuss how  integrated call-first triage, shared digital records, and an educated public can help us build a better system for everyone.
(Note: This episode was recorded in October 2025, prior to Dr. Danielle Martin’s election as Member of Parliament for University-Rosedale.The views and opinions expressed by Dr. Martin in this discussion were her own at the time of recording and do not represent or reflect the views, policies, or positions of the Government of Canada.)
Listen to the full conversation on EM Cases on their podcast feed (search “Emergency Medicine Cases” on your favourite app.
View a one-page summary of the conversation produced by EM Cases
Listen to our previous interview with Dr. Danielle Martin
Read more about the Dutch model of primary care or listen to our 4-part series on primary care in The Netherlands
More about Primary Focus:
Subscribe to our Substack newsletter
Have an idea for an episode? Email primary.focus@unityhealth.to
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. 
Primary Focus receives financial support from the MAP Centre for Urban Health Solutions, the 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.

Original Emergency Medicine Cases Show Notes:
There are few things more frustrating for an Emergency Physician than caring for patient after patient who lands in the ED not because it’s necessarily the best place for their care, but because every other door in the health care system was closed, confusing or impossible to find. Emergency Medicine and Primary Care often operate in different worlds—one built around rapid diagnosis and uncertainty, the other around continuity and prevention—but our patients move constantly between the two. In this special EM Cases podcast, EM–Primary Care Health Systems Strategies, we step outside the usual ED lens with Dr. Tara Kiran (host of the Primary Focus podcast) and Dr. Danielle Martin to ask how we can deliver the right care, in the right place, at the right time. We challenge assumptions about what drives ED use and explore team-based primary care, after-hours cooperatives, call-first triage, virtual care, information sharing and warm handoffs. Drawing on models from Canada, the Netherlands, Denmark and elsewhere, we finish with practical strategies to reduce fragmentation, improve continuity and make the system work better for patients and providers. 
Please consider a donation to EM Cases to support our mission of providing high quality free open access medical education here: https://emergencymedicinecases.com/donation/. 
Disclaimer: This episode was recorded in October 2025, prior to Dr. Danielle Martin becoming a candidate for government office. The views and opinions expressed by Dr. Martin in this discussion were her own at the time of recording and do not represent or reflect the views, policies, or positions of the Government of Canada.


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

Can you imagine driving down the highway and seeing street signs directing you to your local primary care clinic instead of a hospital? In this episode, Dr. Tara Kiran hops in a car with health economist Tino Marti for a healthcare road trip across Catalonia, Spain, to tour three different clinics. They serve different populations in different settings under different governance models. But all three deliver care to every resident in their surrounding community.
First, they visit CAP Vilafranca North, a clinic run by the public agency that runs 80% of Catalonia’s primary care centres, where rotating "health points" ensure even small rural villages of 1,000 people can get care in their community. Next, they tour CAP Castelldefels, a joint venture between the government and local municipalities that embraces the philosophy of "subsidiarity"—allowing nurses and administrative teams to independently treat minor issues so family doctors can focus on complex care. Finally, they head to CAP Sardenya, an entrepreneurial, clinician-owned cooperative that integrates university research and gives doctors more schedule flexibility. 
Listen in to see how the Spanish model combines performance bonuses, quality dashboards, and community engagement to build a system where nobody falls through the cracks.
Learn more about Spanish primary health care:
Read this four-page summary on primary care teams in Catalonia
Review this comprehensive policy paper to dive deeper into primary care transformation in Spain 

Mainpro+ Credits
Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026. 
This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast 

Listen to More From Our Healthcare Infrastructure Series
In Spain: a primary care centre in every community (Part 1)
In Costa Rica: Integrating Public Health and Primary Care
In Vancouver: A Clinic Accountable to the Community It Serves

More About Primary Focus
Subscribe to our Substack newsletter
Have an idea for an episode? Email primary.focus@unityhealth.to
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 receives financial support from 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

Imagine living in a country where no resident struggles to access primary care. There are no wait lists. Everyone can be seen at the local health centre, even if they haven’t registered in advance. In this episode, Dr. Tara Kiran takes you on a journey to Spain—where the right to primary care is guaranteed in law and where every community has a local health centre. Walking through the streets and historic health ministries of Barcelona, Tara speaks with health economist Tino Marti and healthcare strategy director Dr. Rafael Ruiz to understand how neighbourhood hubs bring doctors, nurses, social workers, and even publicly-covered psychologists and physiotherapists under one roof to care for entire communities. Finally, Tara sits down with digital health leader Dr. Oscar Solans to learn about La Meva Salut—a  patient app that has given millions of Catalans easy digital access to lab tests, imaging, medications and more since 2009.Learn more about Spanish primary health care
Read this four-page summary on primary care teams in Catalonia
Review this comprehensive policy paper to dive deeper into primary care transformation in Spain 
Mainpro+ Credits
Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026. 
This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast 
Listen to More Episodes About Community-based Primary Care Models
If you want to learn more about how different jurisdictions organize community-oriented, team-based care models, listen to these related episodes:
In Costa Rica: How a middle-income country built a world-class primary care system
In Costa Rica: Integrating public health and primary care
In Durham: Community Wellness and Black Health
More about Primary Focus:
Subscribe to our Substack newsletter
Have an idea for an episode? Email primary.focus@unityhealth.to
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 receives financial support from 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

More than 5.8 million adults in Canada don't have a regular family doctor, nurse practitioner or primary care clinic--and where you live has a lot to do with whether you're one of them. To make sense of the newest research on primary care in Canada, Dr. Tara Kiran flips the script and welcomes award-winning health reporter Kelly Grant from The Globe and Mail to ask her the tough questions.
Together, they dig deep into the newly released 2025 OurCare Survey data, exploring why provinces like Manitoba and Ontario are faring better, why Quebec leads the nation in out-of-pocket medical fees, and why patients in the Territories report being more satisfied with care. The data raises as many questions about healthcare as it answers — which is exactly what makes this conversation worth hearing.
Explore the Data
The 2025 OurCare Survey tracks how primary care is performing in every province and territory. You can dive into the results yourself at OurCare.ca 
Read the reports at OurCare.ca/survey 
Explore the interactive dashboard at data.ourcare.ca 
Read Kelly’s piece in the Globe and Mail summarizing the key findings
Mainpro+ Credits
Family doctors in Canada can now earn Mainpro+ credits by listening to Primary Focus Podcast episodes published after May 1, 2026. 
This self-learning Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 30 Mainpro+ credits, with 1 credit available per eligible episode. To claim your credit, listen to the episode, review the show notes and complete the self-learning survey. Your certificate will be emailed to you. Find more information at OurCare.ca/podcast 
Listen to an episode about the genesis of the OurCare Survey
A historic win for primary care in Ontario with Peter MacLeod
Why millions of Canadians are still waiting for a family doctor with Dr. Danielle Martin
More about Primary Focus:
Subscribe to our Substack newsletter
Have an idea for an episode? Email primary.focus@unityhealth.to
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 receives financial support from 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

In this episode, Dr. Tara Kiran travels to Durham, Ontario, to visit the Durham Community Health Centre, where CEO Francis Garwe leads a team rethinking what primary care can look like when it is truly rooted in community. Touring a repurposed public school that now houses a wide range of services—from mental health counseling and a regional diabetes team to food security programs, youth programming, and community gardens—Tara sees firsthand how Durham CHC addresses the social determinants of health alongside clinical care. She then sits down with Francis Garwe, Dr. Akeem Stewart, and Dr. Kirk Stewart to discuss how the centre is advancing Black health through initiatives like the Kliniki clinic and a community ambassador model designed to build trust and improve access. Together they explore what it takes to co-create programs with the communities they serve—and what other clinics in Canada might learn from Durham’s approach to equity-driven primary care.
Donate to Durham CHC
Durham CHC relies on private donations, grants, and other sources to fund some of the important services they offer that address social determinants of health. To support the Durham Community Health Centre’s innovative work, visit their website at www.durhamchc.ca.
Podcasthon
Primary Focus is proud to take part in Podcasthon, the world’s largest charity podcast event! We were tasked with creating an episode dedicated to supporting a charity or non-profit that truly matters to us, and we chose Durham CHC. Podcasthon brings together podcasters globally to raise awareness for important causes - without any money involved. It’s all about uniting voices to make an impact, with more than 1,000 podcasts highlighting a charity of their choice. Listen to more episodes as part of Podcasthon here. 
Research and programs mentioned in this episode
Get more information on the Durham Community Health Centre. 
Learn more about Ontario Health’s Black Health Plan, informed by the work done by Francis Garwe and the Durham CHC
Find out about the Black Health Committee, a committee for the Alliance for Healthier Communities
Visit the Black Physicians Association of Ontario website to learn more about their work on Black health
MAINPRO CREDITS: Family doctors can claim Mainpro Credits by completing a linking learning exercise.
Listen to other episodes of Primary Focus in our series on community-driven health equity clinics:
In Costa Rica: How a middle-income country built a world-class primary care systemIn Costa Rica: integrating public health and primary careIn Vancouver: A Clinic Accountable to the Community It Serves
More about Primary Focus:
Subscribe to our Substack newsletter
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 receives financial support from 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