Canada's Health Care Crisis
NP ACORN REMAINS AT THE FOREFRONT OF THE ADVOCACY FOR ONTARIO’S NPS.
“OBVIOUS, EVIDENCEBACKED SOLUTION”:
DR. NP MICHELLE ACORN: The Trusted Voice and Leader of Ontario’s Nurse Practitioners
Dr. NP Michelle Acorn is a seasoned advocate and well respected leader of Nurse Practitioners at all levels of government.
Dr. NP Michelle Acorn is a passionate advocate and leader for the advancement of the Nurse Practitioner (NP) practice in Ontario and across the global stage.
NP Acorn has over 35 years of nursing, health systems, and leadership experience. Prior to her role as CEO of the Nurse Practitioners’ Association of Ontario (NPAO), she served as the inaugural Chief Nurse with the International Council of Nurses, as well as the Provincial Chief Nursing Officer in Ontario where she provided ministerial strategic leadership and expertise.
NP Acorn is a proven healthcare leader with the expertise that drives innovation and excellence. Her diverse clinical expertise includes practicing in the Emergency, as a Hospitalist, innovating GAIN (Geriatric Assess -
NPs are Here to Help Healthcare
In an increasingly turbulent political environment, addressing the healthcare crisis and connecting communities with primary care must remain top priorities for the next provincial government. The Nurse Practitioners’ Association of Ontario (NPAO) is confident that, with the right support from policy-makers, Nurse Practitioners (NPs) can close the critical gap in healthcare and deliver the timely, high-quality services that patients deserve. It’s simpler than you might think.
NPs are healthcare leaders. They have the clinical background, training, and expertise to take on leadership roles within the healthcare system, lead interprofessional care teams, and contribute to the province’s development of practical, patient-centered policies. In addition to primary care, they provide specialty services across all sectors. There must be a shift in focus from only viewing NPs as clinicians to recognizing them as the leaders they are, leveraging their skills to drive system and organizational improvements and positive patient outcomes.
NPs are healthcare leaders. By implementing flexible funding models to include NPs in public health plans, as directed in the latest Canada Health Act interpretation letter, the next provincial government can empower and enable NPs to get care
to communities in need. NPs must be at the table during all these discussions and negotiations. As leaders in healthcare, their voices, perspectives, and expertise carry heavy weight in helping decision-makers shape policies that address gaps in care, improve access, and promote better health outcomes.
NURSE
PRACTITIONERS (NPS) CAN CLOSE THE CRITICAL GAP IN HEALTHCARE AND DELIVER THE TIMELY, HIGH-QUALITY SERVICES THAT PATIENTS DESERVE.
NPAO is committed to working with the next provincial government to advance the needs of NPs and connect patients across the province with the timely, high-quality care they deserve. As NPs working for NPs, we strive to deliver exceptional healthcare for all, grounded in the evidence that NPs make critical contributions to our healthcare system and Ontarians’ quality of life.
ment and Intervention Networks), and pioneering the most responsible provider (MRP) impacts of a NP-led model of inpatient hospital care as well as NP primary care models in corrections. Michelle is recognized as a credible clinician and thought leader and for her leadership, mentorship, teaching, and scholarship locally to globally.
NP Acorn remains at the forefront of the advocacy for Ontario’s NPs. At a time of a healthcare crisis in Ontario, NP Acorn and NPAO continue to spearhead the promotion of NPs as healthcare leaders and advocate for innovative flexible funding models to empower the NP practice. She works with all entities of the provincial government to shape policies that address gaps in care, improve access, and promote better health outcomes for Ontarians.
Improving
Province-Wide
Patient
Care? We Need More MLTs
Ontario’s shortage of medical laboratory professionals weighs heavily on the health care system — a problem that’s only going to get worse.
Katherine Cappellaccil
They represent the fourth-largest health care profession after doctors, nurses, and pharmacists, but often go unnoticed by the public. Perhaps this is because their role isn’t as patient-facing as the others — but their unseen work touches the lives of almost every person who has ever utilized Ontario’s health care system.
WE'RE ASKING FOR IMMEDIATE INVESTMENTS IN CLINICAL PLACEMENTS WHICH WILL ALLOW MORE LABS TO TRAIN STUDENTS ACROSS THE ENTIRE PROVINCE. WE ALSO URGE THE GOVERNMENT TO EXPAND THE ONTARIO LEARN AND STAY GRANT TO ALL MLT PROGRAMS.
Medical laboratory technologists (MLTs) play a critical role, along with assistants/technicians, in performing over 280 million tests annually. 1 Working in hospital, community, and public health labs, it's their job to conduct diagnostic tests on bodily specimens to help confirm and treat diseases.
MLTs help patients in all phases of life — 70 per cent of medical decisions are based on lab results. 2 Thus, the industry’s ongoing staff shortages impact all corners of the health network, and these issues are projected to intensify.
Behind the decline
Several factors contribute to the sector’s shrinking workforce. About 39 per cent of MLTs will be eligible to retire within the next four years. 3 Plus, the COVID-19 pandemic, which added an insurmountable workload to the already-overburdened industry, forced many into early retirement.
“The other issue is that we haven’t seen any new MLT educational programs over the last 25 years or so, despite the province’s rapid population growth,” explains Michelle Hoad, CEO of the Medical Laboratory Professionals’ Association of Ontario (MLPAO). “Long before the pandemic, we were raising concerns about this, but COVID-19 really brought the industry’s shortages into focus.”
Since then, more educational programs have opened. But the benefits are delayed, since it takes three to four years to graduate as a medical laboratory technologist (MLT). And, not enough labs can take students for clinical placements — the MLPAO reported that 61 per cent of responding lab leaders don’t have enough resources to do so.4
Responding to obstacles
The MLT shortage has a profoundly negative impact on Ontario’s health care system. Patients face increased wait times and hindrances to test results and care. With many employees heading for retirement, these issues will only worsen.
“Delayed results are affecting patient outcomes across the board, from emergency care to cancer diagnoses,” says Hoad. “Sixty-seven per cent of labs report that MLT shortages affect test turnaround times, and 44 per cent of pathology labs cannot meet Cancer Care Ontario report times.”5
The MLPAO represents and advocates for the interests of MLTs across the province. It works to underscore the pivotal role MLTs play within the health care system and to push for equal prioritization in funding and support. “We're asking for immediate investments in clinical placements which will allow more labs to train students across the entire province. We also urge the government to expand the Ontario Learn and Stay Grant to all MLT programs.”
Supporting rural students
Currently available for only two MLT programs, the Learn and Stay Grant gives students the chance to attend school at no cost. “If the grant was implemented at St. Lawrence College in Kingston, Ont., it would provide more educational opportunities for students from rural communities,
where our staffing challenges are most acute,” says Jeffrey Dale, CEO of the Eastern Ontario Regional Laboratory Association.
St. Lawrence College’s Dean of Health, Wellness and Community Services, Barb LeBlanc confirms that the student demand for MLT courses has remained consistently high for decades. “Giving us the grant would be worthwhile for the government because these programs directly respond to our region’s labour market needs,” she says.
Care in Northwestern Ontario is especially affected. “Funding for placements and the expansion of the grant will place all our labs in a much better position to support student education and solve human resource pressures,” says Jennifer Sanna-White, Manager of Laboratory Services at Red Lake Margaret Cochenour Memorial Hospital.
Solutions for everyone’s sake
Unfilled MLT positions represent 74 per cent of total openings in rural areas and 82 per cent of openings in remote areas.6 To ensure that patients receive the best care across Ontario, province-wide support is needed to improve the worker shortage. “Patients in the north need to be a focus,” adds Sanna-White. “We need funding to address this issue now.”
Without urgent action, the health care system will continue to struggle to meet patient needs. Addressing the shortage of MLTs must be a top priority for Ontario’s government.
1. “The Medical Laboratory Professionals’ Association of Ontario Welcomes Record Investments for Ontario Medical Labs in Budget 2024.” MLPAO 2025, March 26, 2025. https://www.mlpao.org/news-2/the-medical-laboratoryprofessionals%E2%80%99-association-of-ontariowelcomes-record-investments-for-ontario-medical-labs-inbudget-2024?lang=fr.
2.“About Medical Professionals Laboratory Week.” Centers for Disease Control and Prevention, April 16, 2019. https://www.cdc.gov/lab-week/about-archive. html#:~:text=Today%2C%20medical%20professionals%20 continue%20to,diagnosis%20and%20treatment%20of%20 diseases.
3.“College of Medical Laboratory Technologists of Ontario 2023 Annual Report.” Toronto: College of Medical Laboratory Technologists of Ontario, June 4, 2024. https://www.cmlto. com/wp-content/uploads/2024/06/2023-CMLTO-AnnualReport.pdf.
4.“Lab Employer Survey - Clinical Placements.” Ontario: Medical Laboratory Professionals’ Association of Ontario, November 2024. https://25a97c6d-47fb474b-a64c-d3ec079ca668.usrfiles.com/ugd/054d07_ aaeda90d68d749e9a01127ef6731f58f.pdf.
5. “Report: Patient Care Impacted by Delay in Laboratory Testing.” Ontario: Medical Laboratory Professionals’ Association of Ontario, January 2024. https://25a97c6d47fb-474b-a64c-d3ec079ca668.usrfiles.com/ ugd/86fd4b_69b86a0ef45e4bce829c7ab70116cd2b.pdf.
6. “Supplemental Report: Shortage of Lab Professionals Continues Post-Pandemic (July 2023)”. Ontario: Medical Laboratory Professionals’ Association of Ontario, July 2023. https://25a97c6d-47fb-474b-a64c-d3ec079ca668.usrfiles. com/ugd/86fd4b_49664db22eef45a19cb44a07ec1a491b.
Jeffrey Dale CEO, Eastern Ontario Regional Laboratory Association
Barb LeBlanc Dean, Health, Wellness & Community Services, St. Lawrence College
Michelle Hoad
Jennifer Sanna-White Manager of Laboratory Services, Red Lake Margaret Cochenour Memorial Hospital
2025: Canada Still Only Developed Country with No Rare Disease Plan
To truly help rare disease patients, Canada must turn promises into action and funding.
Durhane Wong-Rieger, PhD
& CEO, Canadian Organization for Rare Disorders
In 2015, the Canadian Organization for Rare Disorders (CORD) presented to the federal government a National Rare Disease Strategy. In March 2023, the federal government announced $1.5 billion over three years for a Rare Disease Drug Strategy, with $1.4 billion in provincial/territorial bilateral agreements. According to the terms, provinces need cover only one drug from a “common list” of 12 drugs in the first two years, and by year three, assume only 10 per cent of the funding for drugs on the common list, with federal funds covering the remaining 90 per cent. However, monies saved
from provincial drug budgets need not be redirected to other rare disease services. The impact? The $1.4 billion will result in almost no net sustainable benefit for persons living with rare disease, unless governments take a different course of action now.
Healthcare professionals are planning to coordinate care and research under the new Canadian Rare Disease Network; the patient community, with leadership from CORD, is engaged in all areas from research and clinical trials to registries and evidence development; and advances in genetics, digital technology, and new therapeutics are creating unprecedented opportunities
for rare disease diagnosis, treatment, and prevention.
The time is now for Canada to catch up with and surpass the rest of the world with national, provincial, and local programs for rare disorders. As we head into another election, we recognize that 2025 is not just like 2015 for rare disorders. Indeed, it will be much worse if we squander the $1.4 billion and do not invest financial and human capital in coordinated, sustainable, comprehensive rare disease plans focused on improving the lives of Canadians.
Chronic disease can be managed with treatments, but they remain out of reach for many. To learn more, visit
Rare Blood Disorder Community at a Loss for Accessing New Treatments
DiRaimo, MS, CCGC Director of Research & Canadian Advocacy, Platelet Disorder Support Association (PDSA)
In a world where emergency rooms are bursting, families are often without access to primary care, and healthcare services are at a premium, one would think that governments and insurers would do everything they could to avoid hospitalizations and unnecessary doctor visits.
For many patients in Canada’s immune thrombocytopenia (ITP) community, that’s not the case.
A rare but serious blood disorder
ITP is a rare, autoimmune platelet disorder that causes a low platelet count in the blood. Since platelets are important in the body to help stop bleeding, a low platelet count results in an increased propensity to bleed internally, even spontaneously. ITP is a potentially life-threatening disorder. Symptoms can vary – from minor symptoms like easy bruising to more critical symptoms like internal bleeding, including in the brain. For some, ITP is not chronic or life threatening; for others, it can be a chronic disorder that individuals live with for their entire lives.
Jennifer DiRaimo, MS, CCGC is the Director of Research and Canadian Advocacy at the Platelet Disorder Support Association (PDSA). She understands first-hand the nature and potentially devastating consequences of ITP – she lost her 10-year-old son to complications from ITP in 2018.
Challenges in the ITP care pathway
“ITP can take shape in many forms. For some, it can be easily treated and relatively minor; for others, it can be serious and potentially devastating. As a disorder that can be wide-ranging, it is important to have care that can address that wide range of cases as well.”
The care pathway for Canadian ITP patients is long, consulted, and restrictive - especially for chronic patients. Patients are typically treated first with corticosteroids and plasma-derived therapies like intravenous immunoglobulin (IVIG), which have issues with both long-term efficacy and, in the case of IVIG, sustainability of supply issues. It’s also very expensive, requiring frequent use due to its short-acting nature.
Following that treatment, most provinces consider splenectomy – a significant procedure that involves the removal of the spleen. This procedure, while effective for some, has serious, sometimes life-limiting, drawbacks: it is irreversible, not guaranteed to resolve ITP, and confers a lifelong risk of serious infection often requiring treatment.
“We’ve been advocating for some time to streamline the care pathways for ITP. The one element that stands out in discussions with patients and clinicians is the potential inclusion of splenectomy as a second-line treatment”, DiRaimo noted. “In a time where we hear about healthcare shortages and surgical backlogs, why wouldn’t we look to other alternatives if they are available to us that are more or just as effective, and less burdensome on both the patient and the healthcare industry?”
The need for innovative therapies Those alternatives do exist. Within the last decade, several new, innovative therapies have come to light for the treatment of ITP, including a new class of treatments called thrombopoietin receptor agonists (TPO-RAs.) These therapies are proven to effectively treat ITP in chronic patients and provide treatment with significantly less risk and side effects than surgery or conventional therapies.
TPO-RAs are used across the world. Their use in ITP treatment is supported by the Canadian Hematology Society and is recommended in both Canadian and international medical guidelines for the treatment of ITP – but remain out of reach for many Canadian patients.
Barriers ITP patients face In recent years, drug reviews from Canada’s Drug Agency for TPO-RAs have largely prevented patients from being able to easily and equitably access these treatments under provincial drug programs. While these reviews highlight the potential role for TPO-RAs, they also flag some uncertainty due to a lack of robust evidence – which is difficult to collect in a rare disease – which has been enough for provinces to shut the door on providing access for most eligible patients.
“It’s frustrating for many in the ITP community in Canada. Patients dependent on public drug plans are being prevented the opportunity to utilize medicines that have been around for a while, are available in other places like the US and the UK, leaving them with limited treatment routes”, said DiRaimo. “Our fear is that the gap in care is growing, and our community will continue to face unnecessary hardships in accessing the care they need.”
Advocating for a better future DiRaimo isn’t giving up. Under her watch, PDSA continues to advocate to provincial governments across Canada about better access to care for ITP patients. “We have such an active and supportive community of ITP patients, families, and clinicians across the country, and they’re ready to have their voice heard.”
Durhane Wong-Rieger, PhD President
Jennifer
PATIENT CHOICE A TOP PRIORITY: Why Pharmacare Must Put Canadians First
Canada needs a pharmacare solution that expands access without limiting choice or disrupting care for those who rely on critical medications.
Dr. Bettina Hamelin, President, Innovative Medicines Canada
Kathy is a new mother whose child relies on a specific type of insulin to control her type 1 diabetes. However, under the proposed federal pharmacare program, she would lose access to this insulin product and be forced to switch to one covered by the new program. Life as a new mother is stressful enough without the added burden of switching her child’s life-saving medication.
Canadians deserve a healthcare system that ensures timely, reliable, and equitable access to the medicines they need, not one that limits choice or disrupts their existing care.
Instead of addressing gaps in drug coverage, the federal government is proposing a sweeping restructuring that could leave millions of Canadians worse off than they are now. The proposed pharmacare framework threatens to replace a system that works for most Canadians with a one-size-fits-all approach that limits choice and delays access to innovation.
The risk: fewer options, more barriers
Canada’s dual public-private system ensures that millions of Canadians have access to a broad range of medicines through private insurance, often much faster than public plans. Many private plans also cover a wider selection of medicines than government formularies. However, under a federal government-run model, even widely used treatments could be excluded due to cost-containment priorities. This shift could leave patients who rely on employer-sponsored plans without access to the medications they depend on. Doctors and patients may no longer have the flexibility to choose treatments based on individual medical needs. Instead, decisions
about which drugs are covered could be determined by federal government administrators, prioritizing cost savings over patient care.
For those managing chronic illnesses, rare diseases, or complex conditions, losing access to the right medication could be life-altering. No two patients are alike, and not all medicines work the same for everyone. Many individuals with conditions such as diabetes, autoimmune disorders, or mental health illnesses undergo a lengthy process of trial and error before finding an effective treatment. If a government-run plan excludes the medication that works best for them, patients may be forced to switch to a less effective alternative — or, in some cases, go without treatment altogether.
businesses. And rising costs, from housing to groceries, have become a central concern for families across the country. Introducing major, structural changes to drug coverage in this environment risks creating even more uncertainty.
Countries that have adopted centralized, government-run drug plans, such as the United Kingdom and Australia, have experienced slower access to new medicines compared to Canada. Rather than following this path, Canada should focus on a pragmatic, patient-focused strategy that strengthens the system without dismantling what works.
A smarter approach: expanding access without restricting choice
NO TWO PATIENTS ARE ALIKE, AND NOT ALL MEDICINES WORK THE SAME FOR EVERYONE.
The bigger picture: uncertainty at home and abroad
The proposed changes to Canada’s drug coverage system come at a time of widespread uncertainty. Canadians are already struggling with a growing primary care crisis, where millions lack access to a family doctor.
The economic instability, driven by global trade tensions — including new tariff threats from the U.S. — has increased pressure on households and
A smarter approach would ensure that every Canadian has access to the medicines they depend on without forcing millions onto a plan that may not meet their needs. Addressing gaps in coverage must be done in a way that accelerates access to new treatments, reduces administrative barriers, and protects patient choice.
Despite the significant impact these proposed changes could have on patients, the federal government has engaged in minimal consultation with the provinces, healthcare professionals, or industry leaders. These are the very stakeholders who will be responsible for making pharmacare work, yet they haven’t been given a real seat at the table.
There’s no need to dismantle a system that works for most Canadians to help those who need additional support. Rather than imposing a costly, one-size-fits-all model, the government should work with provinces, healthcare experts, and industry stakeholders to strengthen existing programs, enhance access, and protect patient choice.
Dr. Bettina Hamelin President, Innovative Medicines Canada