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Canadian dentists desperate for details on federal dental care plan

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News release from Canada’s Provincial and Territorial Dental Associations

Canadian dentists to MPs: We need answers about the Canadian Dental Care Plan

Lack of consultation with provincial and territorial dental associations is worrying

There are only two months left before the Canadian Dental Care Plan (CDCP) becomes available to many more Canadians. Yet more than 25,000 dentists nationwide are in the dark about how the Government of Canada will safeguard access to dental care.

In a letter sent to Members of Parliament (MPs) this week, the presidents of provincial and territorial dental associations across the country asked how the government will:

  • Safeguard employer-provided dental plans that two-thirds of Canadians currently have access to?
  • Ensure that a strong federal program can be coordinated with existing provincial programs?
  • Protect patient choice and maintain the patient-provider relationship?
  • Ensure minimal, efficient administration that promotes timely access to care?
  • Respect the costs of delivering dental care to maximize provider participation?
  • Increase the number of dental assistants and dental hygienists to meet the demands of the CDCP?

Dentists want to champion a CDCP that will respect patients, providers, and taxpayers. The provincial and territorial dental associations are concerned that the CDCP has been compromised by a lack of meaningful consultation with dentists – who will be expected to deliver on the government’s promises.

The CDCP is currently in final planning stages, with a potential rollout in 2024 that will attempt to increase access to uninsured Canadians under 18, people with disabilities, and seniors who have an annual family income of less than $90,000. Dentists believe all Canadians need access to dental care. If not done properly, two-thirds of Canadians who have great employer-provided dental plans could lose their coverage and be forced into a worse plan. Costs would then skyrocket, which means the $13 billion over five years the government set aside would not be enough to sustain the plan.

Let’s take the time to get it right. We can increase access to dental care right now through an expansion of the interim measure already in place – the Canada Dental Benefit. This establishes a fixed dollar amount that a patient can use to be reimbursed for dental-related expenses.

Facts:

  • Canada’s provincial and territorial dental associations represent more than 25,000 licensed dentists working in more than 16,000 offices. They treat more than 30 million Canadians every year and employ at least 50,0001 oral health care workers.
  • Over 60 per cent of Canadians have a dentist they visit on a regular basis.2
  • A recent survey commissioned by Health Canada found that nearly nine out 10 Canadians are satisfied with the Canada Dental Benefit.3

Quotes:

“To succeed, this plan needs to work for both patients and providers, and to work in each province. What we are recommending is based on decades of experience and caring for the oral health needs of the more than 30 million people that come into our dental offices across the country every year.” — Dr. Bruce Yaholnitsky, President, Alberta Dental Association

“Poorly designed programs do not improve access to care, and they leave the most vulnerable people in society behind. This is an historic opportunity, but only if the government gets it right. Dentists have the expertise, experience, and skills to know what it takes to ensure good oral and overall health.” — Dr. Rob Wolanski, President, British Columbia Dental Association

“As dentists we are excited to be a part of this Canadian dental care program, but there are key critical issues that need to be included for this program to be successful.” — Dr. Scott Leckie, President, Manitoba Dental Association

“New Brunswick dentists are already extremely busy with the recent spike in population and the backlog in demand for services related to Covid-19. This program was intended to provide dental care to the 35 per cent of Canadians who are uninsured. It needs to be easy to understand and to administer, and to be fair to all parties, including patients, dental care providers and taxpayers. Canadians need to know what benefits are being provided and which are not, before they arrive at the dental clinic.” — Dr. Joanah Campbell, President, New Brunswick Dental Society

“The new program must be sustainable in terms of funding, and easy to understand and access. It has to be patient-centred and work for everyone.” — Dr. Shane Roberts, President, Newfoundland & Labrador Dental Association

“While the CDCP has the potential to improve the lives of many Canadians, this can only be achieved if it’s done right. To ensure the greatest possible outcome, we must consider all of the moving pieces and take a patient-centred approach.” — Dr. Juli Waterbury, President, Nova Scotia Dental Association

“The CDCP could be a game-changer for Canadians’ access to dental care. But we have one chance to get it right. Here in Ontario, we have seen that dental care programs developed without the input of dentists are doomed to fail. Just look at the Ontario Seniors Dental Care Program, where waiting lists are up to two years long in some areas, and some patients have to travel ridiculously long distances to receive treatment.” — Dr. Brock Nicolucci, President, Ontario Dental Association

“This new program has the potential to improve access to care for many Canadians. It must be sustainable, patient-centred, and easy to access for patients. A poorly designed program will not improve access to care which is something we would like to avoid. We want this to work for Canadians.” — Dr. Derek Thiessen, President, College of Dental Surgeons of Saskatchewan

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Alberta

Early Success: 33 Nurse Practitioners already working independently across Alberta

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Nurse practitioners expand primary care access

The Alberta government’s Nurse Practitioner Primary Care program is showing early signs of success, with 33 nurse practitioners already practising independently in communities across the province.

Alberta’s government is committed to strengthening Alberta’s primary health care system, recognizing that innovative approaches are essential to improving access. To further this commitment, the Nurse Practitioner Primary Care Program was launched in April, allowing nurse practitioners to practise comprehensive patient care autonomously, either by operating their own practices or working independently within existing primary care settings.

Since being announced, the program has garnered a promising response. A total of 67 applications have been submitted, with 56 approved. Of those, 33 nurse practitioners are now practising autonomously in communities throughout Alberta, including in rural locations such as Beaverlodge, Coaldale, Cold Lake, Consort, Morley, Picture Butte, Three Hills, Two Hills, Vegreville and Vermilion.

“I am thrilled about the interest in this program, as nurse practitioners are a key part of the solution to provide Albertans with greater access to the primary health care services they need.”

Adriana LaGrange, Minister of Health

To participate in the program, nurse practitioners are required to commit to providing a set number of hours of medically necessary primary care services, maintain a panel size of at least 900 patients, offer after-hours access on weekends, evenings or holidays, and accept walk-in appointments until a panel size reaches 900 patients.

With 33 nurse practitioners practising independently, about 30,000 more Albertans will have access to the primary health care they need. Once the remaining 23 approved applicants begin practising, primary health care access will expand to almost 21,000 more Albertans.

“Enabling nurse practitioners to practise independently is great news for rural Alberta. This is one more way our government is ensuring communities will have access to the care they need, closer to home.”

Martin Long, parliamentary secretary for rural health

“Nurse practitioners are highly skilled health care professionals and an invaluable part of our health care system. The Nurse Practitioner Primary Care Program is the right step to ensuring all Albertans can receive care where and when they need it.”

Chelsae Petrovic, parliamentary secretary for health workforce engagement

“The NPAA wishes to thank the Alberta government for recognizing the vital role NPs play in the health care system. Nurse practitioners have long advocated to operate their own practices and are ready to meet the growing health care needs of Albertans. This initiative will ensure that more people receive the timely and comprehensive care they deserve.”

Jennifer Mador, president, Nurse Practitioner Association of Alberta

The Nurse Practitioner Primary Care program not only expands access to primary care services across the province but also enables nurse practitioners to practise to their full scope, providing another vital access point for Albertans to receive timely, high-quality care when and where they need it most.

Quick facts

  • Through the Nurse Practitioner Primary Care Program, nurse practitioners receive about 80 per cent of the compensation that fee-for-service family physicians earn for providing comprehensive primary care.
    • Compensation for nurse practitioners is determined based on panel size (the number of patients under their care) and the number of patient care hours provided.
  • Nurse practitioners have completed graduate studies and are regulated by the College of Registered Nurses of Alberta.
  • For the second consecutive year, a record number of registrants renewed their permits with the College of Registered Nurses of Alberta (CRNA) to continue practising nursing in Alberta.
    • There were more than 44,798 registrants and a 15 per cent increase in nurse practitioners.
  • Data from the Nurse Practitioner Primary Care Program show:
    • Nine applicants plan to work on First Nations reserves or Metis Settlements.
    • Parts of the province where nurse practitioners are practising: Calgary (12), Edmonton (five), central (six), north (three) and south (seven).
  • Participating nurse practitioners who practise in eligible communities for the Rural, Remote and Northern Program will be provided funding as an incentive to practise in rural or remote areas.
  • Participating nurse practitioners are also eligible for the Panel Management Support Program, which helps offset costs for physicians and nurse practitioners to provide comprehensive care as their patient panels grow.

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Addictions

BC Addictions Expert Questions Ties Between Safer Supply Advocates and For-Profit Companies

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By Liam Hunt

Canada’s safer supply programs are “selling people down the river,” says a leading medical expert in British Columbia. Dr. Julian Somers, director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University, says that despite the thin evidence in support of these experimental programs, the BC government has aggressively expanded them—and retaliated against dissenting researchers.

Somers also, controversially, raises questions about doctors and former health officials who appear to have gravitated toward businesses involved in these programs. He notes that these connections warrant closer scrutiny to ensure public policies remain free from undue industry influence.

Safer supply programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from accessing riskier street substances. Yet, a growing number of doctors say these programs are deeply misguided—and widely defrauded.

Ultimately, Somers argues, safer supply is exacerbating the country’s addiction crisis.

Somers opposed safer supply at its inception and openly criticized its nationwide expansion in 2020. He believes these programs perpetuate drug use and societal disconnection and fail to encourage users to make the mental and social changes needed to beat addiction. Worse yet, the safer supply movement seems rife with double standards that devalue the lives of poorer drug users. While working professionals are provided generous supports that prioritize recovery, disadvantaged Canadians are given “ineffective yet profitable” interventions, such as safer supply, that “convey no expectation that stopping substance use or overcoming addiction is a desirable or important goal.”

To better understand addiction, Somers created the Inter-Ministry Evaluation Database (IMED) in 2004, which, for the first time in BC’s history, connected disparate information—i.e. hospitalizations, incarceration rates—about vulnerable populations.

Throughout its existence, health experts used IMED’s data to create dozens of research projects and papers. It allowed Somers to conduct a multi-million-dollar randomized control trial (the “Vancouver at Home” study) that showed that scattering vulnerable people into regular apartments throughout the city, rather than warehousing them in a few buildings, leads to better outcomes at no additional cost.

In early 2021, Somers presented recommendations drawn from his analysis of the IMED to several leading officials in the B.C. government. He says that these officials gave a frosty reception to his ideas, which prioritized employment, rehabilitation, and social integration over easy access to drugs. Shortly afterwards, the government ordered him to immediately and permanently delete the IMED’s ministerial data.

Somers describes the order as a “devastating act of retaliation” and says that losing access to the IMED effectively ended his career as a researcher. “My lab can no longer do the research we were doing,” he noted, adding that public funding now goes exclusively toward projects sympathetic to safer supply. The B.C. government has since denied that its order was politically motivated.

In early 2022, the government of Alberta commissioned a team of researchers, led by Somers, to investigate the evidence base behind safer supply. They found that there was no empirical proof that the experiment works, and that harm reduction researchers often advocated for safer supply within their studies even if their data did not support such recommendations.

Somers says that, after these findings were published, his team was subjected to a smear campaign that was partially organized by the British Columbia Centre on Substance Use (BCCSU), a powerful pro-safer supply research organization with close ties to the B.C. government. The BCCSU has been instrumental in the expansion of safer supply and has produced studies and protocols in support of it, sometimes at the behest of the provincial government.

Somers is also concerned about the connections between some of safer supply’s key proponents and for-profit drug companies.

He notes that the BCCSU’s founding executive director, Dr. Evan Wood, became Chief Medical Officer at Numinus Wellness, a publicly traded psychedelic company, in 2020. Similarly, Dr. Perry Kendall, who also served as a BCCSU executive director, went on to found Fair Price Pharma, a now-defunct for-profit company that specializes in providing pharmaceutical heroin to high-risk drug users, the following year.

While these connections are not necessarily unethical, they do raise important questions about whether there is enough industry regulation to minimize potential conflicts of interest, whether they be real or perceived.

The BCCSU was also recently criticized in an editorial by Canadian Affairs, which noted that the organization had received funding from companies such as Shoppers Drug Mart and Tilray (a cannabis company). The editorial argued that influential addiction research organizations should not receive drug industry funding and reported that Alberta founded its own counterpart to the BCCSU in August, known as the Canadian Centre of Recovery Excellence, which is legally prohibited from accepting such sponsorships.

Already, private interests are betting on the likely expansion of safer supply programs. For instance, Safe Supply Streaming Co., a publicly traded venture capital firm, has advertised to potential investors that B.C.’s safer supply system could create a multi-billion-dollar annual market.

Somers believes that Canada needs more transparency regarding how for-profit companies may be directly or indirectly influencing policy makers: “We need to know exactly, to the dollar, how much of [harm reduction researchers’] operating budget is flowing from industry sources.”

Editor’s note: This story is published in syndication with Break The Needle and Western Standard.

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Dr. Julian M. Somers is director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University. He was Director of the UBC Psychology Clinic, and past president of the BC Psychological Association. Liam Hunt is a contributing author to the Centre For Responsible Drug Policy in partnership with the Macdonald-Laurier Institute.

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