What Carney’s Davos speech teaches us about fixing healthcare

In Davos, Prime Minister Mark Carney spoke about the power of naming reality. He described how systems persist not through force, but because everyone participates in assumptions they’ve never questioned. The breakthrough comes when someone finally says what everyone has sensed but not spoken: this isn’t working.

He was talking about global trade. But he could have been talking about Canadian healthcare.

I am a family physician. For decades, we built primary care around a simple premise: the family doctor would be there for everything. Cradle to grave. All things to all patients. It was a noble vision, and family physicians rose to meet it – skilled generalists who could diagnose the undifferentiated complaint, manage chronic disease, provide palliative care, handle mental health crises.

But the premise asked the impossible. No single professional – however skilled – can meet the comprehensive needs of a modern patient population alone.

It never feels enough. Family doctors are asked to take on more while burning out. We retire early, leave practice – or stay and feel helpless. The 5.9 million Canadians who can’t find a family doctor are living the consequence of a system designed around one profession’s capacity.

Here is the truth we are now discovering: working together is more powerful than working alone.

When nurses, pharmacists, social workers and family physicians share care as genuine teams, patients get better access and providers experience less burnout. The impossible becomes possible – not because anyone works harder, but because the work is done differently.

We have known this intellectually for years. The Romanow Commission said it in 2002: “If health care providers are expected to work together, their education and training should prepare them for this type of working arrangement.”

But knowing and seeing are different things. Our systems have not been aligned to this vision.

We train family physicians as independent generalists – capable of working alone, because we assume they have to. We train nurses, pharmacists and social workers in hospitals and specialty settings – not in the community-based primary care contexts where teams actually form. And we train each profession separately, in silos, then expect seamless collaboration the moment they enter practice together.

We set up the policies, the funding and infrastructure in the same way. You cannot build what you cannot see together.

At Davos, Carney argued that “middle powers” must stop acting alone and start combining their strengths. The same insight applies to healthcare. Nurses, pharmacists, social workers and other health professionals have enormous capacity to transform primary care – if we prepared them for it, resourced them for it and included them at the tables where decisions get made.

Right now, they remain underleveraged. Not because anyone intended this, but because our systems were built around different assumptions – assumptions we are only now seeing clearly.

“The old order is not coming back,” Carney said. “Nostalgia is not a strategy.”

The family-doctor-does-everything model isn’t coming back either. We cannot train enough physicians fast enough. And even if we could, a system built around one profession will always be fragile – one retirement, one pandemic, one wave of burnout away from crisis.

But we can build something better.

We can train physicians for interdependence rather than heroic independence. We can prepare other professions for primary care. We can create education where future teammates actually learn together before they’re expected to work together.

This isn’t theoretical. A $45-million federal initiative called Team Primary Care brought together more than 100 organizations across 20 health professions to do exactly this — develop training so practitioners learn to work together, not just alongside each other.

At the project’s conclusion we affirmed: you can’t just put people in a room and call them a team. 

Teamwork requires intentional preparation, a shared compass, and a vision of team-based primary care that aligns education, funding, regulation, and practice toward a common destination. Not because anyone was wrong before, but because we can now see what we couldn’t see.

Carney’s speech was a call to name reality so we can act on it. In healthcare, the reality is this: no profession can do it alone, but we’ve built our systems as if one could.

Now that we see it, we can change it.
 

Dr. Ivy Oandasan is a family physician and professor in the Department of Family and Community Medicine at the University of Toronto. She co-developed the D'Amour-Oandasan framework for interprofessional education, which has been adopted internationally.