New CMA president says he has a plan to change Canada’s ‘faceless’ health-care system

At a ceremony in August, Dr. Alika Lafontaine was formally introduced as the new president of the Canadian Medical Association (CMA) — the first Indigenous leader in the top job.

It was not a typical gathering of physicians in Canada, and not only because there were Indigenous elders there, giving prayers and songs of blessing.

The ceremony, held in a large conference room in a Toronto hotel, positioned the chairs of those in attendance in a large circle, facing one another. One by one, different people stood to speak, all except for the guest of honour, an anesthesiologist from Grande Prairie, Alta., who remained seated when it was his turn to talk.

“I asked if it was OK for me to sit,” Lafontaine began, with a playful tone in his voice. “Because there’s an old anesthesia saying: ‘Never stand when you can sit, and never sit down when you can lie down.’”

When the laughter from the crowd died down, Lafontaine continued.

“In a circle, it strips away who you are and you can just see each other. And I’ve always, to a great degree, felt uncomfortable standing up behind podiums or away from people, because at the end of the day, I’m not any different than you, I’m just at a different stage in my life with different opportunities,” he said.

Lafontaine has approached his 20 years in medicine with this mindset. He’s affable and quick to put others at ease with a laugh or smile, as he did on a recent trip to Royal Columbian Hospital in New Westminster, B.C., where he met his colleagues in anesthesia and sat down for an interview with Global News’ current affairs program The New Reality.

That approachability might come in handy in his second job, too.

Lafontaine’s term as president of the CMA comes at a time when health care is collapsing and crises are overlapping. Many Canadians are struggling to find a family doctor, the wait time for treatment can be lengthy, and emergency departments are often short-staffed and overloaded with people needing care — if they’re open at all.

Lafontaine has ideas on how to put Canadian health care on a better path forward. His goals centre around bringing back a sense of connection between patients and care providers.

As the health-care system continues to struggle under the weight of staffing shortages and when there’s no relief in sight for care providers, Canadians are facing a system that’s been under stress since long before the COVID-19 pandemic.

“In any crisis, there’s the pause that comes after, where people get the chance to take a deep breath and start to think about, you know, how do I process what just happened? I don’t think we’ve had that breath yet,” Lafontaine said.

He’s heard from colleagues who are scaling back the amount of time they work or are leaving medicine entirely because of the stress they’re experiencing day to day. A recent study found that the mental health of doctors and nurses is worse now than it’s ever been, and more than half of health-care professionals in the country are experiencing severe burnout.

For Lafontaine, the scariest part about what’s happening is that people have lost hope. He said the need to address the declining state of mental health for providers is urgent but so is including Canadians in the conversation about the current issues in health care.

“We often talk about the experience of patient care in isolation of the patients who actually experience it,” he said.

“One of the most amazing things for me to witness was how a generation of Canadians became armchair epidemiologists. If we can include Canadians in this conversation, where they start to understand health care in a way that they didn’t before, I think we’ll move that conversation in the direction it needs to go.”

The CMA is the nation’s largest advocacy group for doctors. Each year a new president is chosen, rotating alphabetically among the provinces and territories.

“I sit here now as the head of an association that’s been around for more than 155 years. You know, there are more than 92,000 physicians across this country. And we all share a belief that we can make a difference in people’s lives,” Lafontaine said.

But this election win was historic, with Lafontaine becoming the first Indigenous president of the CMA, paving the way for Indigenous doctors of the future.

“I’ve had the opportunity to stand on the shoulders of a lot of amazing people and I have to be ready to have people stand on my shoulders,” he said.

“I’m not going to be able to solve these problems by myself. If you look at leadership as a process, where it’s not about your voice, but amplifying the voices of people who are actually creating change, that weight doesn’t feel as heavy.”

Throughout his career, Lafontaine has helped patients navigate the health-care system and advocate for their care. In this new role, he wants to ensure people in leadership positions see the barriers to care that so many Canadians experience, including the way racialized people are disproportionately impacted. And because he’s dealt with it first hand, he knows racism is a deeply systemic issue.

“The experience of racism is real, I’ve experienced it myself.”

“I have family members who’ve experienced it,” said Lafontaine, who also receives stories of racism weekly from patients across the country.

“We have this history in Canada where we’ve been taught to look at Indigenous people in certain ways and we’ve internalized that within the health-care system. You know, organizations like the Canadian Medical Association that have been around for 155 years, they’re on their own path towards reconciliation. And we have a lot of people who are acting as allies, trying to create spaces for these conversations.”

Walking to the path toward inclusion, Lafontaine said racism is now spoken about openly instead of using code words or language that could diminish someone’s experience. However, Lafontaine believes that once systemic racism is treated like the crisis it is, the health-care collective can work toward solutions centred around those lived experiences.

“I know what it feels like to not be included, to have your voice silenced and pushed out, not seen like you’re a part of this wonderful experience of being in a country like Canada. And I think because of that, I really have a strong drive to make sure that people don’t experience those same feelings, because I know how painful that can be,” he said.

To begin moving forward, Lafontaine believes it’s important for people to understand why old methods won’t fix the issues and while the health-care system is collapsing, it doesn’t directly impact many people until they need care.

“When you actually are in the health system, people are waiting, you know, 10, 20 hours to get into an emergency room. Or when someone puts an advertisement into a newspaper hoping that they can connect with the family doctor, you can’t help but acknowledge that we are at a very, very different place than we’ve ever been in health care,” he said.

Designing care around the connection between patients and providers is what Lafontaine said will give Canada a hope of making its way through this stressful time. Over the years, he said, decisions made by provincial and territorial systems have weakened that link, and haven’t allowed for the time and space to connect with one another.

“I think the average Canadian sometimes looks at leadership in medicine as very disconnected with what they’re going through and it’s true, in a lot of ways, that when you come into the system, you feel faceless,” Lafontaine said.

“It’s really important to me to communicate to people that, you know, I see them.”

Looking ahead, Lafontaine sees two clear things that could help immediately. The first is to break down the silos between provinces and territories, to share information, people and resources in a more collaborative way. The second he said, is to move toward true team-based care.

“I think sometimes people think about team-based care as how do you switch out the person who costs the most in the team with the person who costs the least. But in reality, it’s making sure that we all start to work together,” Lafontaine said.

“Physicians have a role, nurses have a role, pharmacists and other members of the health-care team have a role. And it’s respecting that we’re all trained differently and we all do different things well.”

The 40-year-old Lafontaine is a husband and father to four children, who were excited when he was named to his role as president of the CMA. And while it requires more travel and time away from home, he said the support and connection he has with his family has never been stronger.

Lafontaine understands the importance of a strong family bond. From the age of seven, he and his four siblings toured the country and performed on television as The 5th Generation, a pop music group.

Connecting with people is a skill he honed while performing for audiences.

“There are few things that are more powerful than taking someone on a musical journey to explore these feelings that maybe they didn’t want to acknowledge or maybe they had to feel in a different way for the first time.”

In March 2008, under flashing lights and broadcast nationally on GlobalTV, The 5th Generation performed for the audience at what is now called the Indspire Awards, a celebration of Inuit, Métis, and First Nations Peoples who are making a difference in their communities.

Amongst themselves, the Lafontaine’s call their act The Show and while they’ve always been a musical family, The 5th Generation came about because of a tech mishap during a presentation their father, an educator, was giving in 1989.

The bulb went out on the projector being used to show slides to the audience. And while Lafontaine’s father panicked, trying to figure out what to do, the five little kids went up on stage and started singing for the crowd, and they loved it.

“My dad got a call the next week and he thought he was having another booking for a keynote, but they actually just wanted us back just to sing,” Lafontaine said. “That really was the beginning of The Show. It was a two-decade experience where, you know, we started singing in small communities, got to larger conferences and eventually we performed on TV.”

Behind the scenes, the Lafontaine family was supportive of one another’s ambitions outside of music. Dr. Lafontaine said he remembers thinking he’d want to be a physician early on, but it’s different from his memory of when he believed he could make the dream a reality.

His mom is a first-generation immigrant from the South Pacific country of Tonga. His dad is from a small farming community in Saskatchewan, the first to pursue a master’s degree. Together, they raised their children in the Prairie province, trying to create opportunities as the kids got older.

“It was very intimidating for me, coming into medical school without having any medical background on either side of my family. We didn’t have a lot, but my parents really emphasized the importance of education,” Lafontaine said.

Early in medical school at the University of Saskatchewan, Lafontaine nearly walked away from his dream after receiving a test score of 79 per cent. That’s not a bad grade for most students, but it was a low point for the aspiring doctor.

“I remember sitting there after getting that mark just thinking to myself, am I really cut out for this? Is this really something I could do?” he said.

With two decades as an anesthesiologist and now being the lead voice for doctors in Canada, it’s clear Lafontaine was up for the job. The support of his family and mentors along the way empowered him to become a respected member of the medical community — something he doesn’t take lightly.

“One of the things that I’ve always appreciated about being a physician is that you can meet someone that you’ve never met before, they can come from a different part of the world, not speak the same language, and suddenly they start telling you these very intimate personal details about their life, because they expect that you’ll be able to help them,” he said.

“That connection between being a doctor and the patients that we see is really special and sometimes, really sacred. I mean, people bring you into their life and they ask you to help the burdens that they’re carrying.”