“Growth at All Costs” – A Reconsideration in Canadian Health Care

In many sectors, growth is treated as an unquestioned indicator of success - more revenue, more locations, greater market penetration. In health care, however, growth warrants a more disciplined and patient-informed strategy. The outcomes that matter most are not market share or quarterly performance, but trust, continuity, access, and the quality of human relationships at the point of care.

This distinction is particularly important in Canada’s publicly funded health system, where patients are not consumers and governments act as the primary payee on behalf of the public. In this context, value is defined not only by clinical outcomes, but by sustainability, equitable access, and responsible stewardship of finite resources. Any discussion of structure and scale must therefore begin, and remain grounded, in the patient–clinician relationship, which is the foundation upon which access, quality, and cost control ultimately rest.

When Scale Begins to Strain the Care Relationship

In many industries, efficient scaling relies on standardization, centralization, and tightly managed performance metrics. These approaches can be effective where consistency and throughput are the primary objectives.

Health care is fundamentally different.

The patient–clinician relationship is not a by-product of care delivery; it is the core service itself. Patients value continuity, familiarity, and care teams that understand their history and context. Clinicians, in turn, rely on stable relationships, professional autonomy, and local accountability to deliver nuanced, person-centered care.

When growth strategies prioritize expansion without sufficient safeguards, these relationships can weaken. Fragmentation of care teams, increased administrative distance from decision-makers, and standardized operational models can unintentionally erode continuity, therefore increasing downstream costs through duplication, avoidable utilization, and reduced patient trust.

Market-Driven Growth and the Canadian Context

In recent years, Canada has seen increased participation by large, investor-backed organizations in outpatient and ambulatory care. These models emphasize consolidation, integration, and scale, often positioning size as a mechanism to improve efficiency, access, and cost control. They can bring meaningful benefits, including capital investment, infrastructure, and technological capability.

At the same time, this trend raises important questions about alignment with the objectives of a publicly funded system. Governments, as payees, are rightly focused on controlling costs, expanding access, and ensuring system reliability over time. When organizations are primarily accountable to investors, however, strategic priorities may be shaped by growth targets, margin expectations, and expansion timelines that do not always align cleanly with local population needs or long-term system sustainability.

This tension does not imply that larger models are inherently misaligned.  It does however suggest that scale alone is not sufficient proxy for value.

The Case for Decentralized, Community-Anchored Models

Canada’s health system has historically drawn strength from locally rooted care delivery models. When designed well, decentralized and clinician-led structures can advance not only patient and clinician interests, but also the core objectives of the payee.

These models offer several system-level advantages:

Stronger continuity with lower system friction

Stable patient–clinician relationships reduce unnecessary referrals, repeat diagnostics, and avoidable emergency or hospital utilization.  These are key drivers of cost in the publicly funded system.

Decision-making closer to population need

Local governance enables care models to adapt to community demographics, disease burden, and access gaps more efficiently than centralized, one-size-fits-all approaches.

Clinician engagement as a cost and quality lever

Clinicians who retain meaningful influence over care delivery are more likely to adopt evidence-informed practices, manage resources responsibly, and remain within the system which in turn supports workforce stability and access.

Resilience and long-term sustainability

Community-anchored organizations are less exposed to shifts in investor sentiment or capital market cycles, allowing governments to partner with entities focused on long-term service delivery rather than short-term financial performance.

These models do not reject growth. Rather, they support purpose-driven growth, expansion that is paced, intentional, and aligned with capacity, community need, and system affordability.

Re-Centering the Human Dimension of Care

Health care resists simple quantification. What patients remember most is not organizational size or brand presence, but whether they felt known, respected, and supported over time.

Likewise, clinicians deliver their best care in environments where relationships, trust, and professional judgement are protected. Structures that preserve these elements are not inefficient or nostalgic; they are foundational to quality, access, and fiscal sustainability.

A More Thoughtful Path Forward

Growth, investment, and innovation all have a role in modernizing health care delivery. The challenge is ensuring that these forces serve care, rather than reshaping it in ways that undermine its human and relational foundations.

In the Canadian context, models that combine local governance, clinician voice, and community accountability offer a compelling complement, and in some cases an alternative to purely scale-driven approaches. By placing relationships at the center of strategy, health care organizations can advance patient outcomes, clinician sustainability, and government objectives simultaneously.

Author: Barbara Mekinda, Director of Operations, Specialty Medical Partners

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