Every immigrant I know has a version of the same story: they land in Canada, hear healthcare is "free," and spend the next two years figuring out what that actually means. On the latest episode of Real with Ritesh, "Is Healthcare in Canada Really Free? The Truth Newcomers Need to Know," I sat down with Dr. Misbah Akram, a family medicine physician in Calgary with over 25 years of experience across Pakistan, Ireland, the UK, and Canada. She's seen this confusion from both sides - as an immigrant herself, and as the doctor newcomers turn to once they're already lost in the system. We talked about what "free" actually covers, why South Asian immigrants get hit hardest by certain chronic conditions, how trust with a family doctor changes outcomes, and what it takes for a foreign-trained physician like her to practice here. Here's the breakdown, the data behind it, and the full episode.
- 5.9 million people in Canada lacked reliable access to a family doctor as of 2025, and family doctors per 100,000 people fell to 119 in 2024 - a shortage newcomers walk into without knowing it (CMA, 2025; CIHI, 2024)
- Median wait time from GP referral to treatment hit 28.6 weeks in 2025, the second-longest ever recorded, with the GP-to-specialist leg alone averaging 15.3 weeks (Fraser Institute, "Waiting Your Turn," December 2025)
- South Asian immigrants show a 15.9% crude diabetes prevalence versus 11.6% among non-immigrants in Ontario, reaching 26.8% among immigrants from Sri Lanka (Diabetic Medicine, 2018 population study)
- Vitamin D deficiency more than doubles in Canadian winters, from 5% deficient in warmer months to 13% deficient November through March (Statistics Canada, Canadian Health Measures Survey)
- 27% of physicians practicing in Canada trained internationally - 32% in family medicine specifically - and licensing pathways are actively loosening for doctors from several countries (CIHI, 2024; Medical Council of Canada, 2025)
Why "Free" Healthcare Confuses Newcomers Most
Canada's healthcare isn't free - it's prepaid through taxes and incomplete by design, and that gap between the two ideas trips up almost every newcomer Dr. Misbah Akram sees in her Calgary family practice. Unlike the UK's fully public model, Canada covers physician visits and hospital care through provincial health cards, but leaves ambulance rides, physiotherapy, most prescription drugs, and dental care to out-of-pocket payment or private insurance (Real with Ritesh, "Is Healthcare in Canada Really Free? The Truth Newcomers Need to Know," August 2026).
As an immigration consultant, healthcare is one of the first things new clients ask me about, right after housing and schools. Most arrive assuming "free" means the fully public systems some come from. It doesn't - and Dr. Akram told me on the podcast that this single misunderstanding causes more frustration than almost anything else newcomers run into.
That confusion gets worse the moment a newcomer tries to actually use the system. As of a national survey fielded through mid-2025, 5.9 million people in Canada still lacked reliable access to a regular family doctor or primary care team - down from 6.5 million in 2022, but still close to one in six Canadians (Canadian Medical Association, "National Survey: 5.9 Million in Canada Still Without Regular Doctor," 2025). The number of family doctors per 100,000 people fell to 119 in 2024, continuing a three-year decline (Canadian Institute for Health Information, "A Profile of Physicians in Canada," 2024).
Here's what most newcomers get backward: they treat the health card application as paperwork to finish once and forget. Dr. Akram's advice is the opposite - apply for provincial coverage the day you land, because the waiting period before a new health card activates can run up to three months in several provinces, and that's exactly the gap where an uninsured emergency gets expensive fast.
Her first move with every new patient is the same: confirm they understand what their health card actually covers, then get them attached to a family doctor's roster before anything goes wrong - not after.
How Canada's Triage System Actually Works
Canada rations care by urgency, not by who asks loudest, and that system produced a median wait of 28.6 weeks from GP referral to actual treatment in 2025 - the second-longest wait ever recorded in the survey's history. Life-threatening conditions like cancer or a heart attack get seen immediately; a sore knee usually doesn't (Fraser Institute, "Waiting Your Turn: Wait Times for Health Care in Canada, 2025," December 2025).
That 28.6-week figure splits into two stages: 15.3 weeks waiting to see a specialist after referral, then another 13.3 weeks waiting for treatment once the diagnosis is made. Ontario had the shortest total wait at 19.2 weeks; New Brunswick the longest at 60.9 weeks - a reminder that "Canadian healthcare" isn't one system but thirteen provincial and territorial ones stitched together.
Dr. Akram, who practiced in Ireland and the UK before Canada, draws a direct contrast: fully public systems like the UK's NHS see heavier day-to-day misuse because there's no cost signal at all, while Canada's mixed model - where some services carry a price - filters out some of that overuse and protects capacity for people who need it most. It's not a perfect trade, but it's a deliberate one.
The move Dr. Akram tells every newcomer: don't skip the family doctor line to go straight to a walk-in clinic or the ER for non-urgent issues. Walk-ins don't build the ongoing relationship a family doctor needs to catch problems early, and the ER is triaged by severity - which means a long wait for anything that isn't critical.
The Health Conditions Hitting Immigrants Hardest
Metabolic disease is the biggest gap Dr. Akram sees between immigrant and Canadian-born patients, and the data backs her up sharply for South Asian immigrants specifically. A Canadian population study covering more than 431,000 first-generation South Asian immigrants in Ontario found a crude diabetes prevalence of 15.9%, compared with 11.6% among the non-immigrant population - and the gap widens further by country of origin (Diabetic Medicine, 2018).
Immigrants from Sri Lanka showed the highest adjusted prevalence at 26.8%, followed by Bangladesh at 22.2%, Pakistan at 19.6%, India at 18.3%, and Nepal at 16.5%. Dr. Akram attributes most of the gap to lifestyle change, not genetics alone: diets built around home-country activity levels don't automatically adjust to a more sedentary Canadian routine, and cultural food traditions carry real caloric weight that's easy to underestimate.
Winter compounds the problem in a way most newcomers never anticipate. Vitamin D deficiency in Canada more than doubles between the warmer months and winter, from about 5% of the population deficient April through October to 13% deficient November through March, based on the Canadian Health Measures Survey (Statistics Canada, 2023). Add drier air and less sun exposure, and Dr. Akram sees a predictable spike in skin allergies and low-mood complaints every winter among newer arrivals.
The stress layer is the one Dr. Akram says gets missed most often, because it doesn't show up as a single diagnosis - it shows up as irritable bowel symptoms, tension headaches, and blood pressure that won't come down on its own. Migration pressure, career-restart anxiety, and the stigma some cultures attach to naming stress out loud all compound into physical symptoms a lab test alone won't explain. Her advice: name the stress early to your family doctor, even if it feels like it doesn't belong in a medical appointment. Recognizing it, she says, is half the treatment.
Why Trust With a Family Doctor Changes Everything
Patients who trust their family doctor follow treatment plans more consistently and show better outcomes - a pattern Dr. Akram has watched play out over 25 years of practice across four countries, even without a single controlled trial attached to the observation. The therapeutic alliance, as she calls it, decides whether a diabetes management plan actually gets followed or quietly ignored.
That trust takes longer to build in multicultural practices, where language differences and unfamiliar bedside norms mean patients arrive guarded rather than open. Dr. Akram's approach is patience over efficiency: she'd rather spend an extra ten minutes letting a patient explain their concern in their own words than rush to a diagnosis that misses the real issue.
Healthcare trust is just one piece of a much longer adjustment curve newcomers go through after relocating. I've written before about that broader curve in Reverse Migration: When Going Back Becomes Going Forward - the same disorientation that shows up in a doctor's office shows up in almost every other part of settling into a new country.
When Shift Work Quietly Wrecks Your Health
Shift work carries a measurable cardiovascular cost, and it lands disproportionately on newcomers who take rotating-shift jobs in warehouses, care homes, and manufacturing while they rebuild their careers. An estimated 32.8% of Canadian workers do some form of shift work, and population-level analysis attributes roughly 7.0% of heart attacks and 7.3% of all coronary events to shift-work exposure (BMJ meta-analysis, cited across Canadian occupational health literature).
Rotating shifts disrupt cortisol rhythm, fragment sleep, and make consistent meal timing nearly impossible - three things that compound into the same metabolic and cardiovascular risk factors already elevated in South Asian and other immigrant populations. Dr. Akram sees this combination often in patients working warehouse or personal-support-worker shifts, where the job itself is undoing what the rest of their care plan is trying to fix.
Her guidance isn't to quit a shift job newcomers often need for income stability - it's to protect sleep and meal timing as deliberately as any medication schedule, and to flag shift work explicitly to a family doctor so it gets factored into any diagnosis, not treated as background noise.
The Path for Foreign-Trained Doctors, and What to Do Next
More than a quarter of the physicians treating Canadians were trained somewhere else first, and that share is even higher in the specialty most newcomers actually need. Internationally trained physicians make up 27% of all doctors practicing in Canada, rising to 32% in family medicine specifically (Canadian Institute for Health Information, 2024) - Dr. Akram's own path from Pakistan through Ireland and the UK before Canada is one version of that number.
That path isn't fast. Foreign-trained doctors typically face credential re-verification, licensing exams, and sometimes additional supervised training before a provincial college grants a full license - a process that can take years even for physicians with decades of experience. Dr. Akram's advice to foreign-trained doctors eyeing Canada: start the credential-recognition process before you land, not after, because the paperwork timeline rarely shortens once you're here.
Some of that friction is easing. As of 2025, doctors trained in the UK, Ireland, Australia, and the US no longer need to write Canada's MCCQE1 licensing exam in several provinces, including Alberta, and a dedicated federal immigration stream launching in 2026 is expected to fast-track additional permanent residency spaces for licensed doctors who already have a Canadian job offer (Medical Council of Canada, "Pathways to Licensure," 2025).
What keeps foreign-trained doctors once they're through the process, Dr. Akram says, is the professional autonomy Canada offers compared to more corporatized systems elsewhere - most family physicians here are effectively self-employed, setting their own hours and building their own practice instead of working inside a hospital hierarchy for their entire career.
The one piece of advice Dr. Akram was most emphatic about on the episode: don't let AI chatbots replace a doctor for anything serious. Home remedies still work fine for minor complaints, and AI can be useful for understanding a general concept before an appointment - but it can't examine a patient, ask a follow-up question based on what it sees, or catch the detail that changes a diagnosis. Human clinical judgment, in her words, remains non-negotiable.
What Newcomers Should Actually Do
| Challenge | Cause | Recommendation |
|---|---|---|
| No family doctor on arrival | National shortage - 5.9M Canadians without one | Apply for provincial coverage on day one; join a family doctor's roster before you need it |
| Metabolic disease (diabetes, hypertension) | Diet and activity shift, especially for South Asian immigrants | Prioritize lifestyle changes early, not just medication |
| Stress showing up as physical symptoms | Migration pressure, career restart, cultural stigma | Name stress explicitly to your doctor - recognizing it is half the treatment |
| Long specialist wait times | Triage system prioritizes urgent cases | Use a family doctor and walk-in clinics appropriately; set realistic expectations |
| Shift-work health risk | Rotating shifts in warehouse, care, and manufacturing jobs | Protect sleep and meal timing; flag shift work to your doctor explicitly |
| Vitamin D deficiency, dry skin | Low sun exposure, harsh winters | Supplement vitamin D; moisturize proactively through winter |
Settling Into Canada Involves More Than Immigration Paperwork
Healthcare is just one piece of the settlement puzzle newcomers underestimate. If you're planning a move to Canada and want the full picture - immigration pathway, healthcare, housing, and business setup - let's map it out together.
Book a Strategy Call →For more on the broader immigration pathway decisions newcomers face, read Canada PR vs. Citizenship, and for the business case behind the move itself, see Why Indian Entrepreneurs Are Moving to Canada.
Frequently Asked Questions
Is healthcare really free in Canada for newcomers?
Canada's public healthcare, accessed through a provincial health card, covers physician visits and hospital care, but it is not fully free the way the UK's NHS is. Services like ambulance rides, physiotherapy, dental care, and most prescription drugs outside a hospital require separate payment or private insurance, a distinction Dr. Misbah Akram says catches most newcomers off guard.
Why is it so hard to find a family doctor in Canada right now?
5.9 million people in Canada lacked reliable access to a regular family doctor or primary care team as of a 2025 national survey, while the number of family doctors per 100,000 people fell to 119 in 2024 (Canadian Medical Association, 2025; Canadian Institute for Health Information, 2024). Newcomers face this same shortage on top of not yet knowing how to register or where to look.
Why are South Asian immigrants more likely to develop diabetes in Canada?
A Canadian population study found South Asian immigrants had a crude diabetes prevalence of 15.9%, compared with 11.6% among non-immigrants in Ontario, reaching 26.8% among immigrants from Sri Lanka (Diabetic Medicine, 2018). Dr. Akram attributes much of the gap to diet and activity-level changes that come with a more sedentary Canadian lifestyle, not genetics alone.
Can foreign-trained doctors practice medicine in Canada?
Yes, though it takes time. 27% of physicians practicing in Canada were trained internationally, rising to 32% in family medicine specifically (Canadian Institute for Health Information, 2024). As of 2025, doctors trained in the UK, Ireland, Australia, and the US no longer need to write Canada's MCCQE1 exam in several provinces, and a new federal immigration stream launching in 2026 aims to fast-track licensed doctors with a job offer.
Should immigrants trust AI for health advice instead of seeing a doctor?
Dr. Akram cautions against relying on AI chatbots for anything beyond minor complaints. Home remedies still work for small issues, and AI can help explain a general concept before an appointment, but it cannot examine a patient or catch details a trained clinician would notice. Her view: a licensed physician's in-person judgment stays the final word on anything serious.
None of what Dr. Akram described requires the healthcare system to become simpler - it requires newcomers to understand it earlier. The 5.9 million Canadians without a family doctor, the 28.6-week specialist waits, the elevated diabetes risk in South Asian communities - none of that changes because you didn't know about it. It just costs you more time and worse outcomes while you catch up.
That's the real argument for treating healthcare orientation as seriously as any other part of a move to Canada - alongside housing, schools, and work permits, not after them.
If you're planning a move to Canada and want help mapping out the full picture, contact me and let's talk it through.
Sources
- Real with Ritesh, Is Healthcare in Canada Really Free? The Truth Newcomers Need to Know (source episode for this article), retrieved 2026-08-11, August 2026
- Canadian Medical Association, National Survey: 5.9 Million in Canada Still Without Regular Doctor (OurCare Survey 2025), retrieved 2026-08-11, 2025
- Canadian Institute for Health Information, A Profile of Physicians in Canada (family doctor supply and internationally trained physician share), retrieved 2026-08-11, 2024
- Fraser Institute, Waiting Your Turn: Wait Times for Health Care in Canada, 2025, retrieved 2026-08-11, December 9, 2025
- Diabetic Medicine, Differences in Prevalence of Diabetes Among Immigrants to Canada From South Asian Countries, retrieved 2026-08-11, July 2018
- Statistics Canada, Vitamin D Status of Canadians, Canadian Health Measures Survey, retrieved 2026-08-11, November 28, 2023
- Medical Council of Canada, Pathways to Licensure (international medical graduate licensing reforms), retrieved 2026-08-11, 2025
- BMJ, Shift Work and Vascular Events: Systematic Review and Meta-Analysis (shift-work prevalence and coronary risk), retrieved 2026-08-11
