Systemic racism in Canadian healthcare: The impact on physicians and patient outcomes

Abstract Background Systemic racism in Canadian healthcare is deep-rooted, generating inequities in workforce diversity and patient care. Black, racialized, and Indigenous communities encounter heightened barriers to accessing medical care and career advancement due to institutionally rooted biases (7) . Despite Canada's single-payer, universally accessible care, studies have documented widespread inequities in access, care, and health outcomes. The exclusion of foreign-trained healthcare professionals who benefited from the Canadian Immigration Point-Based Comprehensive Ranking System (CRS) from the labor force further entrenches inequities, mirroring systemic biases (14). Addressing these issues is crucial for ensuring equitable healthcare delivery. Objective This narrative review critically assesses systemic racism in Canadian healthcare, considering racial inequality in patient care, career barriers for racialized healthcare professionals, and institution policies with a discriminatory intention. It identifies the structural barriers that preserve inequity and proposes policy-guided recommendations for systemic reform. Methods This narrative review synthesizes empirical research, government reports, and case studies to examine systemic racism in Canadian healthcare. Sources were selected based on relevance, credibility, and publication within the last 15 years. Inclusion criteria focused on studies examining racial disparities in healthcare access, professional barriers, and policy interventions. Case studies were chosen based on their legal and policy significance, particularly those highlighting systemic failures leading to patient harm. Thematic analysis was used to categorize key issues, ensuring a comprehensive policy-driven discussion. Results The review identifies three primary systemic barriers: Racial biases in patient care lead to delayed treatment, misdiagnoses, and higher mortality rates among Black and Indigenous patients. Institutional racism in healthcare workforce structures restricts opportunities for racialized healthcare professionals, limiting diversity in medical leadership. Credentialing barriers disproportionately affect internationally trained physicians (ITPs), preventing them from contributing to Canada's overburdened healthcare system. Case studies highlight the severe consequences of healthcare discrimination. Brian Sinclair, an Indigenous man, died after being ignored for 34 hours in a Winnipeg ER. Joyce Echaquan, an Atikamekw woman, live-streamed racist abuse from nurses before her death. These cases underscore the urgent need for systemic policy reforms to prevent further medical neglect. Conclusion Several evidence-based policy interventions are necessary to dismantle racism in Canadian healthcare. Some of these interventions include mandatory anti-racism and cultural competency training for Healthcare professionals, the collection of race-based health data to track disparities and inform policies, and fair credentialing processes for international medical school graduates to address workforce shortages. There must also be independent accountability and review processes to prevent medical abuse. By taking such actions, a fairer, accessible, and effective system will mean racialized communities receive the care that they deserve. Keywords Systemic racism, healthcare inequities, racial disparities in healthcare, medical discrimination, health policy reform, health equity, Indigenous healthcare, Black physicians in Canada, internationally trained physicians (ITPs), credentialing barriers, implicit bias in healthcare, hiring discrimination, underrepresentation in leadership, workplace exclusion, medical licensure restrictions, anti-racism training, cultural competency training, race-based health data collection, equitable credential recognition, independent Health Equity Oversight Boards, Indigenous-led health policy reforms, New Zealand's cultural safety model, UK NHS race-based data collection, implicit bias reduction programs, Canadian Medical Association (CMA), Public Health Agency of Canada, federal and provincial health policies.