Despite an early start in the transformation of its health system toward a primary care infrastructure, Canada has not kept pace in the production of knowledge that is needed to support forward momentum. Having achieved the three key system features needed for primary care practice (attempted distribution of resources equitably; government control or heavy regulation of insurance; and low or no copayments), Canada now needs to take bold steps to address at least two interrelated challenges: (1) to shift from a disease orientation to a population orientation toward multi-morbidity and (2) to better understand the delineation of the relative roles of primary care physicians and specialists. The Canadian commitment to primary care research has been very weak. Its strengthening would help Canada to move ahead and could contribute greatly to the advancement of primary care as a worldwide imperative of the 21st century.