Raise the Hammer

As a general internist who cares for a lot of people with serious medical problems, I agree that medical fitness to drive is likely a contributing factor behind a meaningful proportion of road traffic accidents.

That being said, I do have a correction to make to one of your points:

there is a great hesitancy from family physicians to remove drivers licenses from individuals with health issues that could impact their safety

The relevant legislation is Section 203 of the Highway Traffic Act, which reads

Every legally qualified medical practitioner shall report to the Registrar the name, address and clinical condition of every person sixteen years of age or over attending upon a medical practitioner for medical services, who, in the opinion of such medical practitioner is suffering from a condition that may make it dangerous for such person to operate a motor vehicle.

That is, the physician does not remove the driver's license. He or she reports to the MTO that there is a condition that may make it dangerous for the person to operate a motor vehicle, and the MTO makes the final decision.

At least, that's how it is supposed to work. In real life, physicians are aware that they way in which they phrase their reports has great influence over what the MTO decides. The duty to report is not discretionary, and I think most physicians do take it seriously, although we're acutely aware of how much independence is lost in a car-dependent society when we do report concerns regarding fitness to drive and the MTO pulls the license.

There is room to improve the mechanism for reporting and follow-up, but more importantly, there is room to improve land use planning and transit service in order to allow people of all ages to be as independent as possible regardless of whether they can (or do) drive.