Canada's doctor shortage will only worsen in the coming decade

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Appeared in the Province, New Brunswick Telegraph-Journal, and Sudbury Star, March 2011

When stacked up against countries with similar health care goals, namely universal coverage, it quickly becomes apparent that Canada's health care system is not worth emulating. While we're a top spender, we have among the longest waiting lists, low levels of medical technologies and perhaps the problem that hits closest to home, a short supply of doctors.

If you think it's bad now, just wait. Over the next decade, the physician shortage will become more severe. Even if government imposed restrictions on the number of doctors being trained in Canada are immediately removed, it won't have an impact for much of the next decade given the time it takes to train a new doctor. The only short-term solution is to recruit more foreign-trained doctors.

In 2006, the most recent year for which data is available, Canada's physician-to-population ratio (age-adjusted) ranked 26th among 28 developed nations that maintain universal access health care. It's not surprising then that some 6.6 per cent of Canadians reported being unable to find a family doctor in 2010. Canada's physicians are unable to meet the demand for health care services because there are simply too few of them.

Those that think the lack of physicians in Canada is merely an inconvenience should examine the research, which clearly shows that the lack of physicians in Canada is a serious problem negatively affecting the health of Canadians.

For example, a 2001 study from the Organization for Economic Co-operation and Development (OECD) found that an increase in the physician-to-population ratio in developed countries results in reductions in premature mortality, increases in life expectancy at age 65, and reductions in infant and perinatal mortality. Similarly, a more recent study published in the scholarly journal Health Affairs found that lower rates of all-cause mortality and lower rates of heart disease mortality were related to higher primary care physician-to-population ratios.

If this isn't worrying enough, consider that Canada's physician-to-population ratio is actually set to shrink in the coming decade. For many years, physician training in Canada has simply been insufficient to maintain an adequate physician-to-population ratio.

Indeed, Canada's doctor shortage would have grown more acute through the 1990s had foreign-trained physicians not filled the gap left by government restrictions on medical training in Canada.

While the number of physicians being trained in Canada has increased markedly in recent years, with the number of MDs awarded rising from 1,543 in 2002 to an estimated 2,459 in 2010, Canada is still not training enough new doctors to maintain the physician-to-population ratio at its current level let alone increase it.

Vitally, the worsening physician shortage will likely be felt more acutely by Canadians than the raw numbers suggest.

The projection that Canada's physician-to-population ratio will shrink considerably without an influx of foreign-trained physicians does not account for the advancing age of Canada's current physicians. In 2010, approximately 38 per cent of Canada's physicians were aged 55 or older. This suggests that Canada will experience increasing physician retirements in coming years, just as health care demand is rising due to the ageing of the Canadian population as a whole.

Equally importantly, demographic changes in the physician population may mean a greater physician-to-population ratio will be required in the future in order to deliver the same volume of services that Canadians enjoy today.

Women now make up a larger share of the workforce than in years past and will likely make up an even larger share in the future. From a physician supply perspective, studies and physician surveys show that female physicians tend to provide fewer services per week to patients and work fewer hours per week than their male counterparts.

In addition, studies of the physician workforce in Canada show that younger physicians today do not work the same hours or bill the same volume of services that their older counterparts did in the past. Older physicians nearing retirement also carry workloads that are much larger than those of new and younger physicians. Further, older physicians in Canada are working longer hours and providing more services than their peers did a decade before.

The bottom line: ageing and retiring physicians provide more services per person than the workforce that will be replacing them.

Canada is in the midst of a physician shortage. Because of insufficient training in Canada, Canada's physician shortage will grow more acute in the coming years without an influx of foreign trained physicians.

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