Despite Canada’s universal healthcare system, many Canadians are still unsatisfied of the care that they receive. Long waiting times for appointments and rushed interactions with the clinicians are seen as the norm and part of it is due to low physician-to-patient ratio. Amongst developed countries, Canada ranked 26th in physician-to-population ratio out of 28 nations with universal healthcare. In addition to lower physician-to-patient ratios, there are also less physicians going into primary care where most Canadians initially turn to for healthcare. The reasons behind this gradual decline is largely rooted in policies, education, and changing physician demographics.
From the 1970s to the 1990’s: a change in policy
In the 1970s, Canada had a surplus of physicians resulting in one of the highest physician-to- patient ratios in the world. However, as a result of an “oversupply” of physicians, new governmental measures were implemented to lower the growth of the physician population. From these policies, the inflow of newly appointed physicians dropped by more than 60% from the period of 1990-1992 to 1994-2000. The physician to patient ratio (physician/1000) was 1.91 in 1993 and dropped to 1.84 to in 1997. Although the ratio went back up to 1.91 in 2007, it is believed that this reported ratio is due to an aging patient population that uses more healthcare services. The real ratio in 2007 is predicted to be lower than the ratio during 1993. In 2011, 15.3% of Canadians older than 12 years of age did not have a family physician. These findings show the drastic effect of the policy change to reduce incoming physicians. Even after the Canadian government made significant efforts to boost the physician population in the early 2000s, it still remains on the decline.
Changes to the physician population
Other than the shrinkage of the physician population, the makeup of the physician population also contributes to the lower physician-to-patient ratio. Many physicians are projected to retire this decade when healthcare demand is rising. In 2010, nearly 40% of physicians were 55 or older and were expected to retire in a decade. Although there was a modest increase in MDs given out in Canada from 2002 to 2010, current projections estimate that this is not enough to make up for the demographic changes.
Low supply of physicians in rural areas:
The shortage of primary care physicians is more severe in rural areas. Physicians in urban areas practiced longer in a clinic with an average of 12.6 years compared to their rural counterparts who averaged at 9.5 years. This is correlated with a higher patient mortality in rural areas compared to urban areas. The main reason behind this statistic is that the majority of medical students are uninterested in rural family medicine. In 2008, only 11.1% of medical students in Canada expressed interest in going into rural family medicine. In addition, the higher turnover of rural physicians may be due to lower satisfaction with their practice compared to their urban counterparts. Due to the shortage of physicians in rural areas, they need to practice a wider range of procedures to make up for the shortage which may add to their overall stress. Furthermore, living further away from family and friends was also found to negatively affect their well-being.
Possible solutions for a deep problem:
Current projections estimate that physician shortage will continue to grow over the coming years. Although there are considerable costs in training more medical students, the issue lies in the low rates of accepted MD students in Canada. With only 17 schools in Canada, competition is steep and largely based on stats such as GPA and MCAT. In contrast, the U.S. have 154 MD programs with an arguably more holistic admissions process. Thus, many Canadians are now turning to the U.S. and other countries to go to medical school where they are also more likely to do their residency.
In addition, increasing interest in primary care for current medical students should also be a priority. Studies have found that a large percentage of medical students matched to a family medicine residency only accepted the residency after being rejected from their top choices. This is not ideal as these physicians may not be happy in a career that they don’t want, which may impede their performance and overall work satisfaction. Thus, a possible solution is for medical schools to consider factors amongst the applicants that is correlated with a future desire to go into family medicine. Many medical schools in Canada highly value research as a prior experience amongst applicants, but studies have found that research experience is inversely correlated to an interest in family medicine. Thus, medical schools may need to change the criteria to accept a more diverse range of applicants. Furthermore, more exposure to family medicine in the medical curriculum may also increase interest in the specialty as well.
With variable reasons behind physician shortage in Canada, there are also many ways to grow the physician population. Many solutions lie in the medical schools to accept more students with diverse interests and backgrounds and to increase the students' exposure to primary care to foster interest.
Barua, B. and Moir, M. "Comparing Performance of Universal Health Care Countries." Fraser Institute, 10 Nov. 2020, https://www.fraserinstitute.org/studies/comparing-performance-of-universal-health-care-countries-2020?utm_source=Media-Releases&utm_campaign=Comparing-Performance-of-Universal-Health-Care-Countries-2020&utm_medium=Media&utm_content=Learn_More&utm_term=700
Globerman, S., Barua, B., and Hasan, S. "The Supply of Physicians in Canada: Projections and Assessment". Fraser Institute, 2018. https://www.fraserinstitute.org/sites/default/files/supply-of-physicians-in-canada.pdf
Malko, Andrei, and Vaughn Huckfeldt. “Physician Shortage in Canada: A Review of Contributing Factors.” Global Journal of Health Science, vol. 9, no. 9, 2017, p. 68. Crossref, doi:10.5539/gjhs.v9n9p68.