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Four million Canadians do not have a regular doctor, and recent immigrants are the most likely by far to be without one, says a report released Wednesday by Statistics Canada.

According to the Canada Community Health Survey, while 86 per cent of those who were born in Canada or immigrated more than five years ago do have a doctor, just 65 per cent of more recent immigrants can say the same. That trend held even when the statistical agency controlled for age, to take into account the fact that recent immigrants are disproportionately young.

Only 73 per cent of Quebeckers have a regular doctor, the lowest rate in the country, while the highest is in Nova Scotia at 94 per cent.

Though the overall proportion of Canadians with a regular doctor has risen slightly over the last ten years, Vincent Dale, a survey manager for the study, said that the figure has been “relatively stable.”

Wednesday's survey, however, is the first to include data on where those without doctors do get medical care.

Those figures suggest that local clinics and community health centres are carrying a considerable load of the primary care burden. Seventy-six per cent of Canadians without a doctor use one or the other for basic medical attention. Emergency rooms are the destination of choice for a further 12 per cent, and 10 per cent seek care through telephone lines, doctors' offices, and hospital outpatient clinics. All told, “eight in ten people without a doctor do have a regular source of care,” Mr. Dale said.

While these statistics may seem alarming, Dr. Raisa Deber, a professor of health policy at the University of Toronto, said that they do not represent significant cause for concern.

Statistics about clinics and community health centres show that Canadians without doctors “will be able to get care if [they] need it,” Dr. Deber said. She added that Canada's overall rate of doctor access of 85 per cent is “damn good.”

But Dr. Deber is concerned that non-traditional primary care venues like clinics and health centres can be an imperfect substitute for a regular doctor in many cases.

“What you really worry about,” she said, “is not having someone able to manage a chronic condition,” as a doctor with personal knowledge of a patient's medical history might.

Dr. Ken Arnold, president of the Ontario Medical Association, is similarly wary of relying too heavily on clinics. “While the patient will be receiving adequate care for the problem they present with, nevertheless there's a great loss of continuity of care using that system,” he said. “It tends to be a matter of band-aiding issues rather than really dealing with them.”

Dr. Arnold's national counterpart, Canadian Medical Association president Brian Day, was more forceful in his criticisms of the primary care system's shortfalls. Doctor availability in Canada is “a big problem,” he said, and one difficult to improve since “family physicians simply aren't paid enough.”

Nonetheless, there are signs that those seeking to shift their medical care from clinics and health centres to regular doctors could soon have an easier task. A report issued this year by the College of Physicians and Surgeons of Ontario noted that the rapid decline in the percentage of family doctors in the province accepting new patients — from 38 per cent in 2000 to just 9 per cent in 2006 — seems to have halted.

In 2007, 10 per cent of Ontario primary care doctors reported they were open to new patients.

Dr. Day, for his part, is not sure that availability of doctors accepting patients is the only relevant barrier. “There's a communication issue,” he said, one that makes it difficult to connect patients to doctors with free space in their practices.

While provincial medical colleges sometimes provide lists of available doctors online, Dr. Day said that such information is often “inaccurate,” sending those looking for a doctor to practices which are not actually taking new patients. He added that immigrants might find the task of navigating the system to find a doctor particularly onerous due to language difficulties and general unfamiliarity with Canadian medical practices.