A large increase in medical-school enrolment, coupled with the on-going recruitment of foreign-trained physicians has produced a record number of Canadian doctors.
In fact, over the past five years, the supply of physicians has been growing at three times the rate of the population, according to the Canadian Institute for Health Information.
The newly published data show Canada had 72,529 licensed physicians in 2011. But they don’t answer one of the most hotly debated health-policy issues: Is that sufficient to meet the health-care needs of Canadians?
“That’s the $64,000 question: Is the supply we have adequate to meet demand?” Geoff Ballinger, manager of health human resources at CIHI, said in an interview. “But the numbers alone can’t answer that question.”
About 4.4 million Canadians do not have a regular family doctor, according to Statistics Canada. However, for many that is a choice – they are content with care at walk-in clinics or feel they don’t need a doctor. Still, about 800,000 of them said they did not have a place to go for regular medical care.
Steven Lewis, a health-policy consultant based in Saskatoon, said this lack of access to primary care is worrisome, but it does not mean there is a shortage of doctors.
In Canada, he said, there has been far too much emphasis on increasing the supply of physicians and not enough attention paid to how the work force is distributed around the country, how doctors practice, and the role of other health professionals like nurses and pharmacists in delivering care.
“Maybe we need to add more bodies, but we need to think about what kind of bodies,” Lewis said. “Simply having more doctors doing the same thing they are now is not going to solve our problems.”
In 2011, 2,533 MD degrees were awarded in Canada, up from 1,695 a decade earlier.
In the past five years alone, the number of new doctors graduating has shot up 24 per cent. Similarly, the number of physicians recruited from abroad has jumped 20 per cent.
International medical graduates, as they are known in public- policy jargon, come principally from South Africa, the United Kingdom, India and Egypt. Currently, about one out of every four doctors was trained outside of Canada.
While there are persistent fears of Canadian doctors seeking out greener pastures (particularly in the United States), the CIHI data show that 99 more Canadian doctors returned to Canada than left last year.
Similarly, there is very little movement between jurisdictions within Canada, with only 588 doctors moving to practise in another province. Alberta and Quebec were most successful at wooing away physicians, while British Columbia and Newfoundland and Labrador were the biggest losers.
The report shows that the number of doctors varies greatly by province, ranging from a high of 240 per 100,000 population in Nova Scotia to a low of 178 per 100,000 in Prince Edward Island. (Rations in the three territories are much lower because patients fly to larger centres for advanced medical care.)
Between 2007 and 2011 the number of physicians practising in Canada grew by 14 per cent; in that same period, the population grew 4.7 per cent.
The number of physicians practising in rural areas grew 10 per cent in that five-year period, while population growth in rural areas was only 2 per cent.
Many provinces and territories have implemented programs to attract physicians to rural and remote communities. The move to rural communities also provides evidence that there is a glut of physicians in urban areas.
In fact, unemployment and underemployment of new medical graduates is a growing problem. About one in six newly trained specialists can’t find work in Canada.
The physician work force in this country is split almost evenly between general practitioners and specialists. There is, however, a push to reform primary-care delivery that has resulted in soaring demand for GPs and falling demand for specialists.
“The reality is we’re getting what we planned for – and we planned very badly,” Lewis said.
One of the reasons that enrolment was boosted at Canada’s 17 medical schools, for example, is the fear that there would be mass retirements as the physician work force ages.
The average age of the Canadian doctor is just over 50 and one in five physicians is over the age of 60. CIHI data show that doctors do not tend to retire in the traditional sense of the word, but gradually reduce their workload.