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While Canadians may not see it when they try to access care, the number of physicians practising in this country has swelled by almost 5,000 over the past five years, according to newly published data.

The medical work force has grown principally because of huge increases in medical school enrolment in the past decade. Recruitment of foreign-trained physicians is up too, and more Canadian doctors are returning from abroad than leaving the country, resulting in more gains.

“We have more doctors, and it looks like that trend will continue in the future,” said Yvonne Rosehart, the program lead for human resources at the Canadian Institute for Health Information.

The main reason growth has been sustained, she said, is because Canadian doctors have shown themselves reluctant to retire, with most practising into their 70s and 80s.

The CIHI study, entitled Supply, Migration and Distribution of Canadian Physicians, 2008, shows that doctors have also made considerable monetary gains in recent years. In 2008, physicians were paid, on average, $266,031. That is up from $231,427 in 2003.

But income varies considerably across the country, from a high of $315,405 in Saskatchewan to a low of $198,455 in Quebec.

In the past five years, physician income has increased, on average, 15 per cent as a number of provincial medical associations have signed lucrative new deals.

Physician payments now account for $25.6-billion of the $183.1-billion in health spending in Canada.

The way physicians are being paid is also changing considerably.

According to CIHI, 78 per cent of physicians are now paid on a fee-for-service basis. The other 22 per cent – and growing – are on alternate payment plans that can consist of salaries, incentives, bonuses and a mix of clinical work, research and teaching duties.

Ms. Rosehart noted that the income figures are complex. They are gross figures, and many doctors have to pay overhead out of their income – and that can easily be 30 to 40 per cent of the total. Also, it is impossible to tell how much individual physicians work to earn that income.

Regardless, medicine remains a popular career option and a growing profession.

There were 65,440 active physicians in Canada last year, up from 60,612 five years earlier.

That means there were 195 doctors for every 100,000 Canadians in 2008, up from 189 for every 100,000 in 2003.

While patients often have the impression there used to be a lot more doctors, that is not the case. In 1978, there were 147 physicians for every 100,000 population.

Robert Ouellet, past president of the Canadian Medical Association, said that while there have been gains, Canada still has a lot fewer doctors per capita than many other countries.

He also cautioned that having more doctors does not necessarily translate into more access. “They counted the numbers of doctors but they didn't count how many hours they put in or calculate how well the system works,” he said.

“We need more doctors but we also need to give them the tools to practise efficiently,” Dr. Ouellet said.

Enrolment in Canadian medical schools hit a new high of 9,640 last year, up considerably from a low of 6,388 in 2000.

In recent years, medical school students have predominantly been women and that is now being reflected in the profession. Almost 40 per cent of general practitioners and 30 per cent of medical specialists in Canada are women.

Almost one in four doctors practising in Canada – 15,100 of the total work force – were trained abroad. Doctors are now recruited principally from India and South Africa, but many older physicians immigrated from Britain and Ireland.

While there is a perception that many Canadian doctors head to the United States and elsewhere for greener pastures, the reality is that there is very little movement.

Last year, 196 doctors moved abroad to practise, while 240 Canadian doctors returned home to work.

Physicians have the distinctions of being one of the oldest professions in Canada. The average age of family doctors is 49, and among specialists it's 50.6.

They also have unusual retirement patterns, with the majority working well into their senior years.

One in eight doctors is over the age of 65.

CIHI data also show that 70 per cent of the physicians aged 70 to 74 in 2003 were still practising medicine in 2008.