The problem of physician-starved Canadian communities has hit Ontario hard, with roughly one in five people saying they had trouble last year finding a family doctor.
That figure jumps to 26 per cent for patients living outside major urban centres, according to the telephone survey of 662 adults done in December by the Ontario College of Family Physicians.
"The figures aren't good and what the public has told us is really quite shocking. It really shows that something has to be done fast," said Dr. Ken Hook, president of the college and a family physician in Tavistock, Ont., near Stratford.
While those Decima Research Inc. figures show patients had trouble finding a family doctor last year, they didn't probe how many of them eventually were able to locate one.
Ontario Health Ministry spokesman Geoff Bell said there are 109 communities in the province designated as underserved, defined as having a severe shortage of physicians or difficulties recruiting them, down from the summer figure of 120.
Canadian Medical Association president Dr. Peter Barrett said yesterday the problem is worldwide and physicians trained in this country can "pretty much go anywhere.
"We're not turning out enough doctors each year. The work force issue is the biggest issue in health care right now."
He acknowledged that to meet demand, Canada has had to seek out international medical graduates, which has been a particularly controversial topic in South Africa.
South Africa's ambassador to Canada, André Jacquet, recently wrote a letter to a Canadian medical journal, stating it is unethical for the West to recruit from developing countries such as South Africa, which has too few doctors and is struggling to cope with millions of poor and an AIDS pandemic.
"The reality is we shouldn't be raiding other countries, as it were, to solve our problem. We should create an environment where our physicians would want to stay here," Dr. Barrett said in a telephone interview from Saskatoon. "We need a made-in-Canada solution where we turn out enough physicians to meet our needs."
Though there are no hard figures on how many family doctors are needed across the country, Dr. Don Gelhorn, president of the College of Family Physicians of Canada, said 240 fewer family physicians are being produced each year compared to a decade ago.
"There's definitely a shortage and that contributes to overcrowding of the emergency room because people who need medical care have to seek it somewhere," he said in a telephone interview from Hudson Bay, in northeast Saskatchewan.
That shortage is partly due to downsizing in the early 1990s, when hospitals were closed or merged, nurses were laid off by the thousands and medical-school enrolment was slashed.
Despite efforts to catch up, with provinces like Ontario expanding medical school enrolment, there still is a need for 400 to 700 more family physicians in the province, said Dr. Hook.
The 55-year-old has personally noticed the difference. Twenty five years ago, when he first began practising in Tavistock, he was one of six doctors treating the town's patients. By April, he'll be one of three.
"I'm working harder, have fewer days off and holidays are difficult to organize," said 55-year-old Dr. Hook, who will be on-call every third weekend and every third night, starting in April.
Fast-tracking international medical graduates, expanding medical-school enrolment, luring Canadian doctors back from the United States, and paying physicians differently are some suggestions that have been made to fix the system.
Dr. Walter Rosser, chairman of family and community medicine at the University of Toronto, called it a "very difficult problem to turn around" that will take years.
While he labelled the doctor shortage as a "pretty significant problem," he said it wasn't yet an "acute crisis."