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Paradox: more MDs than ever, but millions still don’t have a regular doctor

Canada has more doctors than ever – with a net increase of almost 12,000 in the past decade and swelling of the medical ranks by 2,700 last year alone.

Yet, despite the large influx of practitioners, they can't keep pace with demand, as 4.2 million Canadians still don't have a regular doctor.

"Obviously, we don't have the numbers right yet because we still have access problems," Dr. Jeffrey Turnbull, president of the Canadian Medical Association, said in an interview.

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He was responding to a new report from the Canadian Institute for Health Information that shows the physician work force grew by 4.1 per cent in 2009, the single biggest yearly rise in three decades.

The increase was the result of a combination of factors, including larger graduating classes from medical schools, the hiring of more foreign-trained doctors, the return of Canadian physicians from the U.S., and the fact that physicians tend to retire much later than other workers.

There were 34,793 family physicians and 33,308 specialists practicing in Canada last year, along with 5,637 residents, according to the new data.

The CIHI data show that the growth in the physician work force has outpaced population growth, meaning there are more doctors per capita. There were 201 active physicians per 100,000 population across Canada in 2009, up from 190 per 100,000 in 2005, and 150 per 100,000 in 1980.

Michael Hunt, director of health work-force information services at CIHI, cautioned, however, that "numbers alone don't tell the whole story."

The demand for physician services depends on the needs and expectations of Canadians, which have changed markedly over time, with the advent of new technologies, shifting disease patterns (notably far more people living with chronic illnesses) and the country's changing demographic profile.

According to Statistics Canada, 15 per cent of Canadians over the age of 12 do not have access to a regular doctor. That works out to about 4.2 million people.

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The number of doctors required also depends on the way care is organized and the scope of practice of other health professions like nurses, pharmacists and dieticians.

"There's no perfect formula for a 'right' number of doctors to satisfy the health care needs of Canadians," Mr. Hunt said.

Dr. Turnbull of the CMA agreed, saying there are many factors that influence the delivery of care, from patient loads through to payment methods, and those need to be addressed.

But he insisted that other issues cannot be resolved unless there is an adequate number of doctors available to meet everyday needs of patients.

"I think everyone recognizes that we still have shortages, particularly of family physicians," Dr. Turnbull said.

The CMA president also noted that, despite improvements, Canada still has one of the lowest number of doctors per capita among developed countries.

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Clinical payments to physicians hit $17-billion last year, up 9.6 per cent over the previous year.

Spending on physicians is one of the major drivers of overall spending, as it is growing markedly faster than spending on drugs and hospitals.

Those increases are due, in large part, to increased numbers, but physician income is also on the rise.

In 2009, family physicians billed, on average $235,420, while specialists billed $323,003. (These are gross numbers that include overhead like office expenses.)

Seventy-three per cent of payments to physicians are based on a fee-for-service model, while 27 per cent are on alternative payment plans, which include approaches like capitation (a set amount per patient on a roster), along with various incentives.

The CIHI data show that, while numbers are on the rise, the face of medicine is also changing significantly. The most dramatic changes has been the number of women in the profession, a percentage that rose to 35.6 per cent in 2009 from 11.8 in 1979.

The average age of Canadian physicians is just under 50, making them one of the oldest professions in Canada. But it is also an unusual profession in that practitioners start their careers late – 10 years of schooling is not unusual – and retire quite late.

About one-fifth of doctors are under 40 and one-fifth over 60. There is also a significant number of doctors still practicing into their 80s and 90s.

About 74 per cent of physicians received their medical training in Canada, and 26 per cent abroad. The number of foreign-trained physicians has actually been falling for a number of years. However, foreign-trained physicians used to come predominantly from the U.K. and now they come largely from South Africa and Southeast Asia.

Canadians will spend an estimated $192-billion on health care this year, or $5,614 per person, according to CIHI.

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