doctor shortage

In Canada, many people live in a community that doesn’t have enough family physicians to care for all its citizens. More than 1.2 million Canadians were unable to find a regular doctor in 2003, and more than twice as many didn't have one because they hadn't looked for one. Hospitals also have dificulties with difficulties staffing emergency departments, and long waiting lists for specialist services. The problem is particularly serious for rural communities, remote areas and Indian reservations.

How many physicians are needed?

In 2003, Canada had 59,454 doctors, or 1.9 per 1000 people. In a comparison of doctors-to-population, Canada places seventeenth out of 20 OECD countries. In order to rank first, Canada would have needed 48,000 more doctors—an 84 percent increase.

Each year, retirement accounts for between 900 and 1,100 doctors leaving practice every year.
Population growth is projected to average about 371,000 annually for the next decade. Accomadating population growth requires an additional 700 medical graduates every year.
Between 1991 and 1996, the yearly net migration abroad of physicians was about 200 doctors per year.

Thus, in order to maintain the status quo, Canada requires about 2,000 new doctors every year.

Reasons for the Decline in supply

Much of the decline in physician supply can be traced to a sharp drop in Canadian postgraduates entering practice from 1994 to 2000. This decline was due mainly to longer training requirements, such as the elimination of the rotating internship and the increase in the ratio of specialist to family medicine residency positions.

Other factors contributing to lower physician supply include fewer international medical graduates entering Canada and a rising retirement rate. Increased net migration abroad played a minor role and the 10% cut in medical school positions in 1993 accounted for 2% of the decline.

Position: of the Ontario College of Physicians and Surgeons

In order to reduce Doctor shortages, the Ontario Provincial government should do the following:
  • Consider developing and implementing a Physician Assistant Program
  • Allow for restricted registration for residents
  • Develop a process to register specialists recruited to practise in Academic Health Sciences Centres
  • Develop a process to recognize specialists.
  • Allow for the registration of physicians in practice outside of Ontario who have met Ontario’s standards in the past.
  • Create a process to recognize equivalent screening examinations from other jurisdictions (like the US).
  • Increase postgraduate training positions
  • Facilitate career movement between fields of practice.
  • Assess all international medical graduates (IMG’s)
  • Develop e-based legal and ethical training tools for IMGs
  • Help IMGs become familiar with Ontario practice settings and procedures
see the full report

Position: of the Ontario Medical Association

1. Establish a new, independent, and permanent "Office of Physician Workforce Policy and Planning," which would provide a central and ongoing focus for issues related to physician workforce policy and planning in Ontario.

2. Develop access modelling pilots, as proposed in the McKendry Report, for core services in medical fields where patients have ongoing problems getting timely access to care.

3. Further increase medical school enrolment to address the growing shortage of physician human resources in Ontario.

4. Develop and implement a spectrum of incentives aimed at retaining practicing physicians, such as retention bonuses, long service leave (sabbaticals), practice overhead support, retirement/pension plans, improved continuing medical education, locum assistance, and spousal support.

5. Employ the OMA Rurality Index for Ontario (RIO) as a tool for scaling incentive structures.

6. Temporarily increase the number of fully qualified international medical graduate (IMG) positions.

7. Eliminate all coercive measures, such as OHIP fee discounts and physician billing thresholds, which impact negatively on the provision of medical services.

8. Eliminate policies and regulations mandating forced retirement of physicians based solely on age.

9. Develop a new repatriation program aimed at recruiting Canadian-trained physicians currently practising in the United States, Ontario-trained physicians currently practising in other provinces, and Ontario medical students studying in other provinces, to return to Ontario.

10. Improve the flexibility of choice for medical students when determining their field of practice, and facilitate the ability to change field of practice during the training period.

11. Make tuition fees for medical school more affordable to prevent financial barriers to medical training.

12. Increase the flexibility of the Ontario Ministry of Health and Long-Term Care "Free Tuition Program," and further enhance the financial aspects of the program.

13. Increase efforts to improve efficiencies and reduce the administrative burden on physicians in the delivery of medical services.

14. Assess the impact of medico-legal issues on physician resources, and the need for tort reform in addressing the shortage of physicians in Ontario.

15. Analyze, evaluate, and address the impact of increasing patient knowledge about, and requests for, medical services on the overall problem of physician human resource shortages.

16. Develop public education initiatives emphasizing the appropriate use of medical services.

17. Increase research and evaluation activities regarding the integration of non-physician providers into the health-care system.

18. Increasing physician human resources to adequate levels will require increased levels of funding.

see the full report