Then you may be a family physician, bearing the brunt of the doctor shortage.

As a physician, it’s no surprise to you that Canada has a doctor shortage. Just look at your schedule! But if you think Canada’s doctor shortage is bad now, just wait. It’s about to get much worse.

The aging population is creating a double challenge. More health care will be needed as the population ages and at the same time, more doctors will be retiring.

This year, the average age of physicians is 51. These midlife doctors are already dreaming of – if not planning – their retirement. A study of British Columbia physicians shows that they typically retire at age 65. Will the number of new physicians keep pace with the number of physicians retiring? It’s unlikely.

Since 2010, Canada’s population increased by 12% while admissions to Canadian medical school increased by only 6%, says Dr. Geneviève Moineau, the President and CEO of the Association of Faculties of Medicine in Canada (AFMC).

At least the Ontario government has done the math. In March 2022, it announced 160 new medical school spots over five years. It’s the largest medical education expansion in the province in 10 years.

Half of those med school spots will go to the Toronto Metropolitan University (formerly called Ryerson) medical school when it opens in Brampton, Ontario, in 2025. Among the other recipients of undergraduate spots will be U of T’s new Scarborough Academy of Medicine and Integrated Health, which was recently announced.

Already, Canada’s 17 existing medical schools are flooded with applications. Even if government increased funding so the schools could accept more students, the shortage of residency positions would stop some graduates in their tracks, especially if they have their heart set on a specialty that is in high demand.

“For each medical graduate produced in Canada, public funds are expended. When these graduates go unmatched, there are delays to them entering practice and providing care to Canadians,” Moineau says.

Every provincial ministry of health that has a medical school in their province funds residency positions. Moineau, who competed her pediatric residency at U of T, reports that AFMC is advocating these governments to provide 110 residency positions for every 100 graduates.

The advocacy efforts of AFMC and others recently came to fruition in Ontario when the government announced 295 additional residency positions over five years.

The eclipse of the family physician

In 2015, 38.5% of medical graduates chose family medicine as their first choice for a residency. By 2021, that percentage had dropped to 31.4%.

Dr. Ben Chan (Class of 9T2), in his study of the physician workforce in the 1990s, illustrates just how unpopular family medicine has become. His study found that from 1993 onwards, the ratio of family medicine to speciality residencies has declined – substantially.

Today, Canada is desperately short of family physicians. Year after year, the number of family medicine vacancies in a variety of practice settings exceeds the number of graduating family physicians.

There’s no question that family medicine has become an increasingly difficult calling. Overhead costs have skyrocketed, you’re on call way more than you’d like to be, you never finish the paperwork, and you often end up working an 80-hour week. To top it off, your savings account is less than impressive. Often, family doctors in private practice end up getting jobs in a hospital, clinic, or specialist’s office, where they can work a reasonable number of hours and get a good pay cheque.

“Critical to understanding the family physician shortage is the recognition that its origin comes from people choosing to no longer practise in antiquated models of care,” says Dr. Katharine Smart, the President of the Canadian Medical Association. “More doctors alone are not the solution; we need modernized practice environments that attract and retain physicians in longitudinal family medicine.”

To address some of the challenges in the practice environment, the College of Family Physicians of Canada organized a letter-writing campaign on its website. In just over one month, 171 family doctors took the opportunity to write their federal or provincial member of parliament to point out that family physicians have increasingly been asked to take on more non-care related work and bear an increasingly heavy administrative burden.

Research shows that without a family doctor they can turn to, people often neglect critical preventive health measures, such as flu shots. Statistics Canada reports that in 2019, 14.5% of Canadians aged 12 and older did not have a regular care provider. That’s about 4.6 million Canadians without a family doctor. And unless the shortage is urgently addressed, their chance of ever having a family doctor is close to nil.

“Having consistent access to a family doctor or other primary care provider is a key way to ensure we build a healthier population and ultimately avoid a more costly acute care system,” says Smart. “Prevention will always be better than trying to find a cure.”

Come to Canada

Health care workers are a mobile resource, and thousands of doctors from around the world have come to practise here. In Canada, 26% of doctors graduated from an international medical school. More than 50% of the physicians in Saskatchewan are internationally trained.

Thanks in no small part to immigration, Canada has 2.8 physicians per 1,000 people. That’s relatively low for an industrialized nation. Australia, for instance, has 3.83 physicians and Austria has 5.4 doctors for every 1,000 population.

India, Egypt, and South Africa are among the many countries with fewer than one doctor per 1,000 people. Doctors in these countries may be underpaid, overworked, and frustrated with trying to provide care in an under-resourced health care system. Consequently, some may be eager to leave their home country. But is it ethical to accept – if not recruit – doctors from a country that has a doctor shortage more desperate than ours?

Canada’s doctor shortage is bad now, and it’s about to get much worse. The solution will likely be complex, but an answer is needed now.