Shortage of family physicians in Canada will get worse without strong moves by governments
It used to be so simple! After we moved in the 1960s, my mother found us a new family doctor, as I recall, by looking one up in the phone book. She likely asked: when can you see us? — “How about next Tuesday?”
It was often that easy to book a GP.
This has all changed in recent decades, as everyone sees. Finding and keeping a family doctor today is a real worry.
Somewhere between 15 and 20 per cent of Canadians have no family doctor. In B.C., roughly one million people have no GP, while a McGill survey concludes 2 million people in Quebec have none. In Ontario, the figure is officially 2.2 million; the Ontario College of Family Physicians said that by 2026 that shortfall may rise to as high as 4.4 million.
Alarm bells were ringing throughout the early 2000s, as hospital emergency wards became clogged with people seeking basic care.
Now we face a Boomers’ Crunch: boomer-age doctors are retiring in large numbers, just as their cohort seeks more medical care as seniors.
In my Townships locale, two doctors retired in the last decade, with no replacements in sight. We joined a cooperative clinic 20 km away for nursing services and referrals, as needed, to an MD. That works, but nobody thinks it is ideal.
Overall, the doctor shortage risks getting worse before it gets better.
Canadian Medical Association data show Government recruitment websites advertised full-time positions for 2,571 family doctors in late 2022. But only 1,461 completed the postgraduate training required to become licensed family doctors that year.
How did this crisis come about in a rich, developed country?
Specialization an issue
Many analysts point to budget cuts. In the early 1990s, during a deep recession, Canadian governments agreed to reduce medical admissions.
As the Toronto Globe and Mail reported in 2022, “Much of the decline in the share of younger doctors can be traced to 1992, when provincial health ministers agreed to cut medical school admissions as part of a plan to curtail mounting health care costs. A Canada-wide 10-per-cent reduction in admissions in the 1993 academic year left the country with fewer doctors entering postgraduate training for the first time, beginning with the graduating class of 1997.”
These cuts, concludes the paper, “resulted in Canada losing part of a generation of doctors”.
Another point of view is put forward by Dr. Anthony Sanfilippo, professor of medicine at Queen’s University. He wrote a 2023 op-ed titled, aptly, “This is why you don’t have a family doctor” and he is author of a new book, The Doctors We Need (Sutherland House Experts).
Dr. Sanfilippo stresses that medical education has changed, with more specialist training. This downplays general practice. When Sanfilippo graduated from medical school in the early 1980s, he was fully trained to start a practice after one year of internship. Today’s graduates are not, given the number of specialties that crowd medical training.
“Canadian medical schools graduate approximately 3,000 new doctors each year … but only about 45 per cent are choosing to engage in family medicine as a career, and just 50 per cent of those are opting to provide the continuing and comprehensive care that would address the needs of unattached patients”, he writes.
Sanfilippo spoke with Townships Weekend recently, and noted that, while each institution in the doctor-certification process does its job well, there is “no consolidated oversight”. We are left, for example, with family doctors working at a piecework rate, while a team approach and single fees might serve patients better.
A career full of obstacles
Some medical students avoid a career path that seems full of headaches.
Most family doctors, after all, must run a small business whose expenses —from office rental and computer service to staff —are entirely dependent on them. Patients suffer from multiple, complex issues. Time is short with many demands in doctors’ workdays. Paperwork stifles any extra time with sick people.
Macleans magazinein 2021 published the personal account of a youngish doctor, a female with four children, whose life in small-town B.C. might resemble the rural Townships.
In “A doctor’s dilemma”, Dr. Kristi Herrling recounted her daily life, starting with 6 a.m. wakeups, managing her children through school prep, then opening her medical office. After a work day often disrupted with emergencies, she helps her husband to make the family supper. She is finally free at 8 p.m. for a further 2-3 hours of paperwork and clinical data.
This includes all manner of tasks: “charting patient visits, checking labs, reviewing imaging, requesting consults, reading specialist reports, filling out forms, researching unusual presentations, advocating for patients, answering pharmacist queries, speaking to home care nurses, and discussing cases that can’t wait with specialists”. Such administration often takes up 25 per cent of a doctor’s time.
As for time off, Dr. Herrling despairs that a “locum”, or replacement doctor, is often elusive to cover her small-town practice.
Before we can graduate more doctors, governments across Canada must act to get the most patient hours from the existing pool of doctors. To this end, several provinces have expanded the responsibilities of nurse practitioners. Pharmacists in Alberta have been granted more initiative in issuing prescriptions.
Quebec has taken welcome steps to reduce paperwork: signing notes to certify student or employee sick leaves has traditionally made doctors “the police arm of human-resource departments”, said observers. Bill 68 has made this optional. Doctors will also be exempted from approving insurance and workers’ compensation claims. Quebec estimates these reforms will cut unnecessary appointments —up to 750,000 annually.
More practical action is needed, and more general-practitioner grads must be graduated for a growing country. Otherwise, regular appointments with the family doctor could become a thing of the past.
Article originally published in Townships Weekend supplement of the Sherbrooke Record, June 2024.
