A Review of Contributing Factors

Global Journal of Health Science: Vol. 9, No. 9; 2017
Published by Canadian Center of Science and Education
Andre V. Malko and Vaighn Huckfeldt

[Excerpt]

Abstract
The physician shortage in Canada is multifactorial. It is important to identify potential factors and policies contributing to the problem. An extensive literature review to retrieve primary source articles was performed using the PubMed database. Other sources of information included reports identified using the websites of organizations, associations, government bodies and Google scholar, as well as additional primary source articles identified using reference lists of retrieved articles and reports. Healthcare policy changes in the 1990’s limited the growth of physician supply through the reduction of medical school enrolment, restrictions on recruitment of international medical graduates into the workforce, redistribution of family physician and specialist mix and loss of physicians to the US. Inadequate supply of primary care physicians is reflected in the low interest among medical students in a family medicine career and the shortage of physicians in rural areas. Reduction of physician productivity is characterized by an aging physician population, greater proportion of women in the workforce and the reduction of direct patient care hours among the new generation of physicians. The problem is further exacerbated by inefficiencies in healthcare expenditures, judging from high healthcare spending and low physician-to-population ratio. An understanding of factors contributing to the physician shortage is essential in order to develop successful strategies to alleviate inadequate physician supply.

1. Introduction

In the 1970’s Canada enjoyed one of the highest physician-to-population ratios among developed countries and the number of physicians per population was growing steadily until 1993, reaching 1.91 physicians/1000 (Canadian Medical Association [CMA], 2015). At that time the national consensus was that Canada had a surplus of physicians. This viewpoint was reflected in the 1992 Barer-Stoddart report on physician human resources (Barer & Stoddart, 1992), which argued that there was an oversupply of physicians in Canada. The Canadian government followed up on this by implementing various policies to control the growth of the physician supply.

As a result of these policies, the net inflow of physicians into the physician practice pool dropped from 1040 physicians per year in the period of 1990-1993 to 313 physicians in the period of 1994-2000 (Chan, 2002). The absolute physician-to-population ratio (physicians/1000) decreased from 1.91 in 1993 to 1.84 in 1997 before starting to gradually increase again, such that by 2006/2007 it was at the same level as in 1993 (CMA, 2015). Moreover, the aging general population (which utilizes more healthcare services) and aging physician population (which has a lower work intensity), suggests that the “real” physician-to-population ratio in 2006/2007 was still below its level in 1993. Recognizing the problem Canadian government made a significant effort to boost the number of physicians, including the 48% increase in medical school enrolment between 2003 (7808) and 2013 (11 565) (AFMC, 2014) and incorporation of more international medical graduates (IMG) into the workforce, among other things. Despite these efforts, in 2014 physician-to-population ratio was still at 2.24/1000, which ranked Canada 28th among 34 OECD countries with an average of 3.2/1000 (Canadian Collaborative Centre for Physician Resources [C3PR], 2013).

Currently, there is a well-recognized physician shortage in Canada. Statistics Canada reported that 15.3% of Canadians aged 12 and older lack a regular family physician (FP) (Statistics Canada, 2011). The situation in rural areas is particularly alarming. Data shows that less than 10% of the total physician workforce practices in rural areas and access to specialists is even worse with only 2% of specialists residing in rural areas, where 18% of the Canadian population lives (C3PR, 2013). Physician shortage is further exacerbated by an aging physician pool (in 2013 41% of Canada’s 74 526 physicians were aged 55 or older (C3PR, 2013)) and aging general population (Canadians aged 65 and older consume 45% of the total healthcare budget (Canadian Institute for Health Information [CIHI], 2014)).

The nature of physician shortage in Canada is multifactorial. It is important to identify past and present factors contributing to the shortage currently seen in the country. An extensive literature review was performed to determine which factors most significantly contribute to the problem. Understanding of these factors is essential in order to develop successful strategies to alleviate inadequate physician supply.