Why aren’t there enough family doctors?
Barriers like red tape are making it more difficult to access healthcare in Canada.
By: Adam Suleman
Canada has a worldwide reputation for its “free” public healthcare system. While traveling, I meet Americans who glorify our healthcare system and what it supposedly promises. However, the Canadian health system faces many challenges and complications that were particularly apparent during the COVID-19 pandemic - including, crucially, not having enough family doctors. Between 2019 and 2023, the number of Canadians unable to access a family doctor rose from 4.5 million to a staggering 6.5 million. Moreover, Canada ranks lowest among ten high-income nations in terms of access to primary care physicians for routine medical needs.
In addition to longer wait times for specialists, emergency room care, and surgeries, family doctor inaccessibility has left millions of Canadians without adequate medical attention and family physicians increasingly burnt out. The Canadian Institute for Health Information (CIHI) reported a surge in unscheduled hospital visits from 14 million to 15.1 million between 2021-22 and 2022-23, a clear indicator highlighting the escalating strain on our healthcare system. This unspoken crisis that leaves Canadians without adequate medical support will ultimately worsen health outcomes, reduce life expectancy, and lead to premature death.
Family doctors are especially important in Canada because of their “gatekeeper” role in accessing medical drugs, diagnostic services, and specialists. Without primary care, millions of Canadians would be without these necessities, and as the Chair of the General and Family Practice section of the Ontario Medical Association (OMA) suggests, Canada's population health will decline. Even those patients who already have a family doctor struggle to obtain appointments. This can see chronic diseases worsening and essential services, such as cancer screenings and early diagnoses, being delayed.
In response to these challenges, the federal and provincial governments signed a multi-billion dollar accord to support “more medical residency positions and “recognition of foreign medical credentials”. However, funding alone will not meet the increasing need for primary care services from an aging population. Regulatory changes are needed to remove obstructive “red tape” for physicians practicing across the country. The Ontario Medical Association (OMA) suggests these changes should include “removing barriers to foreign credential recognition, simplifying licensing processes, and increasing program access for highly educated and skilled health professionals.”
Expanding the availability of medical residency positions could address the historic shortage of family physicians. While the population has grown by 5 million in the past ten years, only 167 medical residency positions have been added across the nation’s 17 medical schools. Dr. Kathleen Ross, a B.C. family doctor and president of the Canadian Medical Association (CMA), highlighted that “there are definitely not enough physicians working and training. We need to train more. We are simply not keeping up with the demand and number of people retiring." With an underwhelming 5% increase in postgraduate medical training admission between 2014 and 2023, further policies are needed to create and sustain medical residency positions in this country.
Unlocking the potential of foreign-trained physicians could also help address this shortage. Quotas are currently restricting the number of international medical graduates (IMG) - including both foreign-trained Canadian-born doctors, and new arrivals - that can obtain the medical residency which is required to practice in any Canadian province. To fill this gap, the Conservative Party of Canada has proposed to fast-track healthcare professionals from other countries, by introducing a standardized national exam.
Today, family medicine sees the lowest number of graduates entering the field in the past 15 years. It is not surprising given that family physicians report higher burnout rates than any other medical profession, as identified by the Canadian Medical Association. Other reasons often cited include excessive paperwork, rising overhead and labour costs and non-competitive physician fees. Better Incentives and structural changes are needed to address these issues and increase graduate-entry rates into this field.
In the face of an impending shortfall of 44,000 physicians and an anticipated 10 million Canadians being without a family doctor by 2028, policies to address this worsening crisis are increasingly needed. Announcements that Simon Fraser University and the University of Prince Edward Island are opening medical schools over the next two years, provides some hope. However, further action is needed to increase numbers of medical residency positions, support integration of foreign-trained physicians, and strengthen family medicine recruitment by improving incentivization. If implemented, this can significantly increase the number of family physicians meeting the health needs of Canadians.
Adam Suleman is a Master of Public Policy Candidate at the Max Bell School of Public Policy at McGill University. Prior to joining McGill University, Adam worked at Canada's largest healthcare IT provider TELUS Health to transform healthcare and improve health experiences through digital innovation.
I've been reading Jane Philpott's book, "Healthcare for All." She proposes completely revamping primary care to provide universal access to a "primary healthcare home" to everyone in Canada. She says that in education, we can provide universal access to school for children in every part of the country. Primary care could be organized this way as well. Some people already have this – she mentioned about 25% in Ontario – and that it's a far better model of practice, but we need to make it available to everyone, i.e. 100% of the population. She says it could be done within ten years and would not be expensive – about $500 per patient per year. The downstream payoff would be enormous: fewer emergency visits,better healthcare outcomes for patients, less doctor burnout.
Interesting article!
I slightly question the focus on reducing red tape, however. It’s all very well and good to allow newcomers to practice their trade and make it less burdensome to open up new spots, but making it easier to do won’t guarantee that it’ll actually happen.
On foreign doctors, there’s only so many doctors that come to Canada and it won’t be enough to fill the gap. This is particularly true in Quebec, where bilingualism in English and French is often an additional requirement (despite the gov of QC insisting it isn’t). Furthermore, are we really saying that the way to solve our problems is to lure people away from helping thier own countries? There’s a global shortage of doctors, I’m not sure it’s the just thing to contribute to that.
What we need instead is to increase the amount of doctors this country produces domestically, and that can only be done by heavily investing in both expanding the size of our medical school and, crucially, lowering the cost of admission. Furthermore, there will only be more residency spaces if funds are made available to support them.
So yes, the conservative plan sounds like a nice, simple solution, but it’ll be a drop in the bucket that ultimately just acts as an excuse not to make the investments that are needed.
The healthcare system has been neglected by all level of government for decades. Sometimes you just have to spend the money.