Doctor supply outpaces population

The number of doctors practising in Canada is increasing at a faster rate than the population, according to a new report released Thursday.

The 176-page study by the Canadian Institute for Health Information looked at the supply, migration and distribution of physicians in Canada in the last five years.

Between 2004 and 2008, the number of active physicians in Canada grew from 60,612 to 65,440, representing an eight-per-cent increase across the country. Over the same time, the country's population grew by 4.3 per cent.

Before 2004, the number of doctors was increasing at the same rate as the population. 

"The incline in the number of enrollments in medical school, paired with us seeing a larger number of doctors in the workforce now, and also that they don't retire at 65 … breeds a story that there are more doctors out there for the public," said Yvonne Rosehart, who heads the health human resources branch at the institute in Ottawa. "And it should continue in that vein."

It was a different story in the 1990s, when enrollment in medical schools was restricted, she said.

"We have obviously woken up to the fact in the last few years that we have this significant shortage of physicians," said Dr. Cal Gutkin, executive director and CEO of the College of Family Physicians of Canada.

The majority of physicians age 70 to 79 in 2004 were still in the workforce in 2008, a pattern that does not hold for other health care professionals such as nurses.

The report showed that 13.8 per cent of specialists and 8.8 per cent of family medicine physicians are 65 or older.

Retiring later

Professionals who are self-employed, including doctors, tend to work longer generally. Physicians spend a lot of time in school and start working later in life, but Canadians benefit from their years of experience in practising, teaching and doing research in medicine when they don't retire at 65, she added.

"A lot of physicians, and this affects smaller communities, are not retiring because they can't find anybody to replace them," said Dr. Andrew Padmos, CEO of the Royal College of Physicians and Surgeons of Canada.

"This is both good and bad. Good in the sense that it's nice to have a wise, experienced practitioner. It may not be so good in the sense of replenishing the supply of bright, young and very keen physicians coming out of training. So there is a balance there."

While some surgeons are working fewer hours because of a lack of operating time, others are burning out from stress, Padmos said. So while it's great that CIHI is counting heads, it doesn't address the whole picture, he said.

Despite the report's findings, Dr. Bruce Fleming, executive co-ordinator for the Council of Undergraduate Associate Deans at the University of British Columbia, said he's still hearing about communities that are underserved. Small and medium-size communities in the province are short of not only family physicians but also general or orthopedic surgeons.  

During pre-budget hearings this month, Padmos urged the federal government to fulfill its election commitment to fund new residency spots in teaching hospitals, including for doctors returning to a specialty, changing specialties as well as international medical graduates.

Younger MDs working shorter hours

The report confirmed a trend towards feminization of Canada's doctors from what was once a male dominated profession. Among new family doctors in 2008, 52.1 per cent were female, as were 45.1 per cent of new specialists.

Younger doctors, both male and female, are also working fewer hours than in previous generations because of their commitment to quality of life. At the same time, an aging population of patients needs more complex care, which creates a perfect storm in demand for physicians, Padmos said.

The recession has also hit many doctors who are working longer because they can't afford to retire, he noted. 

As the number of doctors increased, there was also an overall increase in what health ministries paid. In 2007–08, the latest year of available data, the average payment per physician who received at least $60,000 in fee-for-service payments increased to $266,031 nationally, representing an increase of 4.6 per cent from the year before.

There were also differences in migration trends between provinces and territories.

After 10 years, almost two-thirds or 66.2 per cent of Canadian-trained physicians were still working in the province where they started, compared with 33.5 per cent of foreign-trained physicians.

Between 1998 and 2008, Alberta and British Columbia experienced a net gain of physicians every year from other provinces, compared to Newfoundland and Labrador, Quebec, Manitoba and Saskatchewan, which all experienced net losses of physicians every year of the decade.

The report used Scott's Medical Database, which includes almost all medical doctors in Canada — not only those who see patients but also those working in research, teaching and administration.