Biopsy of Canada's family physician shortage

Abstract

Family physicians provide comprehensive care for the community and are an integral part of the healthcare system. Canada is experiencing a shortage of family physicians, driven in part by overbearing expectations of family physicians, limited support and resources, antiquated physician compensation, and high clinic operating costs. An additional factor contributing to this scarcity is the shortage of medical school and family medicine residency spots, which have not kept pace with population demand. We analysed and compared data on provincial populations and numbers of physicians, residency spots and medical school seats across Canada. Family physician shortages are the highest in the territories (>55%), Quebec (21.5%) and British Columbia (17.7%). Among the provinces, Ontario, Manitoba, Saskatchewan and British Columbia have the fewest family physicians per 100 000 persons in the population. Among the provinces that offer medical education, British Columbia and Ontario have the fewest medical school seats per population, while Quebec has the most. British Columbia has the smallest medical class size and the least number of family medicine residency spots as a function of population, and one of the highest percentages of provincial residents without family doctors. Paradoxically, Quebec has a relatively large medical class size and a high number of family medicine residency spots as a function of population, but also one of the highest percentages of provincial residents without family doctors. Possible strategies to improve the current shortage include encouraging Canadian medical students and international medical graduates to consider family medicine, and reducing administrative burdens for current physicians. Other steps include creating a national data framework, understanding physician needs to guide effective policy changes, increasing seats in medical schools and family residency programmes, providing financial incentives and facilitating entry into family medicine for international medical graduates.

Keywords: Health Resources; Health Services; Physicians, Family; Primary Health Care; Public Health.

Figure 1

The percentage of the population without a family physician and the concentration of family physicians, medical students (per year), and family medicine residents (per year) across Canada. *The data are presented for the four Atlantic provinces combined: New Brunswick, Newfoundland, Nova Scotia and Prince Edward Island. **The data are presented for the three territories combined: Northwest Territories, Nunavut and Yukon, and represent the percentage of the population without access to a regular medical practitioner (either a family physician, a nurse or a medical specialist), given the unique geographical challenges that the territories face and the limited data that is available. AB, Alberta; BC, British Columbia; MB, Manitoba; NB, New Brunswick; NL, Newfoundland; NS, Nova Scotia; PE, Prince Edward Island; ON, Ontario; SK, Saskatchewan; YK, Yukon; NT, Northwest Territories; NU, Nunavut; Territories: Yukon, Northwest Territories, Nunavut; N/A, Not applicable.