TORONTO – The doctor shortage of a few years ago is being resolved and Canada could be heading towards a glut of physicians, data in a new report on the supply of doctors suggest.
The number of practising doctors in Canada is at an all-time high, with nearly 70,000 active physicians working in the country last year. Out-migration of doctors has declined, licensing of international medical graduates has increased and medical schools are pumping out record numbers of new doctors, said the report by the Canadian Institute for Health Information.
“I think the actual story here is — boy, this was all so predictable and guess what? It’s all coming to pass,” said Dr. Morris Barer, a health policy analyst with the University of British Columbia’s Centre for Health Services and Policy.
“The die has been cast, our future has been set in stone, and now we watch. And I think the people who should be really worried are the funders and policy makers across the country — because the cost pressures are going to increase dramatically.”
Barer doesn’t think Canada currently has a glut, but he’s not sure the country had a shortage a few years ago either. He said there is no magic formula for figuring out what the right number of doctors is for a country.
“Too many factors need to be taken into account in thinking about that and I don’t think that there’s any science that could ever determine that for you,” he said.
“It’s partly a function of what you’re willing to pay for and what sorts of other personnel you’re prepared to train to provide certain parts of health care.”
But more doctors probably means the push to rationalize the delivery of care by devolving some tasks to other health-care personnel — nurse practitioners or physician assistants — may suffer, Barer suggested.
Health economist Arthur Sweetman doesn’t believe Canada has a glut of doctors yet either, but suggests it might be headed that way, with large medical school intakes still underway.
The problem isn’t just about how many doctors the country has, but where they are practising and what their specialty is, he said, suggesting the country may be training too many pediatricians and too few gerontologists, ophthalmologists and orthopedic surgeons to cope when baby boomers become senior citizens.
“We have the short-term glasses on right now. We need to maybe put the long-term glasses on,” said Sweetman, a member of CHEPA — the Centre for Health Economics and Policy Analysis — at McMaster University in Hamilton.
“Are are we still going to need the really high numbers that we’re allowing into medical school now in eight or 10 years?” he questioned. “We need to be planning a decade ahead, because it takes a decade to train a physician.”
Health economists have warned that in a system that is still largely based on paying doctors a fee for every service they do, an oversupply of doctors could see more doctors doing more tests and procedures on a smaller number of patients each in order to ensure they earn a decent living.
The report on the supply of doctors was released in tandem with one that delves into what provinces and territories pay doctors.
Trying to arrive at a representative figure is complicated because the health statistics agency doesn’t get enough data to report on one stream that makes up about 25 per cent of the payments from provinces and territories to doctors, said Yvonne Rosehart, program lead for the physician team in CIHI’s health human resources unit.
CIHI calls that stream “alternative” payments, referring to monies paid to doctors who are on salaries in family practices, who get bonuses to work in rural areas where the fee-for-service model doesn’t really work, or who get other types of bonuses.
The remaining 75 per cent of payments to doctors covers fee-for-service billings.
Some doctors would make most of their income through the fee-for-service, but others would receive payments through a mixture of the two. For instance, some physicians may work the occasional hospital shift in addition to their private practice, earning a salary per shift for the one and fee-for service payments for the other, Sweetman said.
Looking at only the fee-for-service numbers, the agency estimates that on average family doctors earned a gross income of $239,000 last year and specialists earned a gross of $341,000.
Those figures would not be a doctor’s actual income — a doctor who ran his or her own office would have to cover the office overhead out of those gross figures, Rosehart said.
The report said doctors’ salaries increased by 7.4 per cent in 2010, down slightly from the 9.7 per cent and 8.8 per cent increases of the previous two years.
In terms of numbers, there were 203 physicians for every 100,000 Canadians in 2010, up 35 per cent from the rate in 1980. The number of doctors per 100,000 Canadians rose in all provinces and territories — except Yukon and Northwest Territories — over the past five years.