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Science

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 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 aneight-per-cent increase across the country. Over the same time, the country's population grew by 4.3 per cent.

Family physicians by sex, province or territory (2008)

Female Male Total
B.C. 1,787 3,184 4,973
Alberta 1,489 2,524 4,016
Saskatchewan 308 624 946
Manitoba 373 762 1,152
Ontario 4,221 6,883 11,106
Quebec 4,062 4,669 8,766
New Brunswick 321 470 801
Nova Scotia 463 651 1,116
Prince Edward Island 42 100 142
Newfoundland and Labrador 192 378 583
Nunavut 5 5 10
Northwest Territories 13 20 33
Yukon 33 32 65
Totals 13,315 20,296 33,712

Note: Totals include physicians whose sex was not known.

Source: Scott's Medical Database, Canadian Institute for Health Information

Before 2004, the number of doctors was increasingat 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 adifferent story inthe 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 showedthat 13.8 per cent of specialists and 8.8 per cent of family medicine physicians are 65 or older.

Retiring later

Professionals whoare 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 medicinewhen 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."

Doctors old and young

There are 550 family physicians over the age of 75 in Canada: 168 of them are between the ages of 80 and 90.

There are 426 family physicians between the ages of 20 and 29 in Quebec. The province with the next highest total Alberta has 212.

Source: Scott's Medical Database, Canadian Institute for Health Information

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 thatCIHI 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 hearingabout 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 urgedthe federal government to fulfill its election commitment to fund new residency spots in teaching hospitals, includingfor 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.

Family physicians in practice

There are currently about 27,000 to 28,000 family doctors practising clinical medicine, estimated Gutkin.

"We were down to a low in 2004 of 23 per cent of students across Canada selecting family medicine as their first-choice career, and now, this year, we were up to 32.5 per cent," he said.

But more than 40 per cent need to choose the specialty to produce the number of family doctors needed on an ongoing basis in Canada, Gutkinsaid. Hecalled for better support for doctors, such asthe opportunity to work in teams and access electronic records.

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'tafford to retire,he noted.

As the number of doctors increased, there was also an overall increase in what health ministries paid. In 200708, 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 theystarted, 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 usedScott's Medical Database, which includesalmost all medical doctors in Canada not only those who see patients but also those working inresearch, teaching and administration.

With files from the Canadian Press