What doctor shortage?

Earlier this year the Parisbased Organization for economic cooperation and development (Oecd) released the results of a survey of average waiting times for medical care in 25 countries. This was not a shining moment for canada.

Waits for most medical services are far longer here than in most of the comparator countries. This is simply the latest evidence seemingly supporting the notion of a “doctor shortage” that has been a recurring theme in the canadian public discourse for the past 20 years. but a closer look at the evidence shows that, if anything, our problem will soon be too many doctors.

Over the past 15 years, firstyear medical school enrolments in canada have almost doubled, from 1,575 in 1997-98 to about 3,000 in 2012-13, during which time the population increased by less than 25%. The number of foreign medical graduates entering practice in canada annually has also more than doubled since the year 2000. Over that same period, the number of canadians who obtained their medical degrees internationally and entered practice in canada annually has increased 250%. The canadian Institute for Health Information (cIHI) reports released this week indicate that between 2008 and 2012 the number of physicians rose three times faster than the growth of the overall population, and for the sixth year in a row, the number of physicians per population has reached a new peak and is continuing to rise.

More doctors does not always translate directly into more care provided — not every doctor works in a hospital or clinic, or puts in the same hours as another might. but these figures highlight some troubling trends. We are only just beginning to see the effects of the expansion in domestic training capacity. In other words, we are in the early stages of a dramatic expansion in physician supply that will continue for decades. contrary to the continuing doctor-shortage rhetoric from ill-informed or interested parties, a “physician glut” appears already to be in the pipeline. even our aging population will not need all these new physicians — every study ever done has found that demographic change adds only about 0.5% annually to per capita use of services.

Meanwhile, average medical expenditures per physician in canada (adjusted for fee changes) have been rising, not falling, even as the overall supply of trained physicians expands and the average hours worked by each doctor falls. If average hours of work are falling, how is it that adjusted payments per physician are rising? either physicians are delivering more services per hour, or their fees are actually rising much faster than the official fee schedules show (or both). And if they are finding ways to deliver more care, in spite of putting in fewer hours, how is it that we need more doctors?

Some patients continue to have difficulty finding family doctors, and face excessive waiting times, particularly for certain specialists and some diagnostic tests and surgeries. These are real problems. but evidence is beginning to emerge of canadian-trained doctors who cannot find work in their home country. We suspect this is the beginning of a new and unfortunate trend.

An estimated 3,570 canadians are currently studying medicine at schools in the united Kingdom, Australia, Poland, the caribbean and elsewhere. Assuming a four-

Despite long wait times, Canada is actually facing a glut of physicians, some of whom can’t find work

year training program, these soon-to-be-doctors represent a potential increase to domestic supply of nearly 900 new physicians per year, a dramatic increase from the current rate. To enter practice they must not only pass canadian qualifying examinations and complete residency (specialty) training here; but there are not enough residency positions to meet expected demand. Again, the problem is too many doctors, not too few.

canada’s health services need to recognize the reality of the new domestic training situation. The goal shouldn’t be more doctors, but getting the physicians we already have (or soon will) the training, expertise and resources to ensure they can find work where canada needs them.