Is there a doctor shortage in Canada?

Physician Shortage

Is there a doctor shortage in Canada?  About 5 million Canadians cannot find a family physician.  We wait months to see a specialist.  People experiencing severe mental illness generally wait months and in some cases over a year to see a psychiatrist.  We wait months and even years for surgery.

However, it is an uncontroversial fact that there are literally thousands of medical doctors in Canada who have met the Canadian standard by passing the Medical Council of Canada examinations.  The problem is that our government has erected barriers which prevent them from becoming licensed to practice.

These barriers accord with the government’s fiscal policy.  In the early 1990s Canadian provinces adopted the Barer Stoddart economic theory of health care management:  If we control the number of physicians, we control public access to health care, and thus we control health care spending.

In Canada, the correct number of physicians is not related to public need.  It is a simple matter of dividing the provincial allocation of the health care budget for physicians by the average cost of a physicians.

When the Barer Stoddart economic theory was adopted by provincial ministries of health, the number of physicians that Canada trained dropped dramatically.

Because we have a government controlled universal health care system, it is a simple thing for the government to control the number of physicians by controlling the gateways to licensing.

Allow me to explain:  Most immigrant physicians and all new medical graduates must work in entry level jobs as resident physicians before they can become fully licensed to work in Canada.

The provincial ministries of health control the number of these residency positions for the purpose of controlling the number of physicians who can become licensed to practice.

The provincial ministries of health have a monopoly over the residency training required for Canadians (whether born or immigrated here) to become licensed.  There is a government report which states that there are municipalities, community groups, and large corporations who are so desperate for physicians that they would fund residency training positions. But this is not allowed.  If it were, the government would lose control of being able to control the number of licensed physicians.

I would like to provide you with some data.  I am going to use BC as my example.

Last year (2020/2021 year), 515 physicians stopped practicing medicine in BC.

Last year BC funded the training of 349 new resident physicians. In addition, about 30 immigrant physicians were individually assessed to practice as family physicians.  This allows licensing of 379 new physicians.  Thus, BC was short by 136 if our only goal was to replace those physicians who stopped practicing last year.

Because of additional demand caused by COVID, logically we would expect the ministries would be training more physicians considering physician burnout and physicians and other health professionals predicting the collapse of our medical system because of professional shortages.

But that did not happen.  For the year before last (2019/2020 year) (with the decision-making being before COVID) BC funded 352 resident physician positions.  So, after COVID, the BC Ministry of Health decided to cut 3 residency training positions.  Across Canada last year, the number was reduced by 32.

This is predictable, when viewed from the fiscal management theory from which Canadian health care operates.  Although the government presents a narrative that it is working to meet Canadian health care needs, this narrative is created to assuage the public for political reasons.  The narrative in fact is contradicted by facts.

Last year across all Canada there were 1831 Canadian citizens and permanent residents who met or exceeded the minimum Canadian standard who applied to work as resident physicians in Canada.  Because the ministries of health and faculties of medicine segregate and restrict Canadians who graduated from international medical schools to a small number of positions, only 410 are working as physicians today.  Working as a resident physician is a pre-requisite to becoming fully licensed for all new graduates and most immigrant physicians.  In 2021, 1421 Canadian citizens and permanent residents who are qualified and applied to work are not practicing because of government fiscal policy to restrict the number of physicians who can be licensed.  Many other qualified applicants have given up trying to get these entry level positions because the costs related to application are great and the chances of success slight.  This barrier is not related to competence; it is a function of the government only allowing a trickle of physicians into the licensing pathway.  Studies report that many of these physicians who have met the Canadian standard to work as resident physicians are literally driving taxis.

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The fact is that our health care system is grossly mismanaged, and the glaze the government puts on this subject is political, not factual.

It is not accurate that immigrant physicians and Canadians who studied medicine abroad are not licensed because they have not had their credentials recognized nor that they are a threat to public safety.  Objective evidence demonstrates that graduates of Canadian and American medical schools are held to a lower standard when applying for entry level jobs than those who graduated from international schools.

The fact is that the physician shortage Canadians experience is a function of the government barricading the door to thousands of qualified physicians.  The barricades are a function of the fiscal management policy practiced by our government.

Canada’s health care system consistently ranks at or near the bottom of developed countries.  We are the 4^th last in number of ICU beds out of 36 developed countries.  We ranked 7^th last in ratio of physicians to population.  We consistently have the longest waiting lists.

Despite “universal” health care 17% of Canadians report that the cost of health care is a barrier to care.

For comparison, Germany is a country that spends about the same amount as Canada on universal health care.  Germany has about 75 million people (compared to Canada’s 38 million) and is one of the top-rated health care systems in the world compared to Canada which is consistently rated as having one of the worst systems in the world.  Canada has 2.7 physicians and 1.4 government administrators per 1000 people.  By comparison Germany has 4.25 physicians and 0.15 administrators per 1000.  Although Germany and Canada spend essentially the same, Germany has more family physicians, more specialists, more acute care beds, more psychiatric beds, and far surpasses Canada in its inventory of diagnostic equipment.  Where Canada excels is in the number of administrators: we have 10 times as many administrators as Germany.