The Solution to Canada's Physician Shortage
Due to government restrictions on education and training, the number of physicians per capita in Canada will fall between now and 2015, unless Canada relies on foreign-trained doctors to fill the gap, according to Canada's Physician Shortage, released today by The Fraser Institute. The study also finds that future physician supply is best determined without direct government oversight and intervention.
This new study looks at the evolution of Canada's physician supply over time and the factors that helped shape it. It also provides a sensible solution to the problem.
- In 2002, Canada had many fewer physicians per capita than most other developed nations that have universal access health insurance programs. This has happened despite the fact that Canadians enjoyed one of the highest physician-to-population ratios in the developed world in the early 1970s.
- Higher physician-to-population ratios are related to reductions in premature mortality, all-cause mortality, heart disease mortality, and infant and perinatal mortality, and increases in life expectancy at age 65.
- The shortage of physicians arose because of government intervention.
- Canada's reliance on foreign trained medical graduates is having a negative effect on the supply of physicians in some lower-income countries, notably South Africa and India.
"Starting in the early- to mid-1980s, government officials and researchers voiced concern about the generous and growing supply of physicians and recommended governments reduce the number of medical education and training positions available," pointed out Nadeem Esmail, the Institute's senior health policy analyst and author of the study. "Unfortunately, this guidance was misinformed and the resulting decisions made by provincial governments have adversely affected the lives of Canadians."
A lack of access to physicians has two important consequences. First, it inconveniences those in need of treatment, which alone may be sufficient justification for policies encouraging an increase in physician supply.
The evidence examined in the paper clearly suggests that an increase in the number of physicians practicing in Canada would improve access to health care services for Canadians both in terms of access to family physicians and in terms of shorter waiting times.
The paper also finds a second important consequence: an increase in the supply of physicians will improve the health of Canadians. According to published studies and reviews of the literature on physician supply and health of the population, Canadian mortality rates will improve if there are more doctors per capita.
Although it would seem that an easy solution to the problem is to increase the number of foreign-trained doctors practicing in Canada, the paper finds that the shortage of physician services in Canada should not be overcome this way. A superior solution is to allow qualified Canadian students to acquire the education and training necessary to become physicians able to practice in Canada and to remove restrictions on the volume of services they are able to deliver.
This would have an immediate impact as physicians currently practicing in Canada would be given greater opportunity to expand the services they provide. This would also mitigate both future shortages and surpluses of physicians by more directly connecting physician training to Canadians' health care needs.
These benefits are not only predicted by theory, but also borne out in practice. "Nations that have allowed the market to determine the number of domestically-trained physicians have enjoyed greater access to doctors than those nations that, like Canada, have tried to actively manage physician supply," said Esmail.
Allowing physicians to employ international medical graduates in training (as apprentices), and other qualified health professionals to assist in the expansion of the volume of services delivered would also help alleviate the current shortage in the near term.
"The only way for Canadians to ensure that they have enough doctors to meet demand in the long term is to deregulate the supply of physician services," concluded Esmail. "Students and physicians must be free to determine their area of training and practice based on the needs of patients. The benefits of such growth in the physician-to-population ratio are many and include better health outcomes for Canadians and better access to the care that physicians deliver."