Supply of doctors jumps: report

Canada had about 68,000 physicians working last year, following the biggest annual increase in medical doctors in 20 years, according to a new report.

The Canadian Institute for Health Information released its annual report on the supply and payment of doctors on Thursday.

In 2009, about 68,100 physicians were working in Canada, an increase of almost 2,700 over the previous year — more than triple the rate of growth of the Canadian population as a whole, the report's authors found, and the highest growth rate in two decades. 

Last year was also the first time since 1991 that the average age of doctors has not increased. In 2009, the average age of a physician in Canada was 49.7 years, although one in five practising doctors is still 60 or older, the analysis showed.

Since it was the first year the average age has stabilized, it's too early to say whether the reversal is a trend, but the institute plans to keep watching to see if new physicians continue to drive the average age down, said Geoff Ballinger, manager of health human resources for CIHI in Ottawa.

New graduates from medical school accounted for the biggest component in the increased supply of doctors, Ballinger said. These graduates made up 2,300 of the 2,700 new active physicians.

There was also an increase in the number of doctors returning to Canada after working in other countries. In 2009, there was a net gain of 92 doctors, the highest number in five years.

'Still behind the 8-ball'

Most of the rest of the increase came from international medical graduates trained in other countries.

Overall, there were 201 physicians per 100,000 Canadians compared to 150 doctors per 100,000 Canadians in 1979.

Although numbers are up, ideal number of doctors isn't clear. That uncertainty makes it difficult for health planners who need to anticipate future needs when it takes five to 10 years to train a new doctor.

"It's always good news when we're graduating more physicians and when we have more physicians in our workforce," said Dr. Rob Boulay, president of the College of Family Physicians of Canada.

"Does it mean that magically all of our problems are going to go away? I don't think so," added Boulay, who practises family medicine in Miramichi, N.B. 

As the number of family doctors increases, health outcomes improve, Boulay said, which is important given the expected tidal wave of chronic-disease care.

For him, the number of physicians over 50 is "dramatic."

"Twenty per cent of our physician workforce is going to probably leaving practice within the next five to 10 years," Boulay said. "We're probably still behind the 8-ball in terms of physician resources."

Head count gaps

Ballinger and Boulay pointed to several reasons more doctors could be needed:

• New doctors tend to work fewer hours and see fewer patients since they are also establishing their own families, compared to doctors from a previous generation.
• New doctors face a learning curve and need more time with each patient before they get comfortable and develop a relationship.
• Planners need to take retiring doctors into consideration.

The report gives the number of physicians, but that alone doesn't reflect the whole picture, agreed Dr. Nick Busing, president and CEO of the Association of Faculties of Medicine of Canada.

"A head count is not a bad proxy for how are we meeting the need, but it's not a very good proxy," Busing said.

"It's not all about just the numbers of physicians. What's their productivity? Are they now working in teams? Do we have a nurse anesthetist now working in our operating rooms? Do we have nurse a practitioner working in primary care? All of those things modulate how many docs, for instance, you would need."

Keeping doctors

The report also looked at payments to doctors, and they are increasing, reaching more than $17 billion in fiscal 2008-2009, with all provinces reporting a rise.

Spending on physician services represents the fastest-growing category of health spending, according to an earlier report from the institute.

Physician in-province retention is a third focus of the report.

Retention rates of Canadian-educated medical graduates who set up practice in a province other than their place of graduation was significantly lower, 44 per cent, compared to 72 per cent of those who started working where they graduated and who were still practising in the same province 10 years later.

Research has shown that once doctors are comfortable in an area where they've done their residency, they tend to stay there, Boulay said, which is why provinces are moving to training doctors in smaller communities.