The Canadian Institute for Health Information’s (CIHI) “Physicians in Canada, 2013: A Summary Report”, indicated that the year 2013 saw the highest number of physicians ever recorded in Canada, and the increases are likely to continue, they say. As of the publication of CIHI’s summary report, there were 77,674 doctors in Canada, representing an increase of 3.4 percent from the year 2012 to 2013. And more doctors could add to this roster based solely on the number of MD (Doctor of Medicine) degrees awarded by Canadian universities. In fact, CIHI reported that Canadian universities awarded 2,662 MD degrees in 2013, a 0.8 percent increase from the previous year.
Over the past five years (2009 to 2013), the number of physicians increase at an incredibly fast rate than the population did, according to the CIHI summary report. As of 2013, the physician ratio is 220 doctors per 100,000 population. This is a 14.1 percent increase compared to the 4.2 percent increase of the Canadian population.
DEMOGRAPHY: THE CANADIAN MEDICAL WORKFORCE
Over the past several years, the female participation in the field of medicine has continued to rise, particularly among family physicians. By 2013, female doctors formed one third of Canada’s physician workforce (38.2 percent). This is reflective of the rapid increase of female involvement from 2009 to 2013, wherein the medical workforce has seen an increase of 22.5 percent in female participation. Meanwhile, over the same period, the number of male doctors rose by just 9.2 percent. By specialty, female doctors are highly represented as family medicine physicians (43.1 percent) while they only accounted for 33.2 percent as specialists.
The physician work force in this country is split almost evenly between general practitioners and specialists. Based on the 2015 CIHI data, there are a total of 40,571 family medicine physicians or general practitioners, and 38,074 specialists in Canada.
Of the medical specialties, anesthesiology (3230 anesthesiologists), pediatrics (2,533 pediatricians), psychiatry (4,196 psychiatrists), and surgery (9,754 surgical specialists) have the most number of medical practitioners.
Meanwhile neuroradiology, pediatric cardiology, developmental pediatrics, and adolescent medicine are the least represented. For instance, neuroradiology has only a total of 8 doctors (across all ages) compared to the 38,074 total number of specialists.
The average age of physicians has remained relatively stable over the past five years (49.7 in 2009 and 50.3 in 2013), according to CIHI. This is attributed to the increasing number of younger physicians entering the workforce. On average, family medicine specialists were 50.0 years old in 2013 while specialists were 50.5 years old. While the proportion of younger physicians (those who graduated with their MD degree less than six years ago) in the workforce grew slightly, from 4.8% in 2009 to 5.3% in 2013, there is a fear that the field of medicine may be facing an aging workforce. This is because over the same period of time, the proportion of the workforce that received an MD degree more than 30 years ago increased from 29.8% in 2009 to 32.9% in 2013.
From 2012 to 2013, the average gross clinical payment per physician was more than $328,000 and this has remained unchanged (0.3%) from the previous year. The average gross clinical earnings per physician ranged from $261,000 in Nova Scotia to $371,000 in Ontario.
MEDICAL STUDENTS: CSAS IN FOCUS
Canada’s doctor to patient ratio is among the lowest among industrialized nations. This is despite the 69 percent increase in medical school enrolment. However, over the decades, there has been an increasing subset of Canadians who have chosen to pursue medical education abroad. According to the Canadian Resident Matching Service (CaRMS), the definition of a Canadian studying abroad (CSA) is Canadian who has left the country to pursue medical education abroad. He or she is a Canadian born citizen or a permanent resident and may have or may have not undergone some earlier education in Canada.
This migration of Canadian medical students abroad is influenced by two reasons. Based on CaRMs’s study, the most common reason is that most CSAs felt that they would be unable to secure a place in a Canadian school. Second, more schools are opening enrolment to international students hence, attracting CSAs. In fact, approximately 80 schools in almost 30 countries reported having Canadian students studying medicine.
Demographically, the majority of CSAs continue to be male (52.5 percent) compared to females who accounted for the remaining 47.5 percent. Most of these male CSAs are older, single and with more post-secondary education than their medical student counterparts in Canada. In addition, most CSAs have not applied to Canadian medical schools as many times as thesuccessful student studying in Canada. This suggests that due to their age and higher education, CSAs opt to study abroadbecause they have decided they would not be successful inCanada, or would rather not wait several years to be successfulin their Canadian medical school applications. Finally, most CSAs (90 percent), expressed interest in returning to Canada but reported frustration with the perceivedbarriers to pursuing postgraduate education in Canada such as choice of discipline, return of service, and high competition for positions.
GOVERNMENT INITIATIVES: Attempts to increase workforce
To address the perceived shortage of medical workforce and to encourage the return of Canadians studying abroad, the government has placed strategies such as:
1. Canada Student Loan Forgiveness – The Canada Student Loan Forgiveness offers eligible doctors, residents in family medicine, and nurses who work in rural communities to receive up to $ 40,000 per student over a maximum of five years ($8,000 annually).
2. Northern and Rural Recruitment and Retention Initiative (NRRR Initiative) – This government-initiative offers financial incentives to eligible doctors who have full-time practice in an eligible community of the province. The grants range between $80,000 and $117,600, paid over a 4-year period.
3.Re-entry Program– This program funds physicians currently practicing in Canadato re-enter postgraduate medical training.
4. Repatriation Program: Additional Postgraduate Medical Training Positions in Ontario– This program funds additional postgraduate medical training positions to recruit physicians who have completed or partially completed postgraduate residency training outside Canada.
Canada may only have a perceived shortage, but this may turn into reality if Canadian students studying abroad, as well doctors who are practicing in the country are not given incentives and programs that could attract them.