Commission on the Reform of Ontario's Public Services

We have fewer physicians than other jurisdictions
Numerous studies suggest that we do not have enough medical doctors. The CIHI concluded
that fewer physicians per capita in Canada “may lend insight into why Canadians continue to
report difficulties in accessing health care when compared to other countries.” 16 According to
the World Health Organization, among the countries in the Commonwealth Fund report, only
Australia has fewer physicians per capita. At 19 physicians per 10,000 people, Canada
compares unfavourably to the United States at 27 and especially to the continental European
G7 countries where most are well into the 30s. On the basis of raw data, Canada is in the
middle of the OECD pack on physicians per capita. Yet in a 2008 report, 17 the Fraser Institute
calculated that adjusting for population age, Canada tied for 23rd out of 28 comparable OECD
countries on physicians per capita. And Canada seems to be falling behind: 24 OECD
countries increased their physician-to-patient ratio by at least 10 per cent from 1990 to 2008
whereas the ratio only improved five per cent in Canada. 18 Further, 22 per cent of Canadian
physicians are over age 60 so there is a pending wave of retirement. 19 The effectiveness of
physicians is also constrained in Canada because of their low use of electronic records.
The Commonwealth Fund report found that only 37 per cent of Canadian physicians used
electronic records to serve their patients, the lowest rate among the 11 countries studied.
The trends in Canada since 1990 are still heavily influenced by cutbacks of the 1990s.
During the past decade, however, the number of most health practitioners has grown.
According to CIHI, the number of physicians graduating from Canadian medical schools
climbed by almost 50 per cent between 1999 and 2009. Between 2001 and 2008, there was
an increase of 16 per cent in registered physicians and 15 per cent in registered nurses;
between 2004 and 2008, the number of nurse practitioners grew by 90 per cent. 20
These statistics appear to make a definitive case that we have not only fewer doctors than
elsewhere, but too few doctors in absolute terms. This may not be the case. It may simply be
that we do not make efficient use of their time. Suppose that nurses relieved doctors of the
task of giving most vaccinations. Suppose that a full set of electronic records enabled an
elderly person to stop making multiple visits to different doctors, explaining his or her ailments
again and again. Suppose that pharmacists played a greater role in issuing prescriptions.
These and other changes could free up enough physicians’ time, perhaps by enough to
reduce, if not eliminate, any “shortage” of doctors.
16 Canadian Institute for Health Information, “Health Care in Canada, 2010,” p. 85, downloaded from
https://secure.cihi.ca/estore/productSeries.htm?pc=PCC64.
17 Fraser Institute, “How Good is Canadian Health Care? 2008 Report,” p. 55, downloaded from
http://www.fraserinstitute.org/research-news/display.aspx?id=13104
18 CIHI, “Health Care in Canada, 2010,” op. cit., p. 85.
19 Ibid., p. 84.
20 Ibid., pp. 82–84.
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