May 23, 2024 - Canada has the highest number of general practitioners per capita, a new study from the C.D. Howe Institute has found, and the lowest access among comparator countries. This lack of access to family physicians is quickly becoming a critical issue in Canada, with millions of Canadians lacking access to a primary care provider.
In “The Doctor Dilemma: Improving Primary Care Access in Canada,” author Tingting Zhang investigates this paradox and reports on recent provincial progress in implementing strategies to improve access to primary care. She analyzes the supply and demand for family physicians in Canada and highlights five well-established strategies for improving access to primary care, all of which the provinces are pursuing to varying degrees.
“Addressing primary care access challenges with many interrelated contributing factors is a challenge for policymakers,” states Zhang. “Canada requires a comprehensive approach that combines strategies to improve access to primary care.”
Without changes to the status quo, the analysis shows the gap between the supply of and demand for family physicians is likely to grow. Many factors contribute to current primary care access challenges. Similar to the population, the physician workforce is aging and there are not enough new medical graduates to both replace retiring physicians and take on the growing population of patients that don’t have a regular family practitioner. Physicians have also been spending fewer hours on direct patient care over time. Unnecessary administrative work, in particular, requires about 18.5 million hours of physician time every year in Canada, equivalent to 55.6 million patient visits. In addition, economic and cultural factors contribute to medical trainees preferring to specialize instead of opening up general family practices.
The report examines five well-established strategies for improving primary care access and summarizes recent provincial policy actions to implement them:
- Expanding the number of training positions for prospective family doctors and accelerating pathways for international medical graduates to enter family medicine, whether direct-to-practice or through access to residency positions;
- Reducing the administrative burden for family physicians;
- Providing alternate payment models;
- Expanding the scope of practice of other primary care providers; and
- Expanding team-based models of care.
Some provinces have only taken limited steps to improve primary care access, such as Quebec in expanding scopes of practice for non-physician healthcare professionals to provide some primary care. Other provinces, such as Nova Scotia, are implementing more comprehensive strategies to address primary care access challenges. Improving access to primary care is a challenge across the country. Comparing and contrasting the policies across provinces shows that some provinces are taking more aggressive actions to improve than others.
For more information contact: Tingting Zhang, Junior Policy Analyst, C.D. Howe Institute; and Lauren Malyk, Senior Communications Officer, C.D. Howe Institute, 416-865-1904 Ext. 0247 or lmalyk@cdhowe.org.
The C.D. Howe Institute is an independent not-for-profit research institute whose mission is to raise living standards by fostering economically sound public policies. Widely considered to be Canada's most influential think tank, the Institute is a trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based and subject to definitive expert review.