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Physician Shortage in Canada: Past and Present Thoughts.
Xiomara Arias Fernandez
HESA 4000: Canadian Health Delivery System
Dalhousie University
Fall 2009

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According to Chan (2002), since the second millennium started there has been a public
clamour in physicians’ circles that there was a shortage of physicians in Canada. In an escalating
fashion, this became the common conception and policy-makers and governments decided to
take it seriously applying measures in order to augment the reserve of doctors. Consequently by
2002 medical school enrolments soared and an increasing number of foreign medical graduates
were being allowed entry into the health system, increasing the number of family doctors but
also decreasing the number of specialists (Phillips, Peterson, Fryer & Rosser, 2007). In fact,
according to the Canadian Institute for Health Information as cited by Phillips et al (2007), in
2004 there was an increment of four percent (per 100.000) in the number of family physicians
and a decline of two percent in the number of specialists. Paradoxically, a decade before, the
uniform consensus was that Canada had a physician surplus and thus policies were directed to
regulate and to repress such as supernumerary physician’s number. Chan (2002), who analyzed
the roots of the claimed “shortage” in the 1990’s, reported that there were changing patterns in
Canada’s patient population and physician workforce which heavily influenced the supply
/demand in medical services and decreased physician inflow. Chan’s report also points out that
undoubtedly the implementation of policies in that decade contributed to assisting those changes.
The views of Chan in his report were useful in unveiling cardinal determinants surrounding the
boom of physician shortage early in the second millennium and with guidelines and
recommendations at hand the issue seemed heading towards resolution. However, nowadays the
topic of decreasing physician supply has not vanished. It is yet a concern perceived as a threat to
the health system’s stability – the polemic issue continues to be debated – and still authors with
erudition in the matter are consigning their opinions and pursuing studies to reveal potential

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solutions. The purpose of this paper is to overview the old and the more recent forces that have
driven physician shortages in Canada. As will be shown, critics have suggested proposals to deal
with the imbalance in demand and supply of medicine professionals.
To McElroy (2004), the causes of physician shortage are complex. In his opinion two of the
most significant factors contributing to the issue are the tendency that students have to select
specialities other than family medicine and locations that are less needed (i.e. underserviced rural
communities) and the issue of physicians’ displacements to other countries. In relation to the last
factor, Alvarez, Selmer and Leeb, (2002) stated that: from 1.995 to 1.997 “There… [was]…
considerable interest in international migration of health professionals” (p. 20) and according to
them, Statistics Canada reported approximately 1,380 graduated of healthcare programs moving
to the United States in those two years. In effect, as also Phillips et al. (2007) established, the
Canadian-educated physicians’ emigration to the U.S is one of the major contributors to the
shortage. It is Interesting to note that Philips et al. (2007) state that the tendency to migrate has
been maintained until recently: from 1995 to 2005 The Canadian Medical Association reported a
loss of 2,323 of practicing physicians who went to the U.S.A (Watanabe, Comeau & Buske,
2008).
Physician departure and retention play a valuable role in health workforce shortages
(Decter, 2002), and these two factors have been analyzed by many other authors. For instance, as
shown by Cohn, Betancourt and Simington (2009) various elements, other than the natural
process of retirement, are crucial in causing brain drain and physician turnover. Contrary to what
is commonly thought, according to Atchison and Carlson, (as cited in Cohn et al, 2009) monetary
compensation is one of the lesser motives because physicians renounce their practice and move
to other places. Similarly in the investigation conducted by Wong (as cited in Cohn et al, 2009)

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one of the main causes for why physicians change workplaces, is to look for job satisfaction and
this is determined mainly by recognition, respect and a sense of belonging more than monetary
reward. To recognize these extents is critical in leading healthcare management organizations to
effectively create a plan to achieve physician retention in order to improve the physician shortage
issue (Rondeau, 2002).
In looking for a rationale about physician shortage, part of McElroy’s (2004) same vision
was already held by the Canada College of Family Physician (CCFP). In 2004, The CCFP
analyzed the accountability that some medical schools have in students’ career choices. The
CCFP report revealed that there is a need to enhance more believable roles and recognition of
teachers in the family medicine discipline, otherwise students will continue to have a distorted
impression that family doctors lack of values and that they play a secondary role in the
healthcare system. A distorted view of the family physician’s role plays in the health
community, could lead undergraduates to carry out other more meaningful specialities,
neglecting indirectly sooner or later a sustainable supply of family physicians across the country.
Complementary, the medical schools also exert great control over faculty values and attitudes of
students, influence them in entering to rural primary health practice, this could contribute with
the recruitment and retention of physicians in rural areas (Curran & Rourke, 2004).
On the other hand, Busing et al. (2007) disagree with McElroy’s (2004) and suggest that
shortages in Canada correspond not only to family physicians, but also to all other specialities
and to all geographic regions, not only the rural ones. Busing et al (2007) firmly think that
changing patterns in delivering care will not be successful in altering positively the results of the
lack of physicians in Canada. According to Busing et al (2007), it seems that an answer to
shortages is to execute “self-sufficiency” to increment the number of all medical professionals.

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In order to achieve “self-sufficiency” Busing et al (2007) point out that more Canadians students
should be admitted to medicine schools (with the current increase of infrastructure and human
resources to teach), and more international medical graduates should be targeted to enter the
health system.
Although the above insights are accepted by many other authors (e.g., Decter, 2002), inter-
professional practice and team-based care have also been suggested by some as measures to
enlarge the scope of health professionals and deal with shortages. (Masoti, Rivoire, Rowe, Dahl
& Plain, 2006). Shekter-Wolfson (2007) and Allison (2007) take this alternative seriously
highlighting the importance of more proactively linking universities and colleges around
collaborative patient-centred practice as part of the medical curriculum to improve future
healthcare delivery and to address eventually physician shortages.
Finally, measures to focus on mitigating the unavoidable physician turnover (more
specifically, physician retirement rates) have been emphatically exhorted by Watson and
MacGrail (2009). They strongly support the idea that rather than concentrating on increasing the
overall number of physicians, efforts should be directed to strengthen the quality of primary
service by preserving the number of family physicians over the number of specialists being
trained in the medical schools. According to these authors, it is incorrectly assumed that a
general increase of physicians per capita would promote better outcomes in the health of the
population. Just after compare data from nineteen countries of The Organization for Economic
Cooperation and Development (OECD) in 2002, Watson and MacGrail (2009) came to the
shocking conclusion that there was no association between avoidable mortality and overall
physician supply. The results of Watson and MacGrail (2009) show that further research is

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necessary in order to throw more light on the issue of physician shortages and on the role that
physician’s number per area could play in satisfy or not the perceived demand.
This paper has addressed a handful of numerous past and actualized views relating causes,
interpretations and answers to the topic of physician shortages. Among other reflections that
have been brought to discussion are the role of the migration in the health workforce, the
accountability of medical schools in provoking depletion of physicians, and the perceived
shortage of family physicians. This paper has outlined diverse authors’ views with opposed or
equal lineaments about shortage of medical professionals, leaving to the discretion of the readers
the opportunity to develop their own opinion, debate the ideas exposed, or give
recommendations on the issue. Whether or not physician shortage represents a primary obstacle
in delivering health care with appropriateness and to what extent the issues have been
statistically enough documented to be given resolutions, are judgments that should be thoroughly
reviewed having qualified and reliable data at hand. The concepts emerged in this paper lead to
acquiring a greater understanding of the challenges in shortages and encourage stakeholders in
general to actively engage in addressing such important human resource issues in the healthcare
system context.

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References
Allison, S. (2007). Up a river! Interprofessional education and the Canadian healthcare
professional of the future. Journal of Interprofessional Care. 21(5) 565-568.
DOI: 10.1080/13561820701497930
Alvarez, R., Zelmer, J. & Leeb, K. (2002). Planning for Canada’s health workforce: Looking
back, looking forward. Canadian Institute for Health Information, Toronto, Ontario,
Canada. Health Care Papers Journal. (3)2 12-26.
Busing, N., Hebert, P.C., Stanbrook, M., Sebbald, B., Flegel, K., MacDonal, N. & Attaran, A. (
2007).Managing physician shortages: We are not doing enough. Canadian Medical
Association Journal (176) 8 (1057).
DOI:10.1503/cmaj.070258
Chan B. (2002). From perceived surplus to perceived shortage: What happened to Canada’s
physician workforce in the 1990’s? Ottawa: Canadian Institute for Health Information.
Cohn, K.H., Betancourt, B. & Simington, M. (2009). The lifelong interactive process of
physician retention. Journal of Healthcare Management, 54(4) 220-226.
Curran,V. & Rourke,J. (2004) . Medical Teacher. 26 (3) 265–272
Decter, M. (2002). Canadian Healthcare: Time to Plan for the Providers. Health Care
Papers Journal, 3(2) 76-79.
Masoti, P., Rivoire, E., Rowe, W., Dahl, M., Plaine, E. (2006). New additions to the case study
libraries. Collaborative Partnerships: Managing increased healthcare demand without
increasing overall system capacity. Healthcare Quarterly (9) 2: 72-76

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McElroy, R. (2004). Canada’s shortage of physicians. Canadian Family Physician Journal,
50(3) 349.
Phillips Jr., R.L., Peterson, S., Fryer Jr., G.E. & Rosser, W. (2007). The Canadian contribution to
the US physician workforce. Canadian Medical Association Journal, (6)8 1083-1087.
DOI:10.1503/cmaj.060525
Rondeau, K.V. (2002). Health human resource planning requires an effective staff retention
policy. Health Care Papers Journal, 3(2) 45-49.
Shekter-Wolfson, L. (2007). Interprofessional education: a college perspective. Healthcare
Quarterly Journal, 10(4) 8-9
The College of Family Physicians of Canada. (2004). Family Medicine in Canada. Vision for the
future. Ontario.
Watanabe, M., Comeau, M. & Buske, L. (2008). Analysis of international migration patterns
affecting physician supply in Canada. Healthcare Policy, 3(4) 129-138.
Watson, D.E & MacGrail K.M. (2009). More doctors or better care? Healthcare Quarterly
Journal, 9(4) 101-104.