Changes in Canada's medical workforce could affect access to care

A new survey, the largest ever poll of Canada's physicians, indicates that medicine in Canada is changing, with profound implications for supply of physicians and access to care. More than half of all medical graduates are now women, and female doctors reported working seven hours a week less than their male counterparts (47 hours a week compared with 54).

The 2004 National Physician Survey was a collaboration by three of Canada's largest medical organisations, the Canadian Medical Association, the Royal College of Physicians and Surgeons of Canada, and the College of Family Physicians of Canada. Questionnaires were forwarded to almost all licensed physicians in Canada (59 389 of 61 751 physicians. A total of 2362 were eliminated due to retirement, residency or working abroad). Overall, 21 296 doctors responded anonymously to the survey, giving a response rate of 36%.

Overall, doctors reported working an average of 51 hours a week, not including on-call hours. Female doctors reported they worked about 47 hours a week—seven fewer than their male colleagues (54 hours). As women now make up more than half of all the new physicians coming out of Canada's medical schools (58% in 2003-4), the fact that they work fewer hours than their male colleagues has significant implications for the country's healthcare system. While they make up only 31% of doctors in all age groups, in the under-35 age group, they make up 52%.

The survey also found a large number of Canada's doctors are reaching retirement age. If the survey data is translated to the physician population as a whole, as many as 3800 doctors plan to retire in the next two years. This is more than double the current rate of retirement. Older doctors have tended to work longer hours than their younger counterparts.

“We're not training enough physicians,” stressed the president of the Canadian Medical Association, Dr Albert Schumacher, “We're not even close to training replacement here … This year we graduated 2050 doctors in Canada. We enrolled 2250 who will graduate in three or four years. All three medical organisations are calling for a minimum of 2500 graduates. For the same population Great Britain is training 3000.”

The survey also showed that 60% of all family physicians are already either limiting the number of new patients they see or are not taking new patients at all. The situation is similar among specialists, even though the reasons may be different.

Physicians nearing the end of their careers and doctors entering the profession reported that they are choosing to manage their careers in different ways.

Sixteen per cent of doctors polled stated that they had reduced their weekly work hours in the past two years. A quarter said that they plan to cut their weekly work hours in the coming two years.

“We strongly believe that physicians and surgeons in Canada must be able to strike a proper balance between their professional and personal responsibilities,” said Royal College president Stewart Hamilton.

Canada's doctors are also reducing the services they provide. Fewer family doctors are doing cervical smears, suturing, or hearing tests. Also fewer family practitioners provide maternity and newborn care, in hospital care, or palliative care.

Robert Wedel, president of the College of Family Physicians, said that it was critical that adequate policies were put in place by all levels of Canadian government, in a coordinated way, to tackle physician supply issues and to make Canada's physician resource pool more sustainable and stable.

On the positive side, the national physician survey found that Canada's family doctors were becoming happier and had more job satisfaction, irrespective of ongoing physician shortages, added Dr Wedel. More than four fifths of all doctors surveyed reported being somewhat or very satisfied with their relationship with patients.