Canada has the 9th highest GDP in the world. When it comes to physicians per capita (“PPC”), however, the World Bank barely ranks Canada in the top 70. In 2021, Canada ranked 27th out of 37 OECD states in PPC. That year, Canada had roughly 2.8 PPC and allocated 11.7 per cent of its GDP to health care. Important note here: the OECD estimates that Canada’s PPC was inflated by 5 to 10 per cent because it included “professionally active” doctors who worked as health sector managers, educators, and researchers and did not provide direct health care to patients.
In 2022, total health spending in Canada reached $331 billion CAD or $8, 563 CAD per Canadian. This is equivalent to 12.2 per cent of Canada’s GDP and accounts for more than 34.5 per cent of total government spending. Canada’s all-time high in health spending is a response to a health care crisis characterized by backlogged surgeries, clogged emergency departments, burned out staff, patients dying in hospitals while waiting to see a physician, and up to six million Canadians struggling to find a family doctor. Unfortunately, mindlessly investing more money in Canada’s health care system will not solve our problems.
The primary reason patients visit the hospital is to see a physician. The provinces and territories are responsible for the provision of this service. Rather than asking Ottawa for more money every few years, provincial and territorial governments should confront the problem pragmatically: the most logical solution to Canada’s never-ending health care crisis has always been to increase the number of doctors. Although there are countless ways to accomplish this, I propose two options related to improving access to the medical profession.
First, help foreign-trained doctors become accredited to work in Canada. A recent investigation found that the number of international medical graduates applying for residencies in Canada declined by 40 per cent over the last decade. That’s unsurprising given that only 14 per cent of Canadian medical residency opportunities are awarded to foreign-trained doctors to begin with.
To make matters worse, there are more than 13, 000 foreign-trained doctors who aren’t practicing medicine in Canada due to bureaucratic impediments related to accreditation. Since there were only 93, 998 physicians in Canada in 2021, our foreign-trained unlicensed doctors account for roughly 13.8 per cent of Canada’s medical practitioners. If that isn’t appalling, I don’t know what is. Professional medical associations must put these players on the pitch – yesterday!
Second, help more students study medicine. In 2021, Canada ranked 33rd of 37 OECD states in medical graduates per capita – with 7.55 per 100 000 inhabitants. Ireland was rated first, with 25.4. Canada’s shortage of doctors is fueled by the fact that there are only 2, 800 openings for first year students at our 17 medical schools. Unfortunately, nine out of ten applicants are rejected despite outstanding qualifications.
Objectively, there is no difference in potential between pre-med students with a 90 per cent average and a 92 per cent average. Nevertheless, the pre-med student with a 92 per cent average may get the opportunity to become a doctor while the other nine pre-med students with a 90 per cent average must choose between abandoning their dreams or moving abroad to study and practice medicine elsewhere. If we continue to tell our brightest minds to go away for long enough, eventually they do.
Whether medical schools and professional associations like the Ontario Medical Association and the Collège des médecins du Québec are willing to increase the number of doctors by improving access to the medical profession remains to be seen. In a market economy like Canada’s, where doctors are well-compensated, additional doctors serving patients may translate into reduced pay for physicians moving forward.
Be that as it may, medical schools and professional associations must acknowledge the obvious: Canada has a health care crisis exacerbated by a shortage of doctors and its within their power to rectify the situation. By opening the gates for foreign-trained doctors and empowering our youth to achieve their potential, medical schools and professional associations can help bring Canada’s health care system back from the brink of breaking.
To be clear: the pragmatic solution to Canada’s health care problem – increasing the number of doctors by improving access to the medical profession – has always been right in front of our faces. Whether provincial and territorial governments have the political will to lobby the medical schools and professional associations that set the quotas and regulate the medical profession is another story altogether.
George Monastiriakos is a lawyer licensing candidate. You can read his published works at www.monastiriakos.com/publications. He can be reached on Twitter @monastiriakos.