Douglas Todd: What’s behind Canada’s doctor shortage? One factor rarely gets discussed – Image for illustrative purposes only (Image credits: Pexels)
Millions of Canadians lack a family doctor, fueling widespread concern over access to primary care. Politicians and the public often point to expanding medical training or recruiting physicians from abroad as fixes. Yet researchers highlight a subtler dynamic: family doctors today devote fewer hours to patient care than their predecessors did decades ago. This shift contributes significantly to the strain on the system.
Common Causes and the Numbers Behind the Crisis
The Canadian Medical Association has outlined key drivers of the shortage, including physician retirements, fewer new doctors opting for family medicine, modest compensation levels, and an aging population that demands more care. Nearly six million people currently navigate without a regular family physician, with wait times stretching longer each year.
Population growth adds pressure. Since 1976, Canada’s population expanded by 75 percent, while the physician count rose almost 200 percent. Still, complaints about shortages persist. University of British Columbia professor Paul Kershaw noted that physician numbers have surged, but total hours worked have not kept pace.
Declining Hours: A Trend Across Decades
Health researchers like Lindsay Hedden from Simon Fraser University and David Rudoler from the University of Toronto analyzed provincial data and found family physicians see hundreds fewer patients annually than in the late 1990s. Median patient visits dropped by 515 to 1,736 per doctor, depending on the region.
This reflects broader changes in work patterns. In 1990, male family physicians averaged 55 hours per week, according to a Canadian Medical Association Journal study. Today, that figure stands below 48 hours. Female physicians have held steady at around 44 hours weekly over the same period. Both genders contribute to the decline, with men reducing hours most sharply since the early 2000s.
Key Shifts in Physician Workloads:
- Male doctors: 55 hours/week (1990) to under 48 hours (now)
- Female doctors: Steady at ~44 hours/week
- Overall: Slower growth in total hours vs. headcount
- Part-time female physicians: 31% (vs. 11% for males)
Work-Life Balance and Demographic Changes
Demands for better work-life balance play a central role. More physicians now live in dual-earner households and prioritize family time to avoid burnout. The profession has seen “workplace feminization,” with 54 percent of doctors under 40 being female, up from 15 percent four decades ago. Women comprise three in five medical students and gravitate toward family medicine more than men.
Yet the trend transcends gender. Male physicians have curtailed hours substantially, accounting for much of the overall drop in clinical activity. Younger doctors, especially women with children under 18, report fewer weekly hours and higher part-time rates. Older physicians, regardless of gender, tend to log more patient-facing time.
Differences in Practice and Future Pressures
These changes alter care delivery. Female family physicians handle fewer patients and services but spend more time per visit, addressing multiple issues at once. They prescribe less, order more tests, and refer to specialists frequently. Their patient mix skews younger and more female, with less emphasis on off-hours or institutional care like home visits.
Hourly pay for physicians has risen 60 percent since 1990, adjusted for inflation, even as administrative burdens grow. An expanding senior population further taxes resources. With women dominating new cohorts, these patterns will likely intensify, prompting calls for policy adjustments beyond just adding more doctors.
The shortage underscores a tension between professional well-being and public needs. Addressing it may require rethinking incentives, support systems, and care models to align with modern realities.
