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Tingting Zhang: Canada has tons of doctors—yet an alarming number of people have no primary-care provider. What’s going on?

Commentary

A doctor wears a lab coat and stethoscope in an exam room at a health clinic in Calgary, July 14, 2023. Jeff McIntosh/The Canadian Press.

Canadians are in a primary-care paradox.

About 14 percent of Canadians aged 12 and older—approximately 4.6 million people—did not have a regular health-care provider in 2022, according to Statistics Canada. Even more alarming, about 6.6 million Canadians rely on family doctors aged 65 and over, meaning that even more people could soon find themselves without primary-care access due to future family physician retirements.

Canada has the highest number of general practitioners per capita among comparator countries, yet ranks worst in terms of having a doctor or a regular place for medical care (only 86.2 percent of surveyed Canadians had one in 2023). What is happening?

Several factors are contributing to our current primary-care challenges.

First, it’s no secret that the physician workforce, much like the rest of our population, is aging. There are not enough new medical graduates to replace retiring physicians and meet the needs of our growing number of patients.

Moreover, physicians have been spending fewer hours on direct patients. Administrative tasks, such as paperwork for insurance claims, sick notes, and duplicate form requests from different organizations, consume approximately 18.5 million hours of physician time annually in Canada. That is equivalent to 55.6 million patient visits.

There are also economic and cultural factors that are steering medical trainees towards specialties rather than general family practice.

Without changes, the gap between the supply and demand for family physicians will only widen.

My recent C.D. Howe Institute analysis shows that under a normal retirement scenario—where 57 percent of family physicians aged 75 and over retire—the projected supply of family physicians in 2032 will meet 90 percent of the demand. If all family physicians aged 75 and over were to retire, only 78 percent of the projected demand would be met, resulting in a shortage of 13,845 family physicians.

This means that about 9.6 million Canadians will be without a family physician in the next decade. The consequences of this shortage could be dire, leading to delayed or inadequate care, increased costs, and a strain on other parts of the health-care system.

With only about 1,550 family physicians completing residency in 2022, the current pipeline of graduates is insufficient. What needs to be done?

Increasing numbers is essential, but will not suffice to meet the demands of a growing and aging population. We need a comprehensive strategy to tackle this head-on, and five well-established strategies can help.

First, we need to increase the number of training positions for prospective family doctors and accelerate pathways for international medical graduates to enter family medicine, whether direct-to-practice or through residency positions.

Second, administrative processes need to be streamlined to reduce family physicians’ unnecessary workload, freeing up more time for direct patient care.

Another strategy is to introduce payment models such as capitation or bundled payments that better support family physicians, making family practice more attractive and encouraging more patient enrolment and after-hours care.

As well, allowing other primary-care providers, such as nurse practitioners and pharmacists, to take on a broader range of responsibilities could assist with sharing the workload and improving patient access.

Finally, developing and expanding team-based models of care that bring together health-care professionals to provide comprehensive and continuous patient care could also benefit Canadians.

The good news is that some of these steps are starting to be taken by Canadian provinces.

Nova Scotia is the sole province advancing on all fronts; creating a new designated pathway to residency for international medical graduates; committed to reducing physician red tape by 80 percent by 2024; is a leader in paying their family physicians with alternate payment; introduced pharmacist-delivered primary care for 31 minor ailments; and expanded team-based care at new and existing locations. Similarly, British Columbia and Ontario have made notable advancements in several of the five strategies.

Improving primary-care access is a nationwide challenge that requires concerted efforts and innovative solutions. By learning from the policies and experiences of different provinces, Canada can develop and implement effective strategies to ensure every Canadian has access to a family physician and the primary care they need. Canada’s health-care system—and the health of its people—depends on it.

Howard Anglin: Sunak sputters, Starmer slithers, and British voters shrug as the U.K. election limps on

Commentary

Britain’s Prime Minister Rishi Sunak during a Conservative general election campaign event in Milton Keynes, England, May 30, 2024 .Alastair Grant/AP Photo.

The United Kingdom is more than halfway through a general election, but I’ve yet to see any public evidence of it. If you don’t read the papers or follow politicians or political commentators on social media—and most well-adjusted people don’t—you might have no idea the country is on the verge of a political earthquake. I haven’t overheard a single conversation about the election in the streets and I can count on one hand the number of candidate signs I’ve seen displayed—all for minor parties.

Then again, after July 4th, “minor parties” might include the ruling Conservative Party. I lunched this week with a friend whose job it is to predict these things, and he thinks the Tories will be lucky to get 50 seats. Considering the U.K. Parliament is about twice the size of the Canadian Parliament, that is like Trudeau’s Liberals being reduced to less than 25 seats. It’s almost unthinkable (and for the record, I don’t think it will be quite that bad, but my prediction of about 100 seats puts me squarely in the delusional optimists’ camp).

It is fair to ask how much could reasonably have been expected of Rishi Sunak as prime minister. He inherited the millstone of more than a decade of ineffectual Tory government with only a little over a year to remove it from his neck. In another year, the modest progress he has made on inflation and migration might have earned him the benefit of the doubt from a sceptical electorate, but we will never know. As it is, he didn’t even give himself the extra six months he was entitled to when he called this early election.

The snap election call surprised almost everyone, including apparently his own campaign managers.