A lot more, if you were to pay attention to media reports.  Over the last few years, all across Canada there has been much writing and talk about shortages of family MDs. The College of Family Physicians of Canada says that there are about 4 million Canadians without a family doctor (there is an obvious interest in demonstrating shortage as it results in the need for more members).   If you do think of the wait time to see a doctor, you might in fact also conclude that there are physician shortages.

While I cannot challenge the fact that 4,000,000 Canadians may be without a family MD, but on a per person basis, the claim for shortage of doctors does not seem to make sense.  It just does not add up!  There could be issues in rural communities that are limited in terms of access.  But on sheer numbers, there is a gross miscalculation. Let us look at the issue a bit more closely.

For roughly 33 million Canadians, there are approximately 28,000 Primary Care Physicians (does not even consider Nurse Practitioners).  This comes down to about one MD per 1150 Canadians. This may seem high.  But, if one were to assume 1500 hours of patient care time (very conservative, most full time employees work roughly 2000 hours including vacation time), an average visit of 30 minutes (again VERY conservative) will be equivalent to about 3000 visits per doctor.  This means that a doctor can see a person at the least 2.5 times a year.  Now, factoring in those of us who have a family doctor but only visit annually (or myself where it has been 8 years), I FAIL to see the logic behind the implied shortages.   I concede that I may not have all of the facts and my calculations are simplistic.   For this reason, I am open to inputs and would like to be corrected.

A recent press release in Ontario claims that 800,000 Ontarians do not have a family physician. This stat was released by the Ontario Medical Association (OMA) that incidentally is in the midst of negotiating a contract with the Ontario Government.  I pulled out my trusted calculator and came up with virtually the same doctor to patient ratio as previously calculated. (13million Ontarians, 11,400 Family Docs, is 1140 patients per doctor). Per OMA’s numbers, there are 800,000 patients without a doctor, and the system is short by 2500 doctors. Assuming that 51.3% of the doctors are Family Doctors ( Canadian Institute for Health Information states that 51.3% of 2006 doctors were family doctors), the OMA is suggesting that we are short on family doctors by about 1300, which if filled would create a ratio of 1 doctor per 600 patients. Using previous formula of 30-minute visits and 1500 hours of clinic time, each patient would be seen 5 times a year.

This, on the average seems a bit excessive. We are being misled by special interest groups.  These Professional Interest Groups who produce these statistics for the betterment of themselves, are holding us hostage to their interests? This is wrong.   It is like giving Prisoners a key to the prison.  In fact, as a Nurse, my own association is using the same logic to try to boost membership.  Though they are focusing on creating full time positions (except that many of the Nurses I work with would prefer part-time to full-time). 

Now, don’t get me wrong, I am not against physicians.  It’s not the professionals I have issue with, it is with the special interest groups that use scare tactics to boost membership.  

We have a serious productivity as well as economic issues if we actually have enough MDs and they are failing to see 4 million Canadians (this alone could account for significant cost savings!). Why not enforce a fulltime equivalent minimum patient list of say 1500 patients. This would immediately solve this perceived issue of physician shortage and at the same time will have more cost effective options of managing primary care.  Which, incidentally, will reduce the overall burden on the rest of the system.  WHY NOT!

About the Author: Jamie Marcellus is a Registered Nurse Executive with experience in healthcare sales, operations and process improvement in both the public and the private healthcare sectors in Canada.  

Editor:  BIPRO Health, a leading provider of solutions to all healthcare needs: Clinical Quality, speed of Care, Asset Utilization, Pay for Performance, etc.  For details, please visit  www.biproinc.com/healthcare_services.html