Letters

Canada’s shortage of physicians

While there are numerous factors contributing to Canada’s shortage of physicians, three significant ones are migration to the United States, reluctance of medical students to choose specialties and locations where they are most needed, and new practice patterns (lifestyle goals and use of the health care system).

For the first and second factors, we can review the current practice locations of all Canadian medical graduates from the 16 medical schools from 1991 to 1995. Evidence1,2 suggests that 18% had left Canada for the United States by 2003. Reviewing the medical classes of the University of Western Ontario (UWO) in London from 1991 to 1995 inclusive suggests a similar percentage might be in the United States (19%).1,2 Eighteen UWO medical graduates from these 5 years appear to be in Windsor, Ont, and 46 in London, Ont.1,2 Only 14 (2.7%) graduates out of the 507 graduates over this 5-year period chose to practise in the remaining and primarily rural areas of southwestern Ontario.

The UWO is located in the middle of southwestern Ontario. Remarkably, the eight rural underserviced counties of southwestern Ontario, with possibly half its population, received only 2.7% of the graduates while the two largest cities received 12.5% of the graduates. There are currently 195 designated vacancies for family physicians in southwestern Ontario, and none are located in London.3 Losing possibly 18% of all Canadian medical graduates to the United States within 8 to 13 years after graduation seems excessive, especially when there is a shortage of physicians in Canada. The observation that only 14, or 2.7%, of the graduates chose to practise in the rural areas of southwestern Ontario also appears to be grossly out of line. Both these observations should raise considerable concern among educators and governments.

A possible solution to this problem might be to raise yearly medical tuition to the level of the cost in the United States ($50 000 per year) with the offer of a non-repayable bursary in return for participating in one of a number of options, ie, 3 years’ service in a remote area, 4 years’ service in a northern or rural area, 5 years’ service in an underserviced area within 2 hours of a medical school, and 7 years’ service in a community with a medical school coupled with the obligation to provide a 2-week locum a year in an underserviced community.

Similar proposals have been considered after the Supreme Court of Canada made a ruling in 1995 based on the “Charter of Rights and Freedoms” (BC physicians vs BC government). The essence of the decision was that provinces could not restrict licences for new physicians moving to the province to practise in underserviced communities for even a limited time. The physician shortage is extremely complex, but this proposal could be a basis for dialogue on the topic.

—Ross McElroy, MD, CCFP (Retired)
Tavistock, Ont
by e-mail

References

1. MD Select. Canadian Medical Directory CD-ROM 2003. Ottawa, Ont: Canadian Medical Association; 2003.
2. The Association of Canadian Medical Colleges. Canadian medical education statistics. Vol 24. Ottawa, Ont: Association of Canadian Medical Colleges; 2002.
3. Underserviced Area Program, Ontario Ministry of Health and Long Term Care. List of areas designated as underserviced. Toronto, Ont: Ontario Ministry of Health and Long Term Care; 2004.