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Is Canada's doctor shortage the real thing?

It has become a truism that Canada has a serious doctor shortage. Seemingly every few weeks, a report tells us just how dire the situation has become.

The latest grim prognosis, the work of an impressive triumvirate -- the College of Family Physicians of Canada, the Canadian Medical Association and The Royal College of Physicians and Surgeons of Canada -- warned of an "alarming state" in physician supply, and access to care.

Canada has about 61,000 licensed doctors. According to the latest report, about 3,800 plan to retire over the next two years. The authors also warned that about one-quarter of doctors intend to reduce their workload; i.e. see fewer patients.

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Statistics Canada released results of a survey earlier this year that showed 3.6 million Canadians do not have a family doctor. That is a troublesome number. But it is worth noting half those people did not try to find a doctor -- after all, most of us are healthy most of the time -- and the balance didn't necessarily go without care.

The other, oft-cited proof of an "MD crisis" is that Canada has one of the lowest ratios of doctors to population in the Western world. According to the Organization for Economic Co-operation and Development, Canada has about 2.1 practising physicians for every 1,000 residents. That is -- shock, horror -- a lower ratio than Greece (4.4), the Slovak Republic (3.6), Hungary and Switzerland (both 3.5), and the Czech Republic (3.4).

So what do those numbers prove? Is health care better in Greece and Hungary because there are more doctors per capita?

The reality is that we don't know the ideal number of doctors required to deliver good health care. What we do know is that the number will depend on what they do. Doctors, after all, are not our sole health-care providers: Nurses, nutritionists, and occupational-health workers should play an important role, to name only a few.

There is no doubt the doctor demographic is changing. Many older doctors are set to retire, and the younger ones are less willing to work the long hours that have become a hallmark of the profession. (According to the latest survey, doctors work an average of 51 hours weekly; that rises to 70 hours when you include on-call duty.) Young doctors, and women in particular, work about seven hours a week less, and many work part-time, particularly after they have children.

Another report, released earlier this week by the Canadian Institute for Health Information, revealed that the role of physicians, and family physicians in particular, is evolving in other notable ways.

The number of family docs delivering babies, setting broken bones, doing minor surgery, and making in-hospital visits is falling sharply. But family docs are delivering more obstetrical services (care of pregnant women) and more mental-health care. New family doctors are also shunning working solo and instead, joining group practices.

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These younger doctors are on to something: They are doing things differently.

There is no doubt that if doctors do the same old, same old, the physician shortage will persist, and grow worse. Instead of constantly bemoaning the lack of doctors, perhaps we should be asking ourselves if the doctors we do have are being used efficiently.

The most common procedures performed by family physicians in Canada are Pap smears, draining abscesses, removing warts, aspiration of joints, toenail removal, skin biopsies, casting/splinting, inserting intrauterine devices, and interpreting electrocardiogram results.

Can't a number of those procedures be done by nurse practitioners? And what about all the time doctors waste acting as 'travel agents' -- doing referrals and finding hospital beds for their patients? And how about the paperwork that is required to keep a small business (which is what most doctors' offices are) running smoothly.

When government policy-makers tackle the physician-shortage issue, they usually fiddle with the number of places in medical school, which is just a tiny part of proper human-resource management. (If we need more physicians in the short term, there are 12,000 foreign-trained MDs in Canada, driving cabs and working as orderlies.) What policy-makers and health administrators need to do is deliver on the promises to reform primary care, create group practices (and there are a whole variety) that allow patients to be treated efficiently and doctors to use their skills more effectively.

The accepted wisdom is that Canada is short some 5,000 doctors. But is that really true? Though it is considered heresy, the question needs to be asked.

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Right now, we have a perceived physician shortage -- based on the perception that medical care cannot be delivered in a different and better way. Fixing our outdated primary-care model, and investing in prevention to reduce the ever-growing demand for health care is ultimately what will resolve this "crisis," not fiddling with physician supply.

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