Millions of Canadians lack access to a family doctor. Walk-in clinics overflow. Emergency departments see patients who have nowhere else to turn. Meanwhile, physicians report burnout, early retirement, and reduced practice hours. The crisis in physician supply is not simply about numbers—it involves complex questions of where doctors practice, what kind of medicine they do, how they are trained, and what makes a medical career sustainable. Addressing the crisis requires understanding why recruiting and retaining physicians has become so challenging and what solutions might actually work.
The Current Shortage
Scale of the Problem
Approximately five million Canadians report not having a regular family doctor—a number that has grown substantially in recent years. The shortage is worse in some regions than others, with rural, remote, and northern communities facing the most severe gaps. Some provinces have waiting lists of over 100,000 people seeking a family physician. Specialist wait times extend to months or years for some procedures.
Beyond Numbers
Raw physician counts don't capture the full picture. The number of physicians per capita has actually increased over recent decades, but the way physicians practice has changed. More physicians work part-time. Administrative burdens consume time that once went to patient care. Physicians burn out and leave practice early. New graduates may choose specialties or lifestyle over family medicine. The effective physician supply—hours of patient care actually provided—has not kept pace with population growth and aging.
Why Recruitment Is Difficult
Medical School Capacity
Canada trains fewer physicians per capita than many comparable countries. Medical school seats are limited by funding, clinical placement capacity, and historical decisions about the "right" number of doctors. Expanding training capacity takes years—building new programs, accrediting new schools, developing clinical rotation sites. International medical graduates face complex, lengthy credentialing processes that waste their skills and deter immigration.
Family Medicine vs. Specialization
Medical school culture often values specialization over family medicine. Family medicine is sometimes seen as less prestigious, less lucrative, and less intellectually engaging than specialty practice—despite being essential to healthcare systems. New graduates increasingly choose specialties that offer better compensation, more predictable hours, or greater technical focus. Family medicine residency positions go unfilled while specialty positions are oversubscribed.
Geographic Distribution
Physicians concentrate in urban areas. Medical schools are in cities; clinical rotations occur in academic health centres; spouses have careers; children have schools. Rural and remote communities struggle to attract physicians regardless of overall supply. Even within provinces, some communities have surplus physicians while others have none. Creating equitable geographic distribution has proven extremely difficult.
Compensation and Practice Models
Family physicians often earn less than specialists despite long hours and broad responsibility. Fee-for-service payment models incentivize volume over quality and don't adequately compensate for the complex, time-consuming care that patients with multiple chronic conditions require. Walk-in clinics and episodic care may pay better per hour than longitudinal family practice. Financial incentives often don't align with the kind of care that would most benefit patients and the system.
Why Retention Is Difficult
Burnout Epidemic
Physician burnout has reached crisis levels. Long hours, administrative burdens, electronic medical record requirements, insurance paperwork, and the emotional toll of patient care combine to exhaust physicians. The COVID-19 pandemic intensified burnout, with many physicians reducing hours or leaving practice entirely. Burnt-out physicians provide worse care, make more errors, and suffer personally. The system that produces burnout is also harmed by it.
Administrative Burden
Physicians report spending as much time on paperwork as on patient care. Electronic medical records, while useful, have increased documentation requirements. Insurance companies require prior authorizations. Regulatory bodies demand compliance documentation. Each requirement seems reasonable individually but collectively consume enormous time. Physicians trained to care for patients find themselves serving systems instead.
Work-Life Balance
Younger physicians increasingly prioritize work-life balance over the all-consuming dedication that characterized previous generations. This is not laziness but healthy boundary-setting in response to observed burnout among mentors. But when each physician works fewer hours, more physicians are needed to provide the same care. The profession is adapting to changed values, but systems have not kept pace.
Practice Challenges
Running a medical practice has become more complex. Clinic overhead costs have risen. Staff are difficult to recruit and retain. Regulations multiply. Solo practice is increasingly untenable, but group practices require different skills and relationships. Physicians who want to focus on medicine must instead become small business managers—or accept employment models that may limit autonomy.
Solutions Under Discussion
Expanding Training
Increasing medical school seats, developing new programs in underserved regions, and streamlining international graduate credentialing could increase supply over time. But training takes years; current shortages cannot be solved by students who haven't yet enrolled. And increasing numbers without addressing distribution, retention, and practice conditions may not solve the problem.
Incentive Reform
Changing how physicians are paid could shift behaviour. Alternative payment models that compensate for complexity, team-based care, and non-visit work might make family medicine more attractive. Rural bonuses and student loan forgiveness for underserved practice could improve distribution. But designing incentives that work as intended is complex, and poorly designed incentives can create new problems.
Team-Based Care
Expanding team-based care could extend physician capacity. Nurse practitioners, pharmacists, physician assistants, and other professionals can provide care that doesn't require a physician. Team models allow physicians to focus on what only physicians can do while others handle what they can do equally well. But turf battles, payment systems that don't support teams, and scopes of practice restrictions impede team-based care expansion.
Virtual Care
Virtual care expanded dramatically during the pandemic and can improve access in some circumstances. Patients in remote areas can consult specialists without travel. Routine follow-ups can occur by video, freeing in-person capacity for those who need it. But virtual care has limitations—it cannot replace physical examination—and raises concerns about continuity, quality, and physician-patient relationships.
Reducing Administrative Burden
Streamlining paperwork, simplifying prior authorization, improving electronic records, and reducing regulatory requirements could free physician time for patient care. Some of these changes require government action; others require insurer cooperation; still others require professional self-regulation. Identifying which administrative requirements are truly necessary and which are merely habitual or defensive is challenging.
Addressing Burnout
Supporting physician wellness—through reasonable expectations, accessible mental health services, manageable workloads, and sustainable practice models—could improve retention. Changing medical culture to accept that physicians are human beings with limits, not infinitely available resources, is part of this work. But addressing burnout requires systemic change, not just individual resilience programs.
Systemic Considerations
Coordination Challenges
Physician supply involves multiple actors—federal and provincial governments, medical schools, regulatory colleges, professional associations, hospital systems—with different interests and limited coordination. Solutions that require concerted action across jurisdictions are difficult to implement. No single actor controls enough levers to solve the problem alone.
Long Time Horizons
Training a physician takes over a decade from high school to independent practice. Decisions made now won't affect supply for years. Political cycles are shorter than training cycles. Governments may prefer visible short-term actions to the sustained investment that genuine solutions require.
Trade-offs
Some proposed solutions conflict with others. Increasing physician supply may require accepting physicians with less rigorous training. Improving work-life balance means fewer hours from each physician. Expanding team-based care may threaten physician income. Acknowledging and navigating these trade-offs is necessary for progress.
Questions for Further Discussion
- How should Canada balance expanding physician training with maintaining quality and appropriate credentialing?
- What payment models and incentives would most effectively attract and retain physicians in family medicine and underserved areas?
- How can team-based care be expanded to extend physician capacity while maintaining quality and continuity?
- What systemic changes would address physician burnout and make medical careers sustainable?
- How should federal and provincial governments, medical schools, and professional bodies coordinate to address physician supply?