Commentary
By Mackenzie Moir and Nadeem Esmail

While provincial governments announce record numbers of doctors hired and consider options on how to convince family doctors to accept more patients, Canadians still struggle with access to both family physicians and medical specialists.
What may come as a surprise to some Canadians is that this shortage is a consequence of past government decisions. As long as governments continue to try and solve the problem with government-centric reforms, the access problems will likely persist. And it isn’t a lack of spending that got Canadians into this situation—Canada has maintained one of the developed world’s most expensive universal health-care systems for at least two decades.
During the genesis of Medicare in the 1960s, governments became focused on ensuring that there were enough doctors to serve Canada’s growing population. This included the opening of four new medical schools, the ramping up of physician training, and increases in the number of foreign-trained physicians entering the workforce. By the 1970s Canada had one of the highest physician-to-population ratios in the developed world.
Things started to change in the 1980s when medical school enrolments were reduced as provincial governments became increasingly concerned with there being too many physicians. Following the publishing of an influential report in the early 1990s, governments further pruned back physician training and planned reductions in recruitment of international medical graduates.
Canadian governments, in response to growing public concerns about a physician shortage, adjusted their plans and increased medical school enrolments in the late 1990s and early 2000s. Despite the subsequent increases in domestic physician training and promises to increase international medical graduates working in Canada, we remain a laggard. In fact, by 2023 (the latest year of available data), despite some growth in the number of physicians (population adjusted) since the early 2000s, Canada ranked 27th of 30 countries with universal health care. In other words, Canada went from second in the developed world to almost dead last in approximately five decades.
And Canadians shouldn’t hold out much hope for things to improve anytime soon.
RBC Economics estimates Canada will be short 44,000doctors by 2028, and needs another 30,000 doctors on top to just match the average number of doctors in other developed countries. At the same time, Canada’s 17 medical schools enrolled 3,812 first-year medical students in 2024/25 and the number of new graduates in Canada is barely more than half that of the average number in other developed countries.
It’s also worth noting that we may actually need more physicians in the future than even these numbers suggest, as physicians today are seeing fewer patients than in the past.
Governments also impede doctors from seeing more patients, which is a different way to alleviate some of the pressure from our doctor shortage. Doctors in Canada spend nine hours per week (on average) on administration, nearly half of which is perceived to be unnecessary red tape. At the same time, many medical specialists are unable to see and treat as many patients as they might otherwise because of limited access to operating time.
One solution is to allow privately paid access to the time physicians aren’t able to work in the government system, as Alberta is set to do with reforms that will allow physicians to work in both publicly-funded and privately-paid settings.
In the longer term, rather than relying on yet more government-driven planning, Canada’s governments should learn from other countries where doctors tend to be more abundant and where governments have left the determination of how many students should be permitted to train and become doctors to the market rather than government bureaucracies.
As is so often the case, governments are playing catch up to manage the consequences of their own past decisions. A better approach would be to allow the market—that is, patients—to decide how many doctors should be trained in Canada, while allowing Canadians to privately access the time physicians are currently unable to provide to patients in the government system.