Canada Remains a Health-care Paradox According to Dr. Genevieve Moineau, Chief Medical Workforce Advisor, Health Canada: “With the 2023 OECD average number of new graduates at 14.2 per 100,000 population, Canada is at the bottom of the pack, producing 7.5 new doctors per 100,000 people with only Japan, Korea and Israel lagging behind.” She concludes, “There is currently a deficit of 22,823 between supply and demand for family physicians in Canada, and only approximately 1,300 new graduates per year. At this rate, Canada will never solve the existing physician shortage.” In seeking out the WHY for this dilemma of growing demand in the midst of dwindling supply, Dr. Hugh Scully, Professor Emeritus of Surgery and Health Policy at the University of Toronto and past-president of both the Canadian Medical Association and Ontario Medical Association, attributes Canada’s low ratio to insufficient medical school and residency spots and a fragmented licensing system. Cited in a March 27, 2025 article in the publication Canadian Affairs, Dr. Scully asserts: “It’s not that there aren’t people who want to do medicine. It’s just difficult for them to get into medical school in the first place. There are (people)…who should qualify and don’t, because there are only so many (government) funded spots.” He adds: “Canada limits the supply of new doctors through a quota system. Provinces fund medical school seats and residency placements and set funding caps that restrict how many students can be trained each year.” In addition, he notes that the federal government funds about one-quarter of total health-care costs, “but does not make its funding conditional on provinces training more doctors.” And, to make matters worse, “Canada underutilizes internationally trained doctors…because of onerous provincial qualification and licensing requirements.” It has long been whispered in legislature hallways that, since doctors generate health costs, the simple secret to health-care affordability is to limit or cut their number. Apocryphal? Perhaps. Dr. Scully notes further: “one of my colleagues, who’s one of the best cardiac surgeons in the world, is tremendously frustrated (that) it now takes him more time to do administrative work about an operation and consultation than to do the actual operation. That’s simply ridiculous, as many family physicians report that 40% of their time is taken up administratively ‒ for which there’s no compensation ‒ and that they must “spend an hour or two after the end of the day at the clinic doing paperwork.” Dr. Scully emphasizes that, although in 2023-24 the average family doctor in Canada billed $325,000, that individual was also forced to meet the challenges of any small business ‒ paying clinic or office expenses, staff, rent and insurance, And, since these doctors don’t get any benefits or pensions, they still have to pay for their own health and life insurance. In Dr. Scully’s view, Canada should replace its fee-for-service model with fixed physician salaries. But that’s another story. Since 1984, when Canada’s new Medical Care Act replaced the original Canada Health Care Act established in 1964, physicians are virtually forbidden from earning fees privately for certain higher-level/specialized services, forcing them into time-consuming and expensive administration functions at the expense of time (and funding) that could have been spent on patient care. It was a sharp direction change that led to expanded health ministry civilian “administrators” soaking up funds (and especially physician time) intended for patient care. Thus, the issue of “privatizing” health care has become a contorted history all its own. It remains a hot button in any discussion of medical manpower, and use of resources within meeting Canada’s documented underperformance in cutting Health 38 | www.snowbirds.org
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