Physician Supply in Ontario - thoughts?

[la marzocco]

 

 

[alrightythen]

how does our "physician per 100,000 people" compare to other countries?

[jlkhhylyiluh6]

pretty useless to look at "supply" without also seeing the "demand" side. Also, distribution of physicians/resources is far more important than pure number.

[NeuroD]

3 hours ago, beeboop said:

pretty useless to look at "supply" without also seeing the "demand" side. Also, distribution of physicians/resources is far more important than pure number.

Presumably the demand is the "per 100,000" in this sort of crude statistic, and the assumption is that the needs of our population isn't vastly different from that of other provinces (ie: were ageing at the same rate as other provinces etc...)

[blah1234]

Haven't looked at the primary data but I think I would want to know the distribution and types of doctors we are producing. 

I think many communities are still underserved but good luck building the hospital infrastructure for specialists and good luck getting people to work rural.

[Edict]

Different countries use physicians differently. In Canada and the US, doctors are really at the highest end of the totem pole. There is an expectation that physicians make the intellectual decisions and as much as possible the menial routine work is not left up to the physician to complete. In Europe, there are doctors that never make it to consultant staff. More doctors there work in mid-grade roles for life, leave medicine to do other things. In some countries in Europe, they staff ambulances with doctors. Doctors in the UK take blood, which as you can imagine, means each individual doctor sees less patients. 

Our x of doctors/population is less than some countries because of this reason. 

I think the way things are going are reasonable. I would definitely keep the number of medical school spots capped at current levels, maybe some small reductions in Quebec would be reasonable. 

[LittleDaisy]

18 minutes ago, Edict said:

Different countries use physicians differently. In Canada and the US, doctors are really at the highest end of the totem pole. There is an expectation that physicians make the intellectual decisions and as much as possible the menial routine work is not left up to the physician to complete. In Europe, there are doctors that never make it to consultant staff. More doctors there work in mid-grade roles for life, leave medicine to do other things. In some countries in Europe, they staff ambulances with doctors. Doctors in the UK take blood, which as you can imagine, means each individual doctor sees less patients. 

Our x of doctors/population is less than some countries because of this reason. 

I think the way things are going are reasonable. I would definitely keep the number of medical school spots capped at current levels, maybe some small reductions in Quebec would be reasonable. 

They are capping number of medical school admissions in Quebec.

I think that they are definitely overtraining residents in some subspecialties where you know it will be hard to get a job after residency. There is a huge demand in primary care in rural area, but as others mentioned, unless the government comes up with great incentives, rural areas continue to lack primary care physicians. 

[indefatigable]

On 2/8/2019 at 9:19 AM, beeboop said:

Also, distribution of physicians/resources is far more important than pure number.

A big challenge in Canada.

50 minutes ago, Edict said:

I think the way things are going are reasonable. I would definitely keep the number of medical school spots capped at current levels, maybe some small reductions in Quebec would be reasonable. 

It's not just just Canadian grads that make up the workforce - other provinces have a lot more IMGs than QC (~25% vs ~10%) because of the language barrier.   So QC may have more med students than other provinces to compensate.  QC med schools have also had more attrition too.  

Nonetheless, the per capita distributions in QC is basically identical to AB & BC.  (link Appendix Figure 3)
 

[la marzocco]

On 2/9/2019 at 5:43 PM, tere said:

A big challenge in Canada.

It's not just just Canadian grads that make up the workforce - other provinces have a lot more IMGs than QC (~25% vs ~10%) because of the language barrier.   So QC may have more med students than other provinces to compensate.  QC med schools have also had more attrition too.  

Nonetheless, the per capita distributions in QC is basically identical to AB & BC.  (link)

SK have 60% of their doctors who earned their MDs abroad as an example. 

We are still below the OECD average in terms of the ratio regardless:

[shematoma]

It's hard to say what's the right number of doctors to have. We have lots of underemployed and unemployed doctors, particularly specialists these days. The government is at its limit in terms of what it's willing and able to pay for. Older doctors lobby hard to prevent new entrants from taking their jobs. Adding more doctors to the system isn't going to fix things.

We could probably open up the health care market and create a "two tiered health care system." That might help the public sector keep costs down as well as provide employment for all the doctors we're graduating. But that will never happen in this country, despite the fact it exists in almost every other country in the chart above (and they have no shortage of doctors based on the data!)

Comparisons with other countries are complicated by the fact that the role of doctors is different in Canada. There are things that doctors do in other countries that "allied health professionals" do in Canada.

 

[la marzocco]

3 minutes ago, shematoma said:

It's hard to say what's the right number of doctors to have. We have lots of underemployed and unemployed doctors, particularly specialists these days. The government is at its limit in terms of what it's willing and able to pay for. Older doctors lobby hard to prevent new entrants from taking their jobs. Adding more doctors to the system isn't going to fix things.

We could probably open up the health care market and create a "two tiered health care system." That might help the public sector keep costs down as well as provide employment for all the doctors we're graduating. But that will never happen in this country, despite the fact it exists in almost every other country in the chart above (and they have no shortage of doctors based on the data!)

Comparisons with other countries are complicated by the fact that the role of doctors is different in Canada. There are things that doctors do in other countries that "allied health professionals" do in Canada.

I have a thought. As the Canadian population is ageing (due to the boomers), won't we see a mass retirement of doctors in the next 10 years? Shouldn't there be some plateauing in the growth of # of doctors in Canada (as there will be some imminent net loss)?

[shematoma]

1 hour ago, la marzocco said:

I have a thought. As the Canadian population is ageing (due to the boomers), won't we see a mass retirement of doctors in the next 10 years? Shouldn't there be some plateauing in the growth of # of doctors in Canada (as there will be some imminent net loss)?

Fair point. It depends on the age distribution of physicians. The graph above shows physician supply in Ontario went from ~22k to ~32k in about 10 years. Those 10,000 new doctors are unlikely to be baby boomers. Of the 22k remaining doctors in practice before 2007, how many of those are baby boomers? Maybe half of them? We're still adding doctors at a brisk pace so even if they all retired in 10 years, they'd be replaced by new doctors coming onto the market. That's assuming we have ~10k additional retirements in the next 10 years which is highly unlikely. I think it will ultimately make a dent in physician supply but wouldn't fundamentally change the market.

[JohnGrisham]

Depends on the field, some docs i've met are working well and billing just fine into their late 70s.

[NeuroD]

2 hours ago, shematoma said:

It's hard to say what's the right number of doctors to have. We have lots of underemployed and unemployed doctors, particularly specialists these days. The government is at its limit in terms of what it's willing and able to pay for. Older doctors lobby hard to prevent new entrants from taking their jobs. Adding more doctors to the system isn't going to fix things.

 We could probably open up the health care market and create a "two tiered health care system." That might help the public sector keep costs down as well as provide employment for all the doctors we're graduating. But that will never happen in this country, despite the fact it exists in almost every other country in the chart above (and they have no shortage of doctors based on the data!)

 Comparisons with other countries are complicated by the fact that the role of doctors is different in Canada. There are things that doctors do in other countries that "allied health professionals" do in Canada.

  

Good point. We've got lots of unemployed/underemployed docs...adding more before that gets straightened out isn't going to do much good. 

[GrouchoMarx]

23 hours ago, la marzocco said:

SK have 60% of their doctors who earned their MDs abroad as an example. 

We are still below the OECD average in terms of the ratio regardless:

SK having 60% imgs means the fees aren't high enough.

 

Pathology has a huge problem with IMGs being recruited cheaply, rather than fees being revisited. 

[GrouchoMarx]

On 2/9/2019 at 5:26 PM, LittleDaisy said:

They are capping number of medical school admissions in Quebec.

I think that they are definitely overtraining residents in some subspecialties where you know it will be hard to get a job after residency. There is a huge demand in primary care in rural area, but as others mentioned, unless the government comes up with great incentives, rural areas continue to lack primary care physicians. 

Rural areas are hard to live in for most. Highly educated types like doctors usually want to live in urban places because the schools are better for their kids. IMGs despite the xenophobia stay in rural areas because they're forced to. Once they can leave they do. I think it is a similarly egregious abuse of foreigners the same way the tfw program is

[ploughboy]

19 hours ago, GrouchoMarx said:

SK having 60% imgs means the fees aren't high enough.

Sask was also pretty aggressive about recruiting South African docs.  Not sure if that's still the case or not.

[ploughboy]

On 2/9/2019 at 7:21 PM, shematoma said:

 The graph above shows physician supply in Ontario went from ~22k to ~32k in about 10 years. Those 10,000 new doctors are unlikely to be baby boomers.

Definitely not baby-boomers.  That increase is the cohort who entered medical school in the first decade of this century, when there was a big increase in medical school seats in Ontario.  That increase was a response to the relative physician undersupply and consequent waitlists, lack of access and public outcry.  All of that mess came as a result of the cutbacks of the 1990s, when the Barer-Stoddart report was simplistically interpreted as: "physicans are a significant expense in the health care system, so to cut health care costs we will cut medical school enrolment".  

The Barer-Stoddart report, in turn, had its roots in the overall context of a crummy economy, inflation and rapidly rising government expenditures of the early 1980s. 

I've clearly over-simplified, but the take-home point is that the system's time constants are incredibly long (on the order of decades), while the folks trying to drive the system behave as if the time constants are only years.

[Crash Bandit]

On 2/10/2019 at 5:45 PM, GrouchoMarx said:

Rural areas are hard to live in for most. Highly educated types like doctors usually want to live in urban places because the schools are better for their kids. IMGs despite the xenophobia stay in rural areas because they're forced to. Once they can leave they do. I think it is a similarly egregious abuse of foreigners the same way the tfw program is

Agreed.