The number of family physicians in Canada declined last year for the first time since the mid-1990s, a downturn that happened as rapid population growth and a rising number of elderly, chronically ill patients were already straining the primary-care system.
Although the reduction in head count was small – there were 28 fewer family doctors in the country in 2023 than in 2022 – it works out to a nearly 3-per-cent drop in family physicians per capita because the population expanded significantly at the same time, according to new data from the Canadian Institute for Health Information (CIHI).
The new CIHI report, set to be released Tuesday, also found that the average family doctor saw fewer individual patients in recent years than they did 10 years ago, a shift CIHI chalks up partly to sicker patients with greater medical needs.
“We have an aging and increasingly complex patient population, and that requires more time per patient,” said Natalie Damiano, CIHI’s director of health work force information.
The trends laid out in the new CIHI study go some of the way toward explaining why millions of people are struggling to find a family doctor. Statistics Canada survey data show that 17 per cent of Canadian adults – approximately 5.4 million people – didn’t have access to a family doctor in 2023, but one other major survey suggested the share of Canadians without regular access to primary care could be as high as 22 per cent, or more than 6.5 million people.
“I think it’s a huge problem,” said Joss Reimer, president of the Canadian Medical Association, which represents doctors. “We already have six-and-a-half million Canadians who don’t have access to a family doctor, so any drop in the number of family physicians is a critical problem that needs urgent attention.”
CIHI’s summary of the latest health work force data shows that for family physicians, the average three-year growth rates slowed from 2.7 per cent between 2015 and 2017 to 1 per cent between 2021 and 2023. However, looking at the most recent three-year period obscures the fact that there was a drop in head count between 2022, when there were 48,292 family doctors in Canada, and 2023, when there were 48,264 – 28 fewer than the year before.
The number of family doctors per capita fell to 12 per 10,000 in 2023, down from 12.4 in 2022. Still, the per capita figure for 2023 was higher than a decade ago, when there were 11.5 family doctors for every 10,000 people.
That said, family doctors are not the only health workers who provide primary care. The new report notes growth in the supply of pharmacists, physiotherapists and nurse practitioners, among other professions.
Nurse practitioners are experienced registered nurses with two years of additional education who can perform many of the same tasks as family doctors, including diagnosing illnesses, ordering tests and prescribing medications.
The number of NPs in Canada was just shy of 9,000 last year, up from 3,966 in 2014. Although most NPs are still employed in hospitals, the share working in community settings such as primary care rose by about three percentage points over the past decade, to 33 per cent from 30 per cent.
Seventy-three per cent of pharmacists and 70 per cent of physiotherapists worked in community settings in 2023, the report noted.
Some of those allied professionals are working in team-based practices with physicians, but the CIHI report doesn’t make clear how many. Ms. Damiano of CIHI said that expanded scopes of practice for such professionals could be contributing to family physicians seeing fewer people, on top of the increasing medical complexity of patients. Other possible explanations CIHI cited were the heavy administrative burden in family medicine and a desire for better work-life balance among younger doctors.
Family physicians in Canada saw, on average, 1,430 unique patients in 2022-23, down from 1,746 in 2013-14. They likely saw some of those patients many times.
Tara Kiran, a family physician and researcher at St. Michael’s Hospital and the University of Toronto, said decreasing access to primary care has dire consequences for patients and the health system.
“When people don’t have reliable integrated primary care, they are sicker, and the evidence would suggest that it even affects how long they live,” she said.
