Between the 1970s and the late 1980s, a widespread consensus emerged in Canada that the nation was experiencing an oversupply of physicians. As a result, beginning in 1993, some Canadian medical schools began to reduce their first year intakes.
However by the late 1990s—within three to four years of those enrollment reductions—a new consensus emerged. Canada was suddenly experiencing, or was about to face, a serious physician shortage. Medical school enrollment cuts were perceived as the major cause of that shortage, despite the fact that this was mathematically impossible. According to polling conducted in 2002, an overwhelming majority of Canadians (86%) believed there was a shortage of physicians, and an even greater proportion of physicians (89%) reported shortages among their ranks. This shift from perceived surplus to perceived shortage emerged over a period when the actual per capita supply of physicians has remained steady. The view that the root cause of the shortage was enrollment cuts has also persisted, despite the fact that research indicates a variety of other factors—including the amount of time physicians spend in post-graduate training, decreases in the rate of foreign physicians entering Canada, and physician retirements—have played a much greater role.
Due to these, and other developments, federal, provincial, territorial and local health care policy and management communities have identified health human resources as a key and enduring priority for planning and investment. Within the broad health human resources rubric, the timely availability of high-quality physician services remains a preoccupation.
The so-called ‘Anatomy’ project is intended to dig beneath the surface claims of shortage and the surface stability of physician supply per capita, to provide health human resources (HHR) policy-makers and planners with a more comprehensive and nuanced understanding of the service provision dynamics underlying the sudden shift in perceptions. It will investigate the degree to which workforce factors, work patterns, and population-based and policy factors have contributed to changes in access to, and use of, physician services in British Columbia. In particular, it will look at:
- How workforce factors—the size, composition, geographic distribution and organization of the physician population—have influenced access to care in the province
- How work patterns—roster sizes, mix of services provided, patient mix by demographic characteristics and health status, workload—changed since the early 1990s
- What environmental factors—population growth, fee structure changes and policy shifts—have been important in influencing access
This project uses a combination of data from the BC Linked Health Database, the College of Physicians and Surgeons of British Columbia, the College of Pharmacists (PharmaNet) and additional data from the British Columbia Ministry of Health. These data sources will allow CHSPR researchers to use a ‘three-dimensional’ approach (linking fee item records, physician profiles and population data) to investigating the questions outlined above. The project will look at the years 1991 to 2005.
This work, in part, builds on previous CHSPR projects looking into the supply, distribution and practice composition of primary health care physicians in the province.
- Contact: Morris Barer
- Kim McGrail
- Bob Evans
- Charlyn Black
- Greg Stoddart, Clinical Epidemiology and Biostatistics, McMaster University
- Steve Morgan
- Diane Watson
Funding and Support
- Canadian Institutes of Health Research