Number of medical school graduates increasing; average age of physicians stabilizing

Canada experienced the biggest annual percentage gain in the national supply of physicians since the late 1980s, according to a new report released today by the Canadian Institute for Health Information (CIHI). In 2009, there were approximately 68,100 active physicians working in Canada, an increase of nearly 2,700 physicians over the previous year. This represents an increase of 4.1%—more than triple the rate of growth of the Canadian population as a whole (1.2%) and the largest annual increase of the past two decades.

The 2009 edition of CIHI's annual report Supply, Distribution and Migration of Canadian Physicians shows that over the past five years, the number of physicians in Canada has been increasing at a faster rate with each passing year, consistently outpacing population growth. In 2005, there were 190 active physicians per 100,000 Canadians, compared with 201 physicians per 100,000 Canadians in 2009. Over the past 30 years, we've seen an increase of 51 physicians per 100,000 Canadians, a 33% increase.

"Thanks to investments across Canada to train and retain more doctors, we now have more physicians than we've ever had before in this country; however, numbers alone don't tell the whole story," says Michael Hunt, CIHI's Director of Pharmaceuticals and Health Workforce Information Services. "The demand for physician services depends on the needs of Canadians. It also depends on the way care is organized and the scope of practice of other health professions. There is no perfect formula for a 'right' number of doctors to satisfy the health care needs of Canadians."

CIHI's report reveals an increase in both the number of medical graduates from Canadian universities, as well as the number of physicians returning to Canada from abroad. In 2009, Canadian faculties of medicine awarded a record number of medical degrees (2,344), an increase of 34% over 2004 and 47% over 1999. Also in 2009, 295 physicians returned from abroad, compared with 203 who left Canada to work in other countries. This represents a net gain of 92 doctors, the highest gain in physicians returning to Canada from abroad in the last five years. Given the increase in training seats, it is expected that the trend of an increasing supply of physicians will continue in the coming years.

Physician payments up; average age of doctors stabilizing

Due in part to an increase in the overall number of physicians, clinical payments to doctors are also on the rise, reaching more than $17 billion in 2008-2009. This represents an increase of 9.6% over the previous year, the largest annual gain posted in the past 10 years. All provinces reported a rise in payments to physicians, though those increases varied from highs of 13.4% in Quebec, 11.9% in Ontario and 10.2% in Prince Edward Island to a low of 3.9% in British Columbia, Saskatchewan and New Brunswick.

Expenditures for physicians' services represent the fastest-growing category of health spending, according to CIHI's report National Health Expenditure Trends, released in October of this year. In 2009, the average gross fee-for-service billing for a full-time equivalent family physician was $235,420, while the average gross fee-for-service billing for a full-time equivalent specialist was $323,004. (Gross billing includes physician salary payments, as well as other office staff salaries and expenses.)

For the first time since 1991, the average age of physicians in Canada has not increased. In 2009, the average age of a physician in Canada was 49.7 years, about the same as it was in 2008 (49.8 years); however, about one in five practising physicians is still age 60 or older.

"Physicians continue to represent one of the oldest workforces in Canada among health practitioners, with the highest average age. This is in part because physicians tend to be older when they enter the profession due to long years in medical school, and they tend to retire later than other health care workers," says Geoff Ballinger, CIHI's Manager of Health Human Resources. "However, with the increase in new graduates this year, we are seeing a noticeable influx of younger blood in the profession. As a result, the age of the physician population has stopped rising for the first time in almost two decades."

Physicians who begin practice in province of graduation more likely to stay

Today's report also examines the long-term retention of physicians in the province where they begin to practise. The study found that 72% of Canadian-educated medical graduates who set up practice in the province of their graduation were still practising in that province 10 years later. The retention rate of Canadian-educated medical graduates who set up practice in a province other than their place of graduation was significantly lower (44%) and only slightly higher than that of international medical graduates (37%).

"Physician retention is a concern for many Canadian communities," says Hunt. "Many regions of the country have put a variety of incentive programs in place to attract doctors to their communities and keep them where it would otherwise be very difficult to access a physician."

Quick facts on physicians

• Between 2008 and 2009, the national physician supply increased by 4.1%, more than triple the rate of growth of the Canadian population as a whole (1.2%).
• In 1979, there were 150 physicians for every 100,000 Canadians; by 2009, that ratio had climbed to 201 per 100,000.
• In 2009, Canadian faculties of medicine awarded a record number of medical degrees (2,344), an increase of 34% over 2004 and 47% over 1999.
• In 2009, 295 physicians returned from abroad, compared with 203 who left Canada to work in other countries. This represents a net gain of 92 doctors—the highest gain in the last five years.
• Physicians' clinical payments totalled more than $17 billion in 2008-2009, representing an increase of 9.6% over the previous year—the largest annual payment increase in 10 years.
• According to CIHI's 2010 National Health Expenditure Trends report, physician expenditures is the fastest-growing category of health spending.
• In 2009, the average age of a physician in Canada was 49.7, about the same as it was in 2008 (49.8).
• Almost three-quarters (72%) of Canadian-educated medical graduates who set up practice in the province of their graduation were still there 10 years later. Retention of Canadian-educated medical graduates who set up practice in a province other than their place of graduation was much lower (44%) and only slightly higher than that of international medical graduates (37%).