Slashing Med School Admissions Isn’t How You Deal With A Doctor Shortage
Quebec’s health minister announced a reduction in the number of medical school admissions last year in order to keep doctors from ending up unemployed in the future. And yet, one in five Quebecers still does not have a family doctor and, proportionally, Quebec has fewer doctors than most industrialized countries.
« Too many » doctors? Not really
International comparisons confirm what Quebecers have long known: namely, that it is particularly difficult to see a physician when you need to. In a survey comparing patient responses in 11 countries, including Canada, Quebec is last in terms of access to a doctor or a nurse the same day or the following day; last in terms of access to a specialist within four weeks; last in terms of wait times for elective surgery; and, unsurprisingly, dead last for emergency wait times.
Yet a widespread notion that regularly finds its way into news reports is that the province has a lot of doctors. The current health minister has even said that the province has « about 10 per cent » too many doctors. That is 2,000 « too many » on a total of about 20,000.
According to the Canadian Institute for Health Information, Quebec had 2.43 doctors per 1,000 inhabitants, which is slightly higher than the Canadian average (2.3). Nova Scotia (2.58) is the province with the most doctors, while Saskatchewan (1.97) is the one with the fewest. Quebec has somewhat more doctors than Ontario (2.2), and just barely more than British Columbia (2.42) and Alberta (2.41).
The picture looks quite different when we compare Quebec’s medical workforce with that of other industrialized countries. By using the OECD’s definition of « practising doctors, » which includes residents but excludes physicians who have no direct contact with patients, we observe that Quebec has 2.8 doctors per 1,000 inhabitants. Out of some 30 countries, only Turkey, South Korea, Poland, Mexico, Japan and the United States have proportionally fewer doctors than Quebec.
According to these same criteria, Quebec currently has around 23,605 « practising physicians. » If it had the same ratio as Australia, or 3.5 doctors per 1,000 inhabitants, it would have around 6,000 doctors more, some 11,000 more if it had as many as Germany (4.1), and nearly 20,000 more if it had as many as Austria (5.1). It is easy to imagine that the problem of access to health care would not be as acute if this were the case.
Benefits for patients
Increasing the number of doctors would be beneficial in several ways. First, the public system would have a larger workforce from which to fill vacant positions, which currently number in the hundreds. Also, this would allow unaffiliated private clinics to develop without any risk (real or perceived) of them cannibalizing the public system. The growing demand for care and the chronic inability of the public system to satisfy it are business opportunities for entrepreneurs. For example, one doctor already owns seven private clinics and plans to have between 25 and 50 within five years.
Thus, if the government continues to ration care and limit access as it does at present, new doctors will have the option of working outside the public system and continuing to increase the overall supply of care, without affecting the supply in the public sector. More competition in the supply of care will only be beneficial for patients.
For years, the Quebec Health Department has tried unsuccessfully to predict the needs of Quebecers by calculating, 10 years ahead of time, the number of doctors that will be required to meet those needs. This exercise rests on the premise that an all-powerful central authority can possess all the necessary information about the future intentions of millions of patients and tens of thousands of health professionals. The experience of the past 30 years shows that this is a fantasy. There have been multiple committees, study groups, injections of additional funds and structural reforms, with little to no results.
Quebec’s health care system suffers from numerous ills, for which there is no panacea. Having said that, doing away with artificial and arbitrary medical school enrollment quotas and allowing all those with the ability to study medicine to do so would inject a much-needed supply of oxygen into Quebec’s health care system. It could then evolve in response to the needs of patients, instead of according to the dictates of bureaucrats and politicians.
Jasmin Guénette est vice-président aux opérations de l’Institut économique de Montréal, Patrick Déry est analyste en politiques publiques à l’IEDM et l’auteur de « Il est temps de mettre fin aux quotas de médecins ». Ils signent ce texte à titre personnel.