How many friends do you know who cannot find a family physician (FP)? If you are like most Canadians, then you must know one or more. That is not surprising because between 4 and 5 million Canadians do not have a family physician.

How did this situation arise, and why was it allowed to occur? There are several reasons.

Firstly, the aging population. 13.4% of Canada's population is 65 or older, and within the next year, 300,000 people in Canada will turn 65—the highest annual level on record. Patients over 65 have increasingly complex and chronic conditions that can be expected in an aging population. This means each patient requires more medical services to address his or her health needs. But FPs themselves are also aging, and many are retiring later than usual. The average age of Canada's physicians is 50.
Secondly, the average physician today is spending more time on paperwork and less with patients than she or he did 20 years ago.

Thirdly, the public is well informed and has high expectations of the services and tests they feel they are entitled to receive, especially with respect to quality of life in later years. Advances in technology have created increased, not decreased, demands on diagnostic services.

Shortages are not limited to rural areas; urban centres are experiencing widespread shortages, especially centres that absorb large numbers of new immigrants each year. TIn the countries of the Organisation for Economic Co-operation and Development (OECD), the average number of pphysicians per 1000 population is 36% higher than Canada's. To match the OECD ratio, Canada would need 26,000 more physicians. Population growth is going to result in an extra 1.3 million people by 2012. Today we hhave 32,708 family physicians, and we project we will have 36,357 by 2012 (based on current input/output). HHowever, we believe we will need more than 37,908 family physicians by 2012. The shortfall between what we wwill have and what we will need is 1,551 family physicians.

But we are also going to have to deal with shortages in nurses, physiotherapists, radiographers and other allied health professionals. What should we do about this? Here too the solution needs to be multi-pronged:
Today physicians, especially FPs, spend 20% of their working time doing paper work that can be done by secretaries and receptionist with minimal supervision by the physician. In effect this will increase the clinical time of doctors by 10 - 20%, depending on how much is delegated.

There are about 4000 international medical doctors in Canada, unlicensed, but eager to work in their profession, instead of delivering pizza or driving taxis. The licensing of these doctors should be fast tracked, while stillmaintaining national standards that ensure their competence and patient safety.

Several years ago the intake of medical students into medical schools was significantly reduced based on very poor advice the provincial and federal government obtained. Because it takes about 6 to 8 years to fully train a physician, we are now seeing the results of such ill advised policy. Therefore medical school intake needs to be increased, in the hope that we will see the benefit of such action in about 7 years.

Imaginative methods of dealing with patients complaints have to be found, such as a well organised tele-medicine consultation network, such as was started a few years ago for remote communities in northern Ontario.

Qais Ghanem, MD