Canada is facing a medical crisis. Currently, 6.5 million people lack access to a family doctor, and that number is projected to reach 10 million in the next decade. We lag behind our international counterparts, ranking last among 10 high-income countries in access to primary care.
Canada already has thousands of doctors with the training to fill this gap, but who are unable to practice due to limited residency spots and Practice Ready Assessments (PRA) capacity. Currently, only 39% of International Medical Graduates (IMGs) initially match to residencies, and just 18% do so in the second round. This mismatch represents a major loss for the healthcare system, particularly as many IMGs have extensive clinical experience abroad.
IMGs include Canadian citizens and permanent residents who completed their medical training outside Canada and the United States, as well as those who were previously licensed and practicing medicine before moving to Canada (commonly referred to as Internationally Trained Physicians, or ITPs).
A new report out today, Maximizing Medical Talent: How Canada can increase the supply of family doctors by 50% quickly and cost-effectively, outlines two major ways the federal government can address these challenges.
First, the federal government can provide funding directly to faculties of medicine across Canada to create 750 additional family medicine residency positions per year that would be allocated to qualified immigrant doctors. This would represent a 50% increase on the over 1,500 family doctors who exit residency annually. Over the course of a decade, this would add 6,000 new family doctors across Canada. Given the average family doctor serves about 1,500 patients per year, this solution would provide over 1.1 million Canadians with access to primary care annually, and some 9 million Canadians over a decade.
Second, the federal government can increase funding for what are called Practice Ready Assessment (PRA) programs. PRA enable qualified immigrant doctors to complete a 12-week assessment to demonstrate they are competent to also practice medicine in Canada. These immigrant doctors have clinical experience abroad, and rather than spending two years in residency, they can meet Canadian standards much more quickly through a PRA. Unfortunately, only about 1,000 immigrant doctors have been able to complete a PRA since 2018 due to a lack of PRA spots. Federal funding for say, 500 spots per year, could yield at least 1,000 additional family doctors per annum.
Both of these solutions are very cost effective. Funding the first solution would cost about $127.5 million per year for 750 additional doctors annually ($170,000 per doctor). This represents just 0.2% more than the federal government’s $52 billion budget for the Canada Health Transfer in 2024-2025.
Funding the second solution is even less expensive. PRA operate on a cost-recovery model of about $35,000 per spot. This works out to $70 million for 1,000 additional PRA spots per year. In other words, Canada can churn out about 5 more doctors via PRA than it can for each funded medical residency position.
Both spends are very modest and the outlays are supplanted by the economic and social benefits. Providing more Canadians with access to primary care will result in a healthier society, less time wasted in waiting rooms so Canadians can spend more time working and with friends and family, as well as less strain on our health care practitioners who are under significant pressure.
These two solutions are not panaceas. Much more needs to be done to give Canadians better access to primary care. For example, harnessing technology, such as the use of telehealth can also help to improve access to care. We can also leverage existing health professionals such as nurse practitioners and pharmacists who can help to provide primary care access and give family physicians more time to treat patients who require their level of competency.
Nonetheless, Maximizing Medical Talent offers two additional solutions to complement other efforts to get Canada’s health care system on a more sustainable path. With strong federal leadership and the implementation of these initiatives, Canada can work to address its family doctor shortage, improve healthcare outcomes and build a more resilient system for future generations.