The narrative of a 'doctor shortage' is a convenient oversimplification that masks the real issues plaguing Canada's healthcare system. Despite record-high provincial medical budgets, many Canadians still face frustrating delays in accessing timely care. This isn't just a matter of needing more doctors; it's a complex interplay of factors, and understanding them is crucial.
My recent study, Medical Budgets in an Aging Canada, sheds light on this disconnect. One striking observation is that while Canada's population has grown by about 75% since 1976, the number of physicians has increased by nearly 200%. This seemingly contradicts the widespread belief in a doctor shortage. But here's where it gets controversial... the aging population is a significant factor.
In 1976, only one in ten Canadians was over the age of 64. Now, it's one in five. This matters because a typical 65-year-old requires as much medical care as four individuals under 50. The rising pressure on the system from an aging population was entirely predictable. The study quantifies this pressure: while the population grew by 75%, the demand for medical care, adjusted for demographics, increased by 135% – nearly double the rate. This is equivalent to adding almost 19 million extra patients under 50 needing care.
This surge in demand, without matching revenue, is a primary reason why most provinces are running deficits. If the demographics were the same as when the Boomers were young, most provinces would have surpluses today, without changing taxes or spending. Instead, we are filling fiscal holes created by predictable aging-related medical needs. Governments saw this demographic crunch coming. In the 1990s, Ottawa raised Canada Pension Plan premiums by 68% to prepare for boomers’ retirement. But the medical-care side of the equation was never fixed. Provinces didn’t modernize revenues to match the predictable rise in age-related medical spending.
But that conversation keeps getting crowded out by the doctor-shortage misdiagnosis. Canada has many more doctors compared to past demand. Even after adjusting for population aging, the physician work force has grown faster than the demographic-driven need for care. Part of the explanation lies in how medical work has changed. Doctors today work fewer weekly and annual hours than in the 1970s. This reflects expectations for better work-life balance, and a rising share of doctors in dual-earner households.
Staffing incentives also pull physicians away from community-based medicine. Hospital roles often offer higher pay and involve less administrative burden. The result is a siphoning of physician labour away from general practice – the front door of the system. Governments also have less room to invest in the building blocks for a healthy society – housing, child care, education, income supports and a stable planet. When we underinvest in what keeps people well, more people end up needing medical care, adding pressure to a system strained by population aging.
Imagine a concert where organizers triple the number of ticket booths; but each booth is open fewer hours than it used to be. That’s Canada’s medical system. We’ve added doctors faster than age-adjusted demand has grown, but physicians aren’t working the same number of hours they once did. And since governments haven’t invested urgently in preventing illness, more people keep joining the line.
Sustaining universal access to care will require governments to face the demographic reality driving medical demand; update revenues so financially secure boomers contribute in line with their costs; overhaul staffing incentives; and reinvest in the social and ecological foundations of health. That’s the real path to timely care –not repeating the oversimplified claim of a doctor shortage.
What do you think? Do you agree that the focus on a 'doctor shortage' distracts from the deeper issues? Share your thoughts in the comments below!
Dr. Paul Kershaw is a policy professor at UBC and founder of Generation Squeeze, Canada’s leading voice for generational fairness. You can follow Gen Squeeze on X, Facebook, Bluesky, and Instagram, as well as subscribe to Paul’s Hard Truths podcast.
