Three Papers on Physician Labour Supply in Canada

Abstract

Despite Canada's record-high physician-to-population ratio, persistent wait times for specialist healthcare and insufficient primary healthcare access raise questions. Why does Canada face medical service shortages notwithstanding its high physician count per capita? What factors should be accounted for in physician workforce planning? To address these questions, I analyze Statistics Canada's population estimates and Labour Force Survey (LFS), and the Canadian Institute for Health Information's (CIHI's) physician expenditure and socio-demographic data, from 1987 to 2021. I focus predominantly on the supply side but also consider the demand side. In the first paper, I show that despite a 35% increase in physicians per capita from 1987 to 2019, the growth rate adjusted for physician labour supply and population aging is negative four percentage points. A 20% reduction in physician work hours from 1987 to 2020 contributes to this decline. These findings underscore the importance of considering factors beyond physician counts. In the second paper, examining physicians' COVID-19 responses, I find a statistically significant reduction in work hours during the first wave, with a subsequent recovery to the pre-pandemic level. The net reduction was entirely in community settings, with no statistically significant difference between general practitioners/family physicians and specialists. Moreover, no statistically significant gender differences were observed. In the third paper, I investigate factors contributing to the declining physician work hours using the LFS– a general-purpose survey. As the LFS survey weights are not designed for physician-specific analysis, I apply a generalized method of moments (GMM) weighting technique using CIHI's physician population data that improves estimation quality. This illustrates how the bias and/or precision of general-purpose surveys can be improved in profession-specific analyses. Reduced hours among males, the increased share of females, workforce aging, and an increase in absence rates and lengths are key reasons behind the decline.