Nearly six million Canadians do not have regular access to a family doctor. In addition to providing routine care, these physicians are the gatekeepers for advanced medical care.
Physician shortages are a key reason Canada’s health-care system is struggling. Out of 10 advanced countries, Canada ranked seventh on access to care, and seventh overall, in the Commonwealth Fund’s widely-cited report on leading health systems.
Over a series of articles, Canadian Affairs is exploring what Canada can learn from Australia, which consistently ranks at or near the top of the fund’s report.
Australia not only sees the best health outcomes of all countries, but also spends the least as a society on health care. It also outperforms Canada on its physician-to-population ratio and administrative efficiency, which affects physician retention.
“Australia provides more support to doctors than we do here,” said Dr. Hugh Scully, a cardiac surgeon and former president of the Canadian Medical Association.
In this third installment of our health-care series, we examine the causes of Canada’s physician shortage and what could be done to address it.
“What would be a more efficient system? Group practice, salary with benefits and enough people to do the work, and accountability for the services,” said Scully, who is also professor emeritus of Surgery and Health Policy at the University of Toronto.
Talent and training
Canada has one of the lowest physician-to-population ratios among high-income countries, with about 2.4 physicians per 1,000 people in 2024.
By comparison, Australia has about four physicians per 1,000 people, right around the OECD average of 3.9.
Scully attributes Canada’s low ratio to insufficient medical school and residency spots and a fragmented licensing system.
“It’s not that there aren’t people who want to do medicine. It’s just difficult for them to get into medical school in the first place,” he said. “There are [people] … who should qualify and don’t, because there’s only so many [government] funded spots.”
Canada limits the supply of new doctors through a quota‑based system: provinces fund medical school seats and residency placements and set funding caps that restrict how many students can be trained each year.
The federal government, meanwhile, funds about one-quarter of total health-care costs, but does not make its funding conditional on provinces training more doctors.
Canada also underutilizes internationally trained doctors, Scully says, because of onerous provincial qualification and licensing requirements.
“Given the mix of population in our country with the immigration we have, most [international] graduates would be very helpful in many communities,” he said.
Australia, by contrast, has increased the number of doctors it trains domestically and recruited internationally trained doctors.
“For the last 25 years, we significantly increased the amount of health professionals that we train, in particular doctors,” said Mark Cormack, a professor and health‑system policy expert at the Australian National University.
“Each year there is, across most specialties … an increase in the number of professional entry courses and specialist training programs.”
Australia also recruits doctors internationally from countries including Canada, the U.K., Ireland, and New Zealand.
“There’s been a bias towards like‑minded, English‑speaking health professionals,” said Cormack.
And Australia makes it relatively easy for those physicians to qualify to practice.
“[For people from these countries,] the pathway into Australia is pretty smooth, pretty slick, because our training and regulatory arrangements are very similar.”
An Australian-trained family physician would need to spend about one year qualifying before being able to practice in Canada, according to the College of Family Physicians of Canada. In Australia, by contrast, a Canadian-trained doctor could spend just six months getting qualified.
Don Nutbeam, executive director of the research collaborative Sydney Health Partners, agrees that Australia meaningfully reduced its physician shortages through a two-pronged focus on training more doctors and recruiting internationally trained ones.
“Building capacity has come through this combination of trying to grow the numbers at home and, frankly, having a very good migration system,” he said.
“Last year, for the first time, we registered more overseas‑qualified doctors than home‑trained doctors … they’re now about 50/50.”
As a reference point, in Canada, just 20 per cent of all residency spots in 2024 went to graduates of international medical schools.
Scully acknowledged that Canada has been trying to improve pathways for internationally trained doctors, but says work remains to be done.
“There is a lot of work going on … looking at exploring the qualification of international graduates, but we can do more in that context.”
Compensation and incentives
Physician compensation structures are another factor affecting how physicians practice.
Physicians in Canada are typically compensated through a fee-for-service model. Physicians in the public system bill their province for each medically necessary service they provide, and are prohibited from providing medically necessary services privately.
In 2023-24, the average family doctor in Canada billed about $325,000. For medical specialists such as cardiologists or neurologists, it was just over $400,000. For surgical specialists, it was just over $550,000.
But these figures are not take-home pay, says Scully.
In the Canadian system, doctors are essentially running their own small businesses. From their billings, they must pay their clinic’s expenses, such as staff, rent and insurance.
“Doctors don’t get any benefits, they don’t have pensions, they don’t have health [insurance], they don’t have life insurance,” Scully said.
In Scully’s view, Canada should replace its fee-for-service model with fixed physician salaries and benefits.
“Since [doctors’] income is all over the map, it’s very hard to make good planning for [slower periods and retirement],” he said.
Fixed salaries would reduce burnout and early retirement, and would incentivize doctors to prioritize quality and prevention over quantity of visits, he says.
Data show these are real concerns. In 2024, a Canadian Medical Association survey showed up to a third of physicians were considering retiring or leaving Canada over concerns such as lower earnings, unsustainable work hours and excessive administrative work.
An alternative approach is Australia’s more flexible compensation model, which pairs fixed salaries with the opportunity for additional billings.
As Canadian Affairs reported last week, Australia combines universal health care with an active private insurance market. The government incentivizes higher-income patients to purchase health insurance and seek non-urgent care in the private system.
Physicians in Australia have the option of working in the public system on salary as well as in private practice, where they bill patients or the government a fee per service.
The salaries of physicians in the public system range from about C$125,000 for general practitioners to about C$200,000 for surgical specialists. Many doctors supplement these earnings in private practice.
Cormack says this hybrid model helps retain physicians. “It’s an attractive place for health professionals to work. They can earn very high incomes,” he said.
However, this model does have limitations. It can make it harder to staff physicians in poorer communities, since market conditions limit how much physicians can charge.
“[T]here’s much more limited scope for private practice and for charging above the government‑mandated minimum rate,” said Nutbeam, who is a board member of Western Sydney Local Health District, a lower-income region of Australia.
This helps explain why access to care is also an issue in Australia. The Commonwealth Fund report ranked Australia ninth for access to care, noting Australians who do not hold private health insurance often wait longer to receive care.
“Roughly half of Australian patients who do not choose to purchase voluntary health insurance may have to wait longer to receive services,” the report says.
Administrative burden
Another factor affecting access to care in Canada is administrative efficiency. Physicians in Canada spend a substantial portion of their time on paperwork.
“One of my colleagues, who’s one of the best cardiac surgeons in the world, is tremendously frustrated [that] it now takes him more time to do the administrative work about an operation and consultation than to do the actual operation,” said Scully.
“That’s simply ridiculous, and many family physicians report that 40 per cent of their time is taken up administratively, for which there’s no compensation.”
In addition to reducing time for patients, this burden undermines job satisfaction and retention.
“Many physicians wind up missing dinners, missing family activities, missing helping at home because they spend an hour or two after the end of day at the clinic doing the paperwork,” Scully said.
While Canada ranked fifth in the Commonwealth Fund’s report for administrative efficiency, Australia ranked second.
Australia performs better because its health-care system is more centralized, digitally integrated and simpler.
“Australia and the U.K. excel in administrative efficiency by minimizing payment and billing burdens,” the report says. “In Australia, electronic claims processing ensures instantaneous payments from public and private payers.”
Cormack, of the Australian National University, says the system is simple for both physicians and patients.
“If you’re going to see your GP, it’s quite likely that as soon as you go there, you wave your Medicare card, a payment is then made into the bank account of the practice,” Cormack adds.
“From an administrative point of view, you couldn’t get a simpler system.”
Scully says Canada needs to digitize and harmonize more of its medical record, regulatory and payment systems.
“Different places have different medical record systems, and one of the great barriers is that one system can’t talk to another,” he said.
“Going back a while ago, [when I] was in practice, anything I did at Mount Sinai [Hospital in Toronto] couldn’t be registered in the patient’s record electronically when they came to the [Toronto] General [Hospital] for surgery … [you had] two areas that were not communicating with each other.”
Scully would also like to see Canada move to a multidisciplinary model, where physicians practice alongside other health professionals who also earn fixed salaries.
“The best possible model is a group practice where you have family physicians, physiotherapists, nurse practitioners … social services, [and] the major specialties like internal medicine and general [surgery], all part of the group,” he said.
“Group practice, salary with benefits, enough people to do the work, and accountability for the services — That’s my one sentence summary.”
Our young people are not more stupid than foreigners, are they? So why are we robbing other countries of their doctors, thereby depriving their populations of much needed healthcare? Why are we not producing our own doctors right here at home? I have been asking myself this for decades and it’s getting worse by the day.
If we want more doctors in Canada we have to self grow them with free education to become a Doctor! Degreed Doctors that must stay and work in Canada will be earning money and paying taxes that will more than just repay the cost of their education but continue to contribute to the growth of Canadas finances! Its common sense and do-able!
We are the parents of a daughter who could not get a seat in a Canadian medical school after 15 yrs as an Advanced Paramedic in a major Canadian city, but was welcomed with open arms by the Royal College of Surgeons, Ireland. First question you should ask is why could she not get a seat in Canada. Look at how many blocks, yes, blocks of seats, are bought for foreign student use by foreign governments. You will be shocked. That is the first problem. That problem has created a whole new problem; that is, now she is considered an International Student. The first gatekeeper is the Medical Council of Canada. I don’t even want to go there, but suffice it to say, they apply, across the board, regulations that might have been applicable 100 yrs ago to ALL foreign medical schools, some of which surpass in reputation to even the best medical schools in Canada. You need to ask the question, who are they accountable to, and why have they not been investigated. They will blame the provinces, the medical schools, and the various Colleges of Surgeons, all of which have a hand in also undermining our health care system. The third problem is the Americans have first choice of international students by virtue of the early date to select in the matching process. Canadian selection dates are after. Ninety percent of Internationally trained Canadians don’t even bother applying for a Canadian placement because there is, in practical terms, NO RESIDENCY spots available. Because the system is a “matching”, no Canadian international student intheir right mind are going to apply only to a Canadian placement because the chances of them getting a “match” is so small, and if they turn down an american or foreign placement in the hopes of getting a Canadian one, but don’t, they lose the opportunity to get a placement ANYWHERE and have to reapply the following year. The 4th problem, is once they go through their residency, (remember, it’s usually not a choice where they wind up), they have to, in most cases, do another 2 years of Canadian hoop jumping to satisfy, a no longer relevant series of studies and exams. Over 1000 Canadian students are forced to go abroad every year, and an equal number graduate, but don’t return because the medical establishment has soured any chance of them returning. There is no Dr problem, There is a Medical Council of Canada, Matching, Medical School, and College of Surgeon problem, all of whom, individually and collectively undermined our health care system to protect their false sense of self-importance, not the average Canadian. Now you know. Oh by the way, the politicians have been told where the causes lie, but don’t have what it takes to make these institutions, especially the MCC, account for the damage they have caused.