Physician Supply, Demand and Costs in Canada, with a focus on Ontario

Health Expenditures in Ontario Total government expenditure in 2002 was $83.9B; of which $32.8B was for health (39.1%) Largest cost component was hospitals, at $14.8B (45% of health budget) Physician services cost about $7B (21.3%) Fastest growth in cost in recent years is for drugs: double digit growth rates

1. Cost of Services. Health Care forms the largest single component of Provincial Budgets. Health Expenditures as % of Provincial GDP, Provinces & Canada, 2005 Source: CIHI, 2005, ‘National Health and Expenditures Trends, ’ % of GDP

Source: CIHI, 2005, ‘National Health and Expenditures Trends, ’ % of health budget Physician costs have risen and fallen over the years. Rising costs contributed to the decision to reduce enrolment in medical schools (see below). Expenditures on Physician Services as % of Provincial Health Budget, Ontario, Harris (conservative) Rae (NDP) Peterson (liberal) William Davis (conservative) Provincial Premiers

Drug Costs are Rising: Expenditures on Drugs as % of Provincial Health Budget, Ontario, Source: CIHI, 2005, ‘National Health and Expenditures Trends, ’ % of health budget

Source: “Drug Expenditure in Canada, 1985 to 2007” Canadian Institute for Health Information, Total drug expenditure in Canada, 1985 to 2007, showing current and constant dollars. Note: this includes prescription and non-prescription drugs, dispensing charges & taxes. Almost all of the growth has been in prescription drugs.

Costs of Care are Driven by Age of Patients. Government Health Expenditures per Person, by Age of Patient, Ontario, 2002 Age of Patient Source: CIHI, 2005, ‘National Health and Expenditures Trends, ’

2. Demand for Services. Demand, of course, is driven by the size and age of the population. Projected Population Growth, Ontario, Population 65+ Overall Population

Demand for Services: Medical Services per Patient, by Age of Patient, Ontario, 2002 Source: Ontario Medical Association # services Age of Patient

3. Physician Supply: Number of MDs per 100,000 Population by Province, Canada, 2005 RankProvinceMDs / 100,000 1Nova Scotia218 2Quebec215 3British Columbia199 4Newfoundland193 5Alberta188 6Manitoba179 7Ontario176 8New Brunswick172 9Saskatchewan156 10Prince Edward Island144 Canada190 Source: CIHI “Supply, Distribution and Migration of Canadian Physicians, 2005”

Population per GP, Canada and the Provinces, 2005 Source: CIHI: “Supply, distribution and migration of Canadian physicians”, 2005

Physicians per 100,000 population, Ontario, Source: Ontario Medical Association MDs / 100,000 On the left of the diagram, MD supply was not keeping pace with the growing population Increased medical school capacity began to pay off

Physician Supply: How Do We Compare? Physicians per 1,000 Population for Selected OECD Countries Belgium France Germany Australia Canada USA UK Source: OECD 2006 Health Data So, Canada has been flat-lining. What about Ontario? See next slide...

How are we tackling the physician shortage? First Year Enrolment in Ontario Medical Schools, Source: ACMC “Canadian medical School Statistics The Bob Rae cut-back Deficit = about 7 years x 80 physicians ≈ 560 total

Growing MD numbers in Ontario Number of new certificates of registration issued by College of Physicians and Surgeons of Ontario Why the increase? Increased medical school enrolment Inflow from other provinces (incentive strategies) Repatriated Ontario physicians More international medical graduate residency positions

Trends in overall numbers of MDs, Ontario, Source: OPHRDC, “Physicians in Ontario” # of MDs

Annual gains & losses in staff 2. Nurses in Ontario, Migration of Physicians between Canada & U.S., Net

So, will this fix it?? A side-effect of the enrolment reduction was to increase the average age of Ontario doctors. And older doctors see fewer patients... Age Distribution of Ontario Physicians, 1994 and 2005 Source: Ontario Medical Association % of MDs 1994 mean age 39.5 yrs 2005 mean age 49.1 yrs Light grey bars = 1994; dark = 2005 A survey by the College of Physicians & Surgeons of Ontario gave different figures: Average age has risen from 50.7 years in 2005 to 51.2 in 2007; 14% of practicing Ontario physicians are > 65 years old.

Growing numbers of young physicians are female... Source: OMA Physician age group Male doctors Female doctors Average consultations per family doctor by age and sex of the physician And, on average, they tend to see fewer patients ♂ ♀ Physician age

Percentage of all Family Physicians accepting new patients, Ontario 2007 % Source: College of Physicians and Surgeons of Ontario. MD Dialogue, April, 2008