HOW MANY PHYSICIANS DOES CANADA NEED TO CARE FOR OUR AGING POPULATION

Background: There is concern that the aging of Canada's population wil l strain our health care system. The authors address this concern by e xamining changes in the physician supply between 1986 and 1994 and by assessing the availability of physicians in 1994 relative to populatio n growth and aging, and relative to supply levels in the benchmark pro vince of Alberta. Methods: Physician numbers were obtained from the Ca nadian Institute for Health Information. The amount of services provid ed by each specialty to each patient age group was analysed using Mani toba physician claims data. Population growth statistics were obtained from Statistics Canada. Age- and specialty-specific utilization data and age-specific population growth patterns were used to estimate the number and type of physicians that would have been required in each pr ovince to keep up with population growth between 1986 and 1994, in com parison with actual changes in the physician numbers. Physician supply in Alberta was used as a benchmark against which other provinces were measured. Results: Overall, Canada's physician supply between 1986 an d 1994 kept pace with population growth and aging. Some specialties gr ew much faster than population changes warranted, whereas others grew more slowly. By province, the supply of general practitioners (GPs) gr ew much faster than the population served in New Brunswick (16.6%), Al berta (6.5%) and Quebec (5.3%); the GP supply lagged behind in Prince Edward island (-5.4%). Specialist supply outpaced population growth su bstantially in Nova Scotia (10.4%), Newfoundland (8.5%), New Brunswick (7.3%) and Saskatchewan (6.8%); it lagged behind in British Columbia (-9.2%). Using Alberta as the benchmark resulted in a different assess ment: Newfoundland (15.5%) and BC (11.7%) had large surpluses of GPs b y 1994, whereas PEI (-21.1%), New Brunswick (-14.8%) and Manitoba (-11 .1%) had substantial deficits; Quebec (37.3%), Ontario (24.0%), Nova S cotia (11.6%), Manitoba (8.2%) and BC (7.6%) had large surpluses of sp ecialists by 1994, whereas PEI (-28.6%), New Brunswick (-25.9%) and Ne wfoundland (-23.8%) had large deficits. Interpretation: The aging of C anada's population poses no threat of shortage to the Canadian physici an supply in general, nor to most specialist groups. The marked deviat ions in provincial physician-supply from that of the benchmark provinc e challenge us to understand the costs and benefits of variations in p hysician resources across Canada and to achieve a more equitable needs -based availability of physicians within provinces and across the coun try.