Physician supply: future tense

It is unfortunate that CMAJ published the article by Frank Denton and associates1 on the sensitive and complex subject of physician shortages without including any editorial clarification to assist the reader in understanding the many other crucial aspects of this issue that were not examined by the authors. It was inevitable that the lay press would notice the article and misinterpret it,2 thinking that it supports the notion that physician shortages will lessen in the future.

In their commentary, the authors look back over the past 30 years and conclude that the increase in requirements for physicians is related more to population increase than to aging. They then postulate that because population increases are now lessening, the future need for physicians will increase to a lesser extent than in the past. Yet health care planners must stop looking backward and start looking ahead when making recommendations about physician shortages.

The problem is 2-fold and is well known to all practising physicians.

First, the patient population is changing, and patients are requiring (and demanding) far more physician services than in the past (as indicated by data from the Ontario Health Insurance Plan [OHIP] database). Furthermore, although the authors point out that the type of services needed will not be the same as in the past, they base their calculations solely on population change rather than other inevitable shifts such as type of disease and the development of new technology (not to mention the likelihood of new challenges such as the recent outbreak of severe acute respiratory syndrome). Second, physicians too are changing. They are now opting for a more balanced lifestyle, which means they are no longer working 60 to 90 hours per week, are no longer seeing large numbers of patients each day and will not be practising medicine until the age of 70 or beyond.3^,4 Thus, we are seeing a rapidly growing demand for physician services at the same time as individual physicians are cutting back on hours of work.

We simply must not repeat the mistakes made by health care planners 12 years ago and must not base our policies on retrospective reports. The need for physicians and other health care providers will continue to escalate, and the time to prepare is now.

C.R.S. Dawes Chair, Human Resource Committee Ontario Medical Association Toronto, Ont.