Physician supply: future tense

Frank Denton and associates1 suggest that overall population growth is more important than the aging of the population in determining physician requirements, but 2 points seem to need further explanation.

First, the authors comment parenthetically that between 1970 and 2000 the requirements for physicians in Canada increased by 72%, whereas supply increased by 116%. However, the overwhelming experience of those of us working in the profession is that large segments of the population can no longer find a family doctor; furthermore, getting patients to specialists in a timely manner is often so difficult as to approach futility. This jarring discoordination renders the article's future projections difficult to evaluate and merits an explanation. Could the reason be increasing medical capabilities, technology or demand, or might the cause be less inhuman physician lifestyles?

Second, Denton and associates1 report that although use of physicians' services generally increases with patient age, it declines as elderly patients become very old, except in general practice, where use continues to increase even to the oldest age group. Perhaps the explanation is that GPs caring for very elderly patients do so in relative isolation, with these patients receiving less aggressive management. If so, is this appropriate? Or does it represent an adaptation to scarce resources, not only of human resources but also things such as diagnostic equipment, operating room time, even ground transportation?

There's a thesis topic here for somebody!

Charles T. Low Anesthesia Brockville General Hospital Brockville, Ont.