The number of doctors per capita in Canada will decline by 2015 without more foreign-trained doctors, but increasing the number of spots for qualified Canadian students is a better solution, the Fraser Institute concludes in a report Monday.

Provincial governments have reduced medical school enrolments and post-graduate training programs since 1993.

To solve the physician shortage problem, qualified Canadian students need to be able to get the education and training they need, concluded the report, titled Canada's Physician Shortage: Effects, Projections and Solutions.

Restrictions on the volumes of services doctors deliver should be removed, said the report's author, Nadeem Esmail, a senior health policy analyst with the institute, a right-leaning think-tank.

The report also called for provincial governments to completely deregulate tuition, allowing medical schools and teaching hospitals to determine their own admission levels.

Finding a doctor difficult

In 2003, more than 1.2 million Canadians were unable to find a regular physician, according to Statistics Canada.

Canada also had many fewer physicians per capita in 2002 than most other developed countries with universal health-care insurance programs, a 2005 report by the institute said.

"Without a significant addition of foreign-trained doctors, the Canadian physician-to-population ratio will decline between now and 2015, just as it would have through the 1990s if foreign physicians had not been used to 'top up' the shortfall caused by insufficient medical school admissions," the report said.

"It is irresponsible for a wealthy, developed nation with a highly educated population to rely on international medical graduates to deliver health care to the population."

The report's estimates of the new doctors needed to maintain Canada's number of physicians per capita takes into account:

• Increases in the number of medical school admissions over the last five years.
• The need to replace doctors who die, retire or emigrate.
• An assumption that the country's population will continue to increase at its average growth rate since 1990.

Doctors could employ international medical graduates, as well as nurses and nurse practitioners, to expand the volume of service delivered, at the physician's discretion, the report suggested.

Relying on foreign-trained doctors is negatively affecting the supply of physicians in lower-income countries such as South Africa and India, a 2005 study in the New England Journal of Medicine found.

Doctors near retirement should also be allowed to continue practising after age 65 to increase the supply, Esmail said.