Canada lags behind other OECD countries when it comes to the number of doctors per capita and spending on primary care, according to a new analysis published in the Canadian Medical Association Journal.

"Health systems with strong primary care have better outcomes, lower costs, and greater equity," wrote the nine authors of the study.

"However, even at the beginning of the COVID-19 pandemic, about 17 percent of people in Canada reported not having a regular primary care physician."

At the same time, the analysis revealed that Canada is experiencing a decline in family medicine enrollment as a specialty among medical students, and more family doctors are choosing not to practice general care in clinics. Post-pandemic, 22% of adults in Canada – more than 6.5 million people – do not have a family doctor they can regularly see for care.

To solve these dilemmas, the authors said Canada should learn from the successes of other OECD countries with high rates of patients registered with primary care doctors.

'We need to do the same thing'

The authors compared Canada with nine countries where more than 95% of people have a family doctor, primary care physician, or place of care - including France, Germany, New Zealand, the United Kingdom, Denmark, the Netherlands, Finland, Italy, and Norway - to look for opportunities for improvement here. For the comparison, they studied data from 2018, 2019, 2020, and 2021.

They found these countries tend to spend more on primary care, a larger portion of their health care funded by the public sector, have a higher number of doctors overall, and more family doctors working in family clinics. In Canada, by comparison, many doctors work in emergency departments or practice in a specific field, such as sports medicine.

Among the nine OECD countries included in the study, most doctors are paid by salary or fixed payment arrangements known as capitation, rather than the fee-for-service model common in Canada. They organize after-hours care, and there are few or no publicly funded clinics. They also have smarter information systems that allow doctors to communicate better with patients and allow patients to access their own records online.

While Canada ranked in the middle for health care spending, the proportion of public spending was the lowest, at 70 percent. The study noted this figure has not changed since the 1990s.

Canada had similar numbers of family doctors per capita but a much lower total number of doctors per capita, at 24.4 per 10,000 people. After Canada, the country with the second lowest per capita number was the United Kingdom, with 30 doctors per 10,000 people. Norway had the highest number per 10,000, at 50.4.