One in six family doctors are near retirement age, leaving millions of Canadians in health care limbo

Jane Pritchard is a 73-year-old family doctor in Toronto who wants to retire, but cannot find anyone to take over her 900 patients. 'I stay awake at night, wondering what’s going to happen to them if they don’t have a family doctor,' she says.Cole Burston/The Globe and Mail

Nearly one in six family doctors in Canada are 65 and older and nearing retirement, leaving millions of Canadians potentially losing their access to primary care.

Seniors make up the fastest-growing share of family doctors, with the percentage 65 and older more than doubling to 15 per cent from 6.5 per cent over the past 20 years, according to a Globe and Mail analysis of statistics from the Canadian Institute for Health Information (CIHI). During the same period, the percentage of family doctors between the ages of 40 and 49 shrank to 22.6 per cent from 34 per cent, a legacy of cuts to medical school enrolment more than two decades ago.

Among the provinces, New Brunswick and Quebec had the highest share of family doctors 65 and older at just over 18 per cent in 2021, followed by Prince Edward Island and Nova Scotia.

Doctors who are 65 and older

Per cent, by province, 1968-2021

Canada

Alberta

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

British Columbia

Manitoba

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

New Brunswick

Nfld.

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Nova Scotia

Ontario

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Prince Edward Island

Quebec

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Saskatchewan

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

the globe and mail, Source: cihi

Doctors who are 65 and older

Per cent, by province, 1968-2021

Canada

Alberta

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

British Columbia

Manitoba

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

New Brunswick

Nfld.

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Nova Scotia

Ontario

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Prince Edward Island

Quebec

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Saskatchewan

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

the globe and mail, Source: cihi

Doctors who are 65 and older

Per cent, by province, 1968-2021

Canada

Alberta

British Columbia

Manitoba

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

New Brunswick

Nfld.

Nova Scotia

Ontario

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

Prince Edward Island

Quebec

Saskatchewan

22%

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

1965

‘75

‘85

‘95

‘05

‘15

‘25

the globe and mail, Source: cihi

The aging family physician work force amplifies Canada’s crisis in primary care, adding looming retirements to dwindling interest in family medicine among medical school graduates and a critical shortage of doctors. As older doctors retire, many cannot find younger colleagues to take over their practices.

“There are many places across the country that are struggling to recruit,” said Alika Lafontaine, president of the Canadian Medical Association (CMA). “Primary-care practice is in a really tough spot right now.”

A wave of retirements not only leaves more patients without a family doctor, Dr. Lafontaine said, it further strains hospitals and nursing homes, where many of these physicians also work.

A CMA comparison of job postings to newly qualified family physicians shows that Canada does not have the capacity to absorb those leaving the profession – 6,819 were 65 and older in 2021. Government recruitment websites advertised full-time positions for 2,571 family doctors in December, the CMA data show. But only 1,461 completed the postgraduate supervised training required to become licensed family doctors in 2021 – a gap that has doubled over the past two years.

Jane Pritchard, 73, wants to retire but can’t find anyone to take over her complex primary-care practice. She divides her time between caring for patients at a drop-in centre for women in downtown Toronto; refugees and immigrants from Latin America, including some who speak only Spanish, at her office; and 20 patients in their homes.

When Dr. Pritchard posted an ad on a provincial government website in January, she found only two doctors to interview but neither wanted to take over any of her 900 patients.

“I stay awake at night, wondering what’s going to happen to them if they don’t have a family doctor,” she said.

Dr. Pritchard has known some of her patients at the drop-in centre for 30 years, and is most concerned about the older, Indigenous women with multiple health problems related to residential schools.

The most difficult part is breaking the news to patients that she plans to retire, she said. “Every day when I tell someone, someone cries in my office.”

The town of Wheatley in southwestern Ontario will lose its only family doctor on Dec. 31, when David Eaton retires. The Thamesview Family Health Team with which he is affiliated asked the Ontario Ministry of Health for funding last year for a nurse practitioner to care for his 1,600 patients until a doctor can be found.

Denise Waddick, executive director of Thamesview, said she hopes the government will approve the funding in the new year. One in five of the 105,000 residents who live in the Municipality of Chatham-Kent, including Wheatley, don’t have a family doctor and many physicians are nearing retirement, she said.

“So that number is only going to continue to grow if we’re not able to recruit family doctors.”

Dr. Pritchard and Dr. Eaton are far from alone. But because of a lack of data on how many hours family doctors work, or how many divide their time between office-based primary care and practising in hospitals, nursing homes or walk-in clinics, it’s difficult to know which communities will be hardest hit by doctors retiring.

The Globe has reported that access to primary care is getting worse in many parts of the country. But significant gaps in data mean Canadians don’t know how many family doctors work in primary care – a clinical setting that allows continuity of care from infancy to old age. The CIHI figures reflect only the number of licensed family doctors, not where and how they work. That lack of information is hindering the provinces’ ability to deal with the growing crisis.

Much of the decline in the share of younger doctors can be traced to 1992, when provincial health ministers agreed to cut medical school admissions as part of a plan to curtail mounting health care costs. A Canada-wide 10-per-cent reduction in admissions in the 1993 academic year left the country with fewer doctors entering postgraduate training for the first time, beginning with the graduating class of 1997.

Eva Ryten, then-director of research at the Association of Canadian Medical Colleges, objected to the cuts, arguing at the time that Canada needed more doctors, not fewer, to meet the needs of an aging and growing population.

“I was kind of like a lone voice counteracting the generally accepted view that was desired by not just the federal government, but the provincial governments as well,” said Ms. Ryten, who is now retired.

Although medical school admissions have crept back up in recent years, the cuts initiated in 1992 resulted in Canada losing part of a generation of doctors. Just under half of the family doctors were 50 years of age and older in 2021, The Globe analysis shows.

Dr. Lafontaine, the CMA president, said provinces need to move past the idea of “managing physician numbers as a cost-containment measure.”

Candace Bradshaw, president of Doctors Manitoba, an association that represents physicians in the province, was in the smallest graduating class when she finished medical school in Winnipeg in the late 1990s – with just over 65 students. “So now my generation and who I graduated with, we’re all mid-career,” she said. “There’s just not enough of us.”

A survey by Doctors Manitoba in October found that the province’s shortage of family doctors could get much worse: 43 per cent are planning on either retiring, leaving Manitoba or reducing their clinical hours in the next three years.

In her own family medicine practice in Winnipeg, Dr. Bradshaw is not accepting new patients and she has to say “no” to patients asking her to add their older children to her roster. “The guilt is pretty heavy,” she said.

Rates of doctors 65 and older have dipped recently in only two provinces: to 16 per cent from 17.7 per cent in Nova Scotia; and to 16.7 per cent from 20 per cent in PEI.

As part of a recruitment program launched in PEI in 2020, physicians are actively involved in attracting new doctors. The province is also creating two full-time physician relief positions to fill in for family doctors on sick leave or vacation, and it is setting up a new practice model, where doctors work in teams.

“All of those things, I think, are going to make a difference in the long term,” said Dr. Megan Miller, chief physician recruiter. “We just wish we could get there faster.”

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