Anatomy of a Doctor Shortage
Posted: 20 Jun 2007
Fifteen years ago, it was widely believed that Canada had a surplus of physicians. In the early 1990s, several provinces reduced their medical school enrollments. Almost immediately spokesmen for medical schools were claiming that these moves had created an emerging physician shortage, which would grow steadily more severe, such that enrolment expansion was an immediate priority.Yet the Canadian physician-to-population ratio has remained relatively stable for the past 15 years. And, as Chan (2002) pointed out, it would be mathematically impossible for enrolment cuts in the early 1990s to have had any significant effect on physician numbers over the following decade. Furthermore, average rates of billings per physician, adjusted for fee changes, were not falling and for many specialties were rising - an apparent increase in "productivity". Medical shortage claims did, however, resonate with the media and the experience of some members of the public - "I can't find a doctor" and "Waiting times for specialist consultations are too long." So "[w]hy does it feel like a shortage?" (Chan 2002), despite the lack of evidence in the aggregate data? Watson et al. (2003) found, for general/family practitioners in the province of Manitoba, that the relationship between physician age and average billing rates had twisted, falling for more recent cohorts of younger physicians but rising among older physicians with established patient rosters. This would reconcile the stability of average billings with public perceptions of difficulty in finding physicians willing to take on new patients. It would also suggest that as older physicians retire, the relatively stable rates of average physician "productivity" or at least fee-adjusted billings, might drop quite sharply.This paper will present preliminary results from a new project designed to explore the sudden transformation of a "surplus" to a "shortage" by analyzing (anonymised) individual-level billing data for the province of British Columbia, for both general practitioners and specialists, over the period 1990/91 to 2005/06. Billings in each year will be adjusted to a single base-year fee schedule, to yield a measure of "real" output by year, region, and specialty that can be examined relative to both full-time equivalent physician supply and age-adjusted patient population. We will be able to test the Watson et al. findings over the full range of physician services. More generally, if there is now a "shortage" of physician services, what kinds of services are now in reduced supply relative to the population, in which regions, and when during the past decade and a half did this reduction occur? Are reductions traceable to reduced full-time equivalent physicians, or reduced billing activity per full-time equivalent? And if, as other national work is suggesting, physician hours of work are falling, is this reflected in reduced service volumes? If so, which ones?
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