Does Primary Care Really Need More Doctors?

The headline of a CBC on-line article on February 10, 2025, was “Ontario parties are promising family doctors for all. Compare the plans” as part of the current Ontario provincial election campaign. The article starts with some context: 

“Some 2.5 million Ontarians don't have a family doctor or regular access to any other primary care provider, such as a nurse practitioner. That leaves them waiting in walk-in clinics when they get sick or turning to hospital emergency rooms if they have no other options. Projections suggest another three million Ontarians will lose their family doctor to retirement in the next few years.” 

In our first two blogs, we hope we’ve made a compelling argument that supports ‘team-based’ care, not being rostered to a single, solo provider such as a Family Physician or Nurse Practitioner. Both doctors and NPs are of course very capable, but life in 2025 and beyond is getting more and more complicated, and one provider seeing you in 10- or 20-minute appointments often does not have the knowledge or the time to address all your concerns.

This leads to the bigger topic of Health Human Resource (HHR) planning. Which health professions can contribute to primary care, and what mix of providers produces the most comprehensive preventive and chronic care for the best value (outcomes/cost)?

A Health Canada publication – “Caring for Canadians: Canada’s Future Health Workforce” provides some data about the number of Nurses, Nurse Practitioners, Occupational Therapists (OT), Physiotherapists (PT), Pharmacists, and Physicians currently and projected to 2034. It includes the number of training programs, supply vs demand, rural vs urban, etc. While it does not include Social Work, Clinical Exercise Physiologist, Psychologist, Addictions Counsellors, and many other contributing professions, it has some useful core information.

What the Health Canada report does not say explicitly is that general population anxiety and political decisions that pour money into training more doctors, and endless media headlines focusing only on doctors misses the bigger picture. Without considering the broader HHR landscape, with shortages in other critical professions, we will only dig a deeper hole and not solve our access and quality of care problems. Health Homes ARE the way of the primary care future, but they will be handicapped by current and future non-physician HHR shortages. 

The Health Canada report gathered a wide range of data from all provinces other than Quebec. Using HHR as we traditionally do today, the shortages in the present and future look like this: 

The ‘Gap Head counts’ refers to the supply of providers versus the care demands/needs in communities. The number of available LPNs will increase due to increased training and few retirements, reducing the gap. The RN pool will increase then stabilize between 2026-2031, but then the gap will increase. The shortage gap of demand/supply of Family Physicians will remain generally the same from 2022-2034. Note the gap number ranges from 5,000 – 40,000 on the graph. 

The above graph shows trends for Registered Psychiatric Nurses (RPN), Nurse Practitioners (NP), Occupational Therapists (OT), Physiotherapists (PT), and Pharmacists (PH). But note the gap range is smaller from 500-4,000 on the graph as this is a better resourced group, although there are shortages. 

The following figures tell a similar story but looks specifically at the gap that will be occurring in urban centres versus rural and remote locations. 

URBAN

RURAL/REMOTE

Therefore, according to Health Canada projections, the physician shortage will persist. While projections are fraught with many challenges as there are so many variables that can change, this is further evidence that Health Home primary care clinics that plan and deliver services for their specific communities will more likely be successful if they are creative in the care team mix, provider scope of practice (what they can do at the clinic), with less central dependence on physicians, and more effective shared care that is  collaborative and coordinated. The physician role is unquestionably important, but like the quarterback on a football team, or the conductor of an orchestra, a small core of Family Physicians, with deep knowledge of the human biomedical pathologies can be complemented by a team of experts in social work, nutrition, physical activity, psychology, etc.

The figures shown above could be significantly different if more of the care load was shared across more health professions, resulting in more physician time, more focused patient visits, possible greater provider satisfaction, fewer earlier retirements and so on. The figures tell us we need to change – more of the status quo is intolerable.

It also indirectly reminds all of us that self-care such as finding ways to eat nutritious food, move our bodies regularly, get restorative sleep, minimize alcohol and other toxic substances, and build and maintain person-to-person social networks, will reduce the demand on ‘the system’ and improve the gaps described above.

NOTE: As a demonstration clinic for the health-home model of primary care, funded by Nova Scotia Health, we want to clarify that the opinions expressed in our newsletters are the opinions of the administrators and staff of the Mentor Clinic, and not necessarily of the NSH administration.