Geographic Distribution of Physicians in Canada: Beyond How Many and Where Health Human Resources All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system now known or to be invented, without the prior permission in writing from the owner of the copyright, except by a reviewer who wishes to quote brief passages in connection with a review written for inclusion in a magazine, newspaper or broadcast. Requests for permission should be addressed to: Canadian Institute for Health Information 495 Richmond Road Suite 600 Ottawa, Ontario K2A 4H6 Telephone: (613) 241-7860 Fax: (613) 241-8120 www.cihi.ca ISBN 1-55392-736-2 (PDF) © 2005 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre : Répartition géographique des médecins au Canada : au-delà du nombre et du lieu ISBN 1-55392-738-9 (PDF) Geographic Distribution of Physicians in Canada: Beyond How Many and Where Prepared by: Raymond W. Pong, PhD Laurentian University, Sudbury, Ontario J. Roger Pitblado, PhD Laurentian University, Subdbury, Ontario Geographic Distribution of Physicians in Canada: Beyond How Many and Where Table of Contents Acknowledgements .................................................................................................. i Authors’ Notes........................................................................................................iii Foreword................................................................................................................ v Executive Summary ................................................................................................ vii 1. Introduction ....................................................................................................... 1 1.1 Background ................................................................................................ 1 1.2 Beyond Head Counts.................................................................................... 2 1.3 Objectives of the Study and Structure of the Report......................................... 3 2. Data and Methods .............................................................................................. 4 2.1 Target Populations....................................................................................... 4 2.2 Southam Medical Database........................................................................... 4 2.3 National Physician Database.......................................................................... 6 2.4 2004 National Physician Survey .................................................................... 7 2.5 Geographical Units of Analysis and Urban–Rural Designations ........................... 9 2.6 Measures of Unequal Distribution ................................................................ 12 3. Enumeration and Mapping of Canada’s Physicians ................................................ 13 3.1 Sex Distribution......................................................................................... 18 3.2 Age Distribution ........................................................................................ 22 3.3 Language Composition ............................................................................... 24 3.4 International Medical Graduates................................................................... 26 3.5 Unequal Geographical Distributions .............................................................. 28 3.6 Distance Measurements............................................................................. 38 3.7 Revising Physician Counts: Full-Time Equivalents ........................................... 39 4. Differences in Practice Characteristics Between Urban and Rural Family Physicians ... 45 4.1 Urban–Rural Differences in Family Physicians’ Scope of Practice ..................... 47 4.2 Urban–Rural Differences in Family Physicians’ Clinical Procedures.................... 52 4.3 Changes and Anticipated Changes to Scope of Practice.................................. 55 5. Summary and Discussion................................................................................... 57 5.1 Major Findings...........................................................................................57 5.2 Limitations of the Study and Future Research................................................ 59 References ........................................................................................................... 63 Geographic Distribution of Physicians in Canada: Beyond How Many and Where Appendices Appendix A—List of Abbreviations......................................................................... A–1 Appendix B—Technical Appendix........................................................................... B–1 Appendix C—Medical Specialty Categories—Southam Medical Database..................... C–1 Appendix D—Medical Specialty Categories—National Physician Database ................... D–1 Appendix E—2004 National Physician Survey Questions............................................E–1 Appendix F—Maps of Distribution of Physicians by Specialty .....................................F–1 Appendix G—Data Tables ..................................................................................... G–1 Geographic Distribution of Physicians in Canada: Beyond How Many and Where Acknowledgements The Canadian Institute for Health Information (CIHI) wishes to thank Dr. Raymond W. Pong and Dr. J. Roger Pitblado for authoring this report. Dr. Pong is the Research Director of the Centre for Rural and Northern Health Research (CRaNHR), Laurentian University, Sudbury, Ontario. He is also a faculty member of the Northern Ontario School of Medicine and the School of Nursing at Laurentian University. Dr. Pitblado is Professor of Geography at Laurentian University and Faculty Investigator with CRaNHR. CIHI also wishes to thank the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada for their review of and input on this report. The study described in this report was conducted in part utilizing original data collected for the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada’s National Physician Survey Database. The survey was also supported by CIHI and Health Canada. The National Physician Survey, and all of the data contained therein, as well as the copyright-protected works of the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada, cannot be copied or reproduced in whole or in part without permission of the College of Family Physicians of Canada, the Canadian Medical Association and the Royal College of Physicians and Surgeons of Canada. CIHI 2005 i Geographic Distribution of Physicians in Canada: Beyond How Many and Where Authors’ Notes In 1999, we prepared a Health Canada–commissioned study titled Geographic Distribution of Physicians in Canada.1 As far as we are aware, this remains the only publication that provides an analysis of the sub-provincial and sub-territorial characteristics and geographic distribution of Canada’s physicians, from a national perspective. This publication was based on data from 1996 or earlier. We are grateful to the Canadian Institute for Health Information (CIHI) for giving us the opportunity to update and expand our analysis. The present work could not have been prepared and published without the support of a number of staff members of the Health Human Resources department at CIHI. Help was also provided by the Health Expenditures department. We gratefully acknowledge their assistance. This report was designed to provide what we feel is an objective overview and description of some of the geographies of Canada’s physician workforce. We hope that it will be helpful to policy-makers, planners and researchers who are interested in issues concerning health human resources, particularly the medical workforce. Specific policy-related recommendations were not intended to be part of the report, though readers may construe some statements as being policy-oriented. Such statements are solely the responsibility of the authors and may not reflect the views of CIHI or of those who reviewed the report. Raymond W. Pong, PhD J. Roger Pitblado, PhD CIHI 2005 iii Geographic Distribution of Physicians in Canada: Beyond How Many and Where Foreword The Canadian Institute for Health Information (CIHI) is one of Canada’s leading sources of quality, reliable and timely health information. More and more, Canadians are turning to CIHI for information they can trust. CIHI is a not-for-profit, pan-Canadian organization governed by a strong and active 16-member board of directors whose membership strikes a balance among the health sectors and regions of Canada. The key to CIHI’s achievements is partnership. CIHI is a focal point for collaboration among major health players—from provincial and territorial governments, regional health authorities and hospitals to the federal government, researchers and associations representing health care professionals. The result of this cooperative effort is a strong and responsive health information system. CIHI provides Canadians with essential statistics and analysis about their health and