The Family Doctor Shortage Isn’t Just a Numbers Problem

More than six million Canadians don’t have a family doctor. I grew up seeing what that statistic looks like from the inside: in Brampton, “do you have a family doctor?” is a real question neighbours ask each other, the way people elsewhere might ask about a good mechanic. Walk-in clinics with two-hour waits are not an inconvenience here; for many families, they’re the whole system.

The obvious framing is arithmetic — too few doctors, too many patients, so train more doctors. That’s partly right, and new medical school seats matter. But the more I read, the more I think the arithmetic framing hides three harder problems.

First, it’s a distribution problem. Physicians aren’t spread evenly across the country, or even across the GTA. Peel Region has grown explosively, and primary care capacity simply hasn’t grown with it. Training more doctors doesn’t help a region they don’t practice in.

Second, it’s a job-design problem. Family medicine residency spots have gone unfilled in recent match cycles — not because medical students don’t care about primary care, but because the job as currently structured can mean running a small business, drowning in paperwork, and earning less than hospital-based specialties. When a role is chronically undersubscribed, the rational response is to fix the role, not to lecture the applicants.

Third, it’s an attachment problem. What patients actually need is a continuous relationship with a team that knows them — what the research calls attachment. Team-based models, where doctors work alongside nurse practitioners, pharmacists, and social workers, can attach more patients per physician while arguably delivering better care. Ontario’s family health teams point in this direction; the waiting lists to join them point at how far there is to go.

I don’t have a policy proposal; I’m an undergraduate who reads a lot and grew up in a shortage. But I’ve stopped saying “we need more doctors” as if it were the whole sentence. The whole sentence is longer: we need primary care that’s organized, funded, and located so that having a family doctor stops being a stroke of luck.