Expanding healthcare capacity in Canada: the potential of internationally trained physicians

Summary

Canada's healthcare system is facing a severe shortage of doctors, leaving millions of Canadians struggling to access essential primary and specialist care. Despite substantial investment in healthcare, Canada still falls behind other OECD countries in having enough physicians to meet patient needs. This crisis, fueled by inadequate workforce planning, an aging population, and increasing physician burnout, has forced more patients to rely on emergency departments for basic care, driving up costs and reducing quality of service. Internationally trained physicians (ITPs) represent a significant yet underutilized resource. However, they encounter numerous barriers, including restrictive licensing practices, insufficient residency spots, and accreditation systems that occasionally value training length more than clinical performance or demonstrated competency. To address these urgent challenges, Canada should expand on competency-based accreditation methods, build on existing Practice Ready Assessment programs, create more residency placements for ITPs, and reduce bureaucratic hurdles. Taking immediate steps toward these reforms will improve healthcare access, patient outcomes, and ensure long-term sustainability of healthcare across Canada.

Canada's healthcare system is at a breaking point, with physician shortages reaching critical levels and millions left without access to essential care.¹ Despite being one of the highest healthcare spenders globally, Canada ranks 26th among 34 OECD countries in physician-to-population ratio (2.4 per 1000 vs. OECD average of 3.1).² This shortfall, compounded by an aging population and escalating physician burnout, has left over 6 million Canadians without a primary care provider, with some regions seeing rates higher than 30% of the population.¹ These gaps contribute to late diagnoses, worsening chronic diseases, and an overburdened emergency department system. Without urgent intervention, the crisis will deepen as physician retirements accelerate and burnout continues to erode workforce capacity. Here, we analyse systemic failures in physician workforce planning, the underutilization of internationally trained physicians (IMGs), and key reforms necessary to address these challenges.

Canada faces a 22,823-family physician shortfall, with only 1300 new graduates annually, making it impossible to close the gap at the current rate, especially in rural areas.³ In some regions, more than half of residents lack access to a primary care provider (e.g., the territories), while Quebec (21.5%) and British Columbia (17.7%) also report severe shortages.⁴ The growth of family physicians (1.58% in 2022) has failed to keep pace with population growth (1.84%), and with 20% of family doctors expected to retire within five years, access will further deteriorate.¹ Administrative burdens exacerbate the strain, with Ontario physicians spending up to 40% of their time on paperwork rather than patient care.¹ Additionally, unfilled residency positions (6% in 2023) and reliance on emergency departments for low-acuity cases (1.29 million visits in Ontario alone) highlight systemic inefficiencies. The cost disparity is stark, with emergency visits ($165 per visit) significantly outweighing the cost of primary care management ($56 per visit). Addressing these inefficiencies is imperative to improving healthcare access.^1,4,5 Critical specialist shortages further strain the system. Rural areas have 0.6 dermatologists per 100,000 people compared to 5.6 in urban centres, delaying diagnoses of conditions such as melanoma.⁶ Anaesthesiologist shortages have resulted in surgical cancellations, and some territories lack even a single specialist in key fields.⁷ These disparities necessitate targeted workforce planning to ensure equitable access across regions.

IMGs represent 25% of Canada's physician workforce, with 31.1% of family doctors trained abroad. Despite this, systemic barriers hinder their full integration.^1,2 While 90% of IMGs express willingness to work in underserved areas, licensing restrictions, residency quotas, and visa policies severely limit their contributions.⁸ In 2023, only 34.3% of IMGs secured family medicine residency positions compared to 97.8% of Canadian graduates.^1,5 Meanwhile, 58% of postgraduate trainees were visa holders, many of whom are restricted by return-of-service agreements with their home countries or ineligible for Canadian residency training.¹ Unlike Australia, which offers a streamlined competency-based pathway for internationally trained physicians, Canada continues to rely on prolonged time-based accreditation, delaying workforce integration and exacerbating shortages. These credentialing barriers force many IMGs to repeat training unnecessarily, creating financial and emotional hardships and leading to workforce attrition.⁹

Canada's time-based accreditation model prioritizes duration of training over demonstrated competencies, delaying IMGs' entry into practice. Additionally, fragmented provincial regulations and limited residency positions further obstruct IMG integration. To address these barriers and optimize Canada's physician workforce, we propose the following key reforms:

• 1.Standardize Accreditation through Competency-Based Assessments: Replace rigid time-based training requirements with competency-based assessments, expand Practice Ready Assessment (PRA) programs, and streamline the recognition of equivalent international credentials.
• 2.Expand Residency Capacity for IMGs: Increase residency positions allocated to IMGs and establish a national framework for equitable selection and integration.
• 3.Incentivize Rural Practice: Implement financial incentives, targeted return-of-service agreements, and expedited licensing pathways to encourage IMGs to serve in underserved regions.
• 4.Reduce Administrative Burdens for Physicians: Streamline paperwork requirements, particularly in primary care, to allow physicians to focus on clinical duties rather than bureaucratic tasks.

Finally, Canada must act now to modernize its physician workforce strategy. Implementing competency-based licensing, expanding residency opportunities, and reducing administrative barriers will not only mitigate shortages but also ensure the sustainability of Canada's healthcare system for future generations. Failure to act will deepen regional disparities, prolong patient suffering, and erode trust in a healthcare system that was once considered a global model for accessibility and quality. Now is the time for bold action to secure Canada's healthcare future.

Contributors

LFLT: conceptualisation, writing–original draft.

FYDM: conceptualisation, methodology, supervision, writing–review & editing.

FNCS: conceptualisation, supervision, writing–review & editing.

There was no funding source.

Declaration of interests

LFLT, FYDM and FNCS: We declare no competing interests.