THE FACTS

The supply of family physicians in Canada is currently lagging behind population growth for the third consecutive year. National data from the Canadian Institute for Health Information (CIHI) shows that while the total number of doctors increased by 2.2% in 2024, the density of family physicians dropped to 119 per 100,000 population. Recent analysis confirms that 5.7 million adults in Canada reported having no access to a regular primary care provider as of 2024–25.

A forensic look at the workforce reveals a bimodal retirement risk: attrition peaks in early career years and again after age 65. In Ontario alone, approximately 1.74 million patients are attached to doctors aged 65 or older, many of whom manage medically complex caseloads. The Canadian Medical Association (CMA) projects a national shortage of 23,000 family physicians by 2026 if current training and retirement trends persist.

Despite federal incentives for international medical graduates and expanded residency seats, 75 family medicine residency positions remained unfilled in the most recent match cycle. The Ontario College of Family Physicians forecasts that up to 4.4 million residents in that province could be without a family doctor by late 2026. Data suggests that 65% of practicing family doctors are currently considering leaving or changing their practice due to administrative burden and burnout.

TAXPAYER COST

THE SPIN

Sources: CBC News, Toronto Star, The Globe and Mail, National Post

The Left: Systemic neglect of the care foundation

The physician shortage is framed as the inevitable consequence of decades of structural underinvestment and the deliberate erosion of the public health foundation. Governments are accused of expanding population targets and offloading medical complexity onto a system they failed to reinforce.

Early-career practitioners are seen as fleeing a model stacked against continuity of care, while senior doctors are forced to choose between burnout and abandoning their patient panels. Unfilled residency seats are treated as proof that the vocation has been made untenable by policy, not a lack of interest. The widening primary care gap is framed as a profound equity failure that leaves the most vulnerable Canadians to navigate a decaying system alone.

The Right: Governance failure and incentive decay

The shortage is framed as a predictable collapse of central planning and a total failure of the incentive structure. Training seats go empty because family medicine has been made administratively toxic and financially uncompetitive through bureaucratic overreach, not a lack of funding. Provinces are criticized for layering on paperwork and complexity without reforming antiquated compensation or accountability models.

Ottawa is framed as chasing headlines with "incentive" programs that fail to address the core problem of retention and throughput. The looms physician gap is treated as a foreseeable management failure where clear warnings were ignored, and necessary reforms were deferred until the system reached a breaking point.

WHAT THIS MEANS

ATTRITION IS THE HIDDEN GOVERNOR

Public debate centres on the 5.7 million people without a doctor and the need for more medical school seats. The binding limiter is the replacement ratio—the fact that it currently takes nearly two new graduates to replace the clinical hours of one retiring "comprehensive" family doctor. The constrained system is the transition from old-model "cradle-to-grave" family practices to newer, team-based models that have lower individual patient volumes.

Think of the family doctor pool as a bathtub. The federal government is trying to turn the tap (medical school seats) as far as it can go. But the drain (retirement) is getting wider. In the 1990s, one doctor might have managed 2,000 patients. Today, because of administrative load and a desire for work-life balance, new doctors often manage panels of 1,000 or fewer. This means even if you replace every retiring doctor one-for-one, you are still losing half of your system's capacity.

This sequencing is a procedural lock-in. A retiring doctor cannot "transfer" their years of patient history to a computer; they must spend hundreds of hours on administrative hand-offs. Because 65% of doctors are considering leaving, the system is facing a massive "reset" of patient data. Money can pay for more doctors, but it cannot buy back the 30 years of history a retiring physician takes with them.

This constraint is ignored because "Medical School Seats" are an easy political win. "Retirement Attrition" is a slow, demographic gravity that happens in private offices. Political cycles reward the "Pledge" of more seats, while the "Physics" of an aging workforce is a decade-long decay that money alone cannot stop.

"You can't fill a bathtub by turning on the tap if the drain is bigger than the pipe."

If the current retirement velocity persists, the 2026 primary care gap will become the permanent "new normal." The risk is that the system appears to be expanding because headcounts are up, while actual care-hours per patient continue to plummet. Over time, the family doctor becomes an elite luxury, not a universal standard.

SOURCE LEDGER

• CIHI —A profile of physicians in Canada (2025 Edition)
• ICES —More family doctors near retirement, raising concern about future of primary care (2025)
• Ontario College of Family Physicians —More Than Four Million Ontarians Will Be Without a Family Doctor by 2026 (2023)
• CIHI —Health workforce, 2024: Recruitment and retention (2025)
• Statistics Canada —High income tax filers in Canada, Table 11-10-0055-01 (2025 Edition)