Six and a Half Million Canadians Lack Family Doctors as Provinces Rush to Expand Team-Based Care

Approximately six and a half million Canadians do not have access to a family physician or family nurse practitioner, according to provincial and federal health-system data, a number that represents close to one in five residents and that varies significantly by province, by region, and by community. The figure has grown across the past five years and reflects the combined effect of an ageing physician workforce, slower growth in family medicine training enrolments, the continuing shift of younger physicians into focused practices and hospital-based work, and the long-running structural challenges of primary-care delivery in rural and remote regions across the country.

What the data show

The most recent national estimate of Canadians without a family physician or nurse practitioner is approximately six and a half million people. The figure is drawn from provincial health system data and from the Canadian Community Health Survey, with provincial and territorial estimates varying within the range from approximately one in seven to roughly one in four residents.

British Columbia, Quebec, and Ontario have all reported significant gaps. Atlantic Canada, particularly New Brunswick and Nova Scotia, has reported some of the highest per-capita gaps in the country. The Prairie provinces have generally reported smaller gaps in proportional terms, although Indigenous communities and rural and remote regions in those provinces have continued to face significant access barriers. The territories have reported particularly significant access challenges, although the structure of primary care in the North differs from the southern provinces in ways that complicate direct comparison.

The provincial data also show significant variation within provinces. Major urban centres with strong primary-care infrastructure typically have lower gaps than smaller communities or rural and remote regions. Regions with strong nurse practitioner-led primary-care systems, including parts of Ontario and the Atlantic provinces, have at times performed better than regions reliant primarily on physician-based primary-care models.

Why the gap exists

The drivers of the family doctor shortage are well-documented. The family physician workforce has aged, with significant retirement waves expected across the next decade. Family medicine residency training has grown more slowly than other specialties, in part because of the structural economics of family medicine practice and in part because of the changing professional preferences of medical school graduates.

Younger physicians have increasingly chosen focused practices, including hospitalist work, specialty clinic practice, palliative care, and other narrower scopes that do not include comprehensive longitudinal primary care for a defined patient panel. The result is that even as the total physician workforce has grown in some jurisdictions, the supply of physicians providing comprehensive longitudinal primary care has not kept pace with population growth.

Burnout among family physicians has been a continuing concern, particularly across the post-pandemic period. Survey data from the Canadian Medical Association and from the College of Family Physicians of Canada have shown high rates of physician dissatisfaction and elevated rates of intent to reduce practice scope or to leave family medicine practice altogether.

The Canada Health Act amendments

The federal amendments to the Canada Health Act that took effect April 1 are intended to support the provincial work of expanding access to primary care. The amendments require provincial and territorial health plans to cover medically necessary services delivered by regulated allied health professionals, including nurse practitioners, midwives, and pharmacists, on the same first-dollar basis as physician-delivered services.

The amendments do not by themselves resolve the underlying capacity issue. There are limits to the supply of nurse practitioners, midwives, and pharmacists, just as there are limits to the supply of family physicians, and the expansion of these allied professions requires sustained investment in education, regulation, and team-based practice models. But the amendments remove a structural barrier that had been limiting the deployment of these professionals in some provinces.

Provincial responses to the amendments have varied. Several provinces have moved to align their fee structures with the new federal requirements, while others have flagged the need for transitional planning. The federal Department of Health has indicated that compliance will be assessed leniently across an initial transition period but that substantive progress is expected within twelve to eighteen months.

Provincial primary-care strategies

Each province has developed its own primary-care strategy, with significant variation in approach. British Columbia has invested in primary care networks, in nurse practitioner-led clinics, and in payment model reform. Ontario has focused on family health teams and on community health centres. Quebec has worked on family medicine groups and on expanded pharmacist scope of practice. The Atlantic provinces have invested in nurse practitioner expansion and in collaborative care models.

The Prairie provinces have pursued a mix of approaches, including team-based care expansion, primary-care contract reform, and rural physician recruitment incentives. Saskatchewan and Manitoba have both faced particular challenges in rural and remote communities. Alberta has been working through provincial health-system restructuring alongside primary-care reform.

The federal-provincial-territorial table on primary care has been a continuing forum for sharing approaches and for coordinating broader strategies. The federal government's role in funding and policy development has been important but has not replaced the central provincial responsibility for primary-care delivery.

The role of immigration and credential recognition

Internationally trained physicians have been a significant source of Canadian primary-care workforce growth across recent decades. Approximately one in three practising Canadian physicians received their initial medical training outside Canada, with significant numbers having trained in the United Kingdom, Ireland, India, the Caribbean, and other jurisdictions.

The credential recognition process for internationally trained physicians has been a continuing concern. The provincial regulators of medicine, alongside the Medical Council of Canada, oversee the licensing process. The process has been streamlined over recent years through initiatives including the practice-ready assessment programme and through expanded examination access, but barriers remain. Several thousand internationally trained physicians who are present in Canada but not yet licensed represent a potential source of additional primary-care capacity if credential recognition can be further accelerated.

The federal government has been working with provincial regulators on credential recognition, with the Atlantic provinces and Saskatchewan having been particularly active in expanding pathways for internationally trained physicians. The Carney government's spring economic update included additional federal funding for credential recognition initiatives, although the federal role is supportive rather than direct given that licensing remains a provincial responsibility.

The team-based care model

The team-based care model, in which physicians, nurse practitioners, registered nurses, social workers, dietitians, pharmacists, and other professionals collaborate to provide comprehensive primary care, has been increasingly recognised as the most effective response to the broader access challenge. The model allows each professional to work to the full scope of their training, supports continuity of care across multiple types of patient need, and produces better outcomes on multiple measures than physician-only practice.

The Canada Health Act amendments support the team-based care model by ensuring that the contributions of non-physician professionals are covered by provincial plans. The provincial work of building team-based care infrastructure, including funding for ancillary professionals, support for shared electronic health records, and training of multidisciplinary teams, continues across all provinces.

The team-based care model has been particularly important for managing chronic conditions, including diabetes, cardiovascular disease, mental health conditions, and others. Patients with chronic conditions benefit from the regular involvement of multiple professionals across the trajectory of their care, and the team-based model is structurally aligned with that need.

What it means for patients

For Canadians who currently have a family physician or nurse practitioner, the broader access challenge has limited direct effect on their care. Continuity with their existing primary-care provider continues, although patients have noted in survey data that wait times for appointments have grown and that the scope of services available within a single appointment has narrowed in some practices.

For Canadians without a family physician or nurse practitioner, access depends heavily on the geographic and operational realities of their community. Walk-in clinics, urgent care centres, virtual care services, and pharmacy-based services have all expanded across recent years to address some of the access gap, although none provides the continuity of care that comprehensive longitudinal primary care offers.

For people with complex chronic conditions, the absence of a primary-care home has particularly significant implications. Chronic disease management, preventive care, mental health support, and coordination across the broader health system all depend on consistent primary-care relationships, and the absence of those relationships produces measurable effects on health outcomes.

What's next

The federal Minister of Health and provincial health ministers are expected to continue engagement on primary-care strategy across the coming months. Provincial primary-care strategies will continue to evolve, with continued investment in team-based care, in nurse practitioner expansion, in physician recruitment and retention, and in credential recognition.

The Carney government's spring economic update included additional federal investment in primary-care infrastructure and workforce development. The implementation of the various measures will roll out across the coming years, with the cumulative effect tested by whether Canadian access to family physicians and primary-care teams improves measurably across the trajectory.

For Canadians who are currently without primary-care access, the message is one of continuing work rather than imminent resolution. The structural changes required to close the access gap will take years to deliver, even with sustained federal and provincial commitment. The patient-by-patient effect of those changes will become visible only as the broader system response matures.