Does Ontario have enough physicians? It's a question healthcare planners and policymakers have been struggling with for years. Supply of Physicians' Services in Ontario, an Atlas Report from the Institute for Clinical Evaluative Sciences (ICES) confirms province-wide trends that many healthcare administrators and providers have experienced first-hand in their regions. Although the supply of doctors in Ontario has remained stable over the past decade, geographic maldistribution and reduced comprehensiveness of primary-care services are growing concerns.

The report illustrates the disparity between the supply of physicians in rural and urban areas by calculating the number of full-time physicians for each District Health Council. Urban areas with teaching centres have maintained a high number of doctors, while the rural district health councils have a shrinking ratio of physicians per capita.

Compounding the problem, general practitioners are offering less comprehensive services. They are focusing more on office visits and less on hospital care, emergency coverage and obstetrics. For example, the proportion of general practitioners providing services in hospitals dropped from 63% in 1991 to 52% in 1997. This reduction in primary-care services has likely had a negative impact on both the continuity of care for the patient and the availability of family physicians in hospitals.

History has shown us that simply adding more doctors without addressing the underlying issues behind the physician shortages will not solve the problem. According to the ICES report, potential solutions include expanded rural medicine training, changes to remuneration for rural medicine services, efforts to structure group practices in rural areas to manage workload and the use of nurse practitioners. Policymakers should identify the potential reasons for family physicians' increased focus on office visits such as low remuneration for outside services, paperwork, medico-legal risk, training or lack of administrative support.

Supply of Physicians' Services in Ontario, is available on the ICES website https://www.ices.on.ca. It is the first in a series of Atlas Reports, which are part of ICES' ongoing health-services research that documents patterns and trends focusing on the quality, equity and effectiveness of health care in Ontario. Future Atlas Reports planned for release in 2000 will include an examination of hospital indicators, such as the lengths-of-stay, inpatient and outpatient services, adverse events, and readmissions for selected diagnoses and procedures for 1991 and 1997.

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