The family physician shortage in Alberta goes beyond the problem of fewer doctors providing services and includes patient factors that demand more time and resources, a new study revealed.

The number of family practices in Alberta that are accepting new patients “decreased dramatically” from nearly 900 in 2020 to 164 in 2024, according to Braden Manns, MD, senior associate dean of the Cumming School of Medicine at the University of Calgary, Calgary, and colleagues. “Nearly 50% of older Canadians with acute illness wait > 6 days to get an appointment with their [family physician], the worst among Commonwealth countries.”

Against this backdrop, “we thought it would be a good idea to try to understand this issue from a workforce planning perspective,” Manns told Medscape Medical News. “Why do up to 25% of [patients] not have family doctors? Why can’t they see their family doctors within a week if they’re sick? Is it simply a head count issue? Or is there something else going on?”

Changing Characteristics

Unlike most previous studies investigating the family physician shortage, Manns and colleagues looked at changes in patients as well as in family physicians over time. In particular, they examined the increasing need for primary care services because of rapid population growth overall, the aging of the Boomers, and recent evidence suggesting that Canadians are developing more comorbidities.

The researchers conducted a population-based cohort study using administrative health data (including physician claims, health records, hospital data, and ambulance reports) to assess adult patients seen by family physicians providing comprehensive primary care in Alberta from 2004 to 2020. They also assessed changes in family physicians during the study period.

The researchers found “notable changes” in the family physician workforce. For example, the proportion of women family physicians increased from 39% in 2004 to about 47% in 2020. “We’re not highlighting this statistic as a bad thing,” Manns noted. “We know that female family physicians tend to spend longer with their patients and that the care they provide is often of higher quality than that of male physicians.”

The idea that women might work part-time or won’t work as many hours as men is “not true,” he said. His team did not address that issue in the current study, but “other studies have shown that women have maintained the number of hours they work per week, whereas men have backed off on the number of hours they work per week.”

The current study also found that the proportion of family physicians trained in low- and middle-income countries rose from 6% to 17%. “That was surprising to us, and I think it reflects that we’re not doing a good job with our own workforce planning and our own training of our own physicians,” he said.

The quality of care provided by family physicians from low-to-middle income countries is not in question, he noted. “In fact, as we get more immigration from these areas, having family physicians who understand patients who are from those countries is good. But although being able to communicate in local languages is great, we’re still not training enough of our own family physicians.”

The researchers also found that the average number of patients seen per day by a family physician fell from 23 in 2004 to 20 in 2020, and the average days worked each year by family physicians decreased from 167 in 2004 to 156 in 2020.

The authors suggested that the decreased number of patients seen per day, and possibly smaller roster sizes, might result from factors such as the greater complexity of patients, as well as family physicians who are combining traditional primary care with focused practices (eg, surgical assistants, hospitalists, or urgent care) and thus are spending fewer days providing comprehensive outpatient care. An increase in burnout and in administrative burden might also have resulted in a reduced capacity for patient care.

On the patient side, the study found that the proportion of patients aged 61-80 years increased from 16.1% in 2004 to 22.1% in 2020, while the proportion of those with five or more comorbid conditions increased from 2.8% to 5.2%.

One limitation of the study is that the researchers did not include children under the age of 18 years, and so even their comprehensive analyses don’t reflect the full spectrum of the primary care workload.

Team-Based Care

“The solution isn’t just more doctors, or doctors with more time,” Manns said. “We need to expand primary care teams to include allied health professionals in one place, under one roof.” He pointed to Alberta’s Primary Care Networks, where family physicians work alongside other allied health professionals such as nurses, dietitians, and social workers to address patients’ needs.

“But while nearly three-quarters of Albertans receive care in primary care networks,” he said, “funding for teams remains very limited, with only about four allied health professionals for every 10 family physicians.”

Carrie Bernard, MD, president of the College of Family Physicians of Canada (CFPC), Mississauga, Ontario, agreed that more team-based care would be beneficial and would “help ensure that the way the students are trained is how they work.”

These days, “almost all family medicine students are trained in teams,” she told Medscape Medical News. “That doesn’t change the number of family physicians; that changes the way they work. We know that working in teams means that each person is supported to work at their full scope, and with these more complex patients, having a dietitian to deal with issues such as diabetes, having pharmacists on the team, all this enables a family physician to see many more patients.”

While some family physicians want to set up their own private practices, Bernard acknowledged, most family physicians no longer do, especially those who are new to the field.

Another strategy that would make going into family medicine more attractive, Bernard suggested, is reducing the administrative burden. Doing away with low-value visits for sick notes when employees miss a day of work would be one approach. This idea has been successful in provinces such as Nova Scotia and Ontario, where sick notes are no longer required for specific conditions.

The CFPC is also working to reduce the number of federal forms that family physicians need to fill out for patients, such as the disability tax credit form. “It takes an inordinate amount of time, and we’ve been advocating and asking the government to stop needing us to police this,” Bernard said. “There are multiple aspects of red tape where governments could just change the way it works, and it wouldn’t cost money.

“More respect and remuneration would also make family medicine more inviting,” she noted. On the university level, “there is an unspoken and sometimes spoken divide between a specialist and a family doctor. We call ourselves family physician specialists because we are specialists in generalist care.” Universities need to change the “respect narrative” for family physicians, and this change is beginning to happen, she said.

“We also have to look at how family physicians are remunerated,” Bernard added. “We’ve seen this in provinces across the country. When a better deal is struck with family physicians who provide comprehensive care, we see a net increase in family physicians providing that care.”

Physician Compensation Model

Indeed, the Alberta Medical Association (AMA), in collaboration with Alberta Health, launched the Primary Care Physician Compensation Model (PCPCM) in March. The model “aims to stabilize family medicine by supporting longitudinal care and improving income equity,” AMA President Brian Wirzba, MD, told Medscape Medical News. The model “acknowledges the complexity of modern primary care and compensates physicians for the full scope of their work, including time spent outside of direct patient visits,” he said.

In addition, to further alleviate shortages, Wirzba pointed to the following strategies also mentioned by Manns and Bernard:

• Expanded team-based care: integrating nurse practitioners, pharmacists, and mental health professionals into primary care teams
• Improved retention and recruitment, especially in rural and underserved areas, through incentives and supportive infrastructure
• Streamlined administrative processes: reducing nonclinical burdens that take time away from patient care
• Collaborative leadership by Alberta Health, the AMA, Primary Care Networks, and academic institutions aimed at aligning workforce planning, training, and compensation with population needs.

“While we have seen very good uptake of the PCPCM (just over 1000 physicians), we would be interested in partnering with the Ministry of Primary and Preventative Health Services to better understand the impact and to determine ways to have more physicians adopt this innovative model, potentially doubling over the next 12 months,” Wirzba said.

Meanwhile, “clinicians should be aware that system-level change is underway, but advocacy remains essential,” he said. “The PCPCM is a promising start, but its success depends on continued physician engagement, transparent evaluation, and responsive policy adjustments.

“Clinicians should also prioritize their own well-being. Burnout is a systemic issue, and sustainable practice models must support both patient care and provider health,” Wirzba concluded.

This work was supported by a Canadian Institutes of Health Research Foundation Award. Mann, Bernard, and Wirzba reported having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.