Stanton Territorial Hospital in Yellowknife, N.W.T., in August, 2022. Most Canadians do not experience health care through abstract debates, but through the frantic attempt to find someone to assess a chronic illness before it spirals into an emergency room visit, writes Rafiq Andani.Emily Blake/The Canadian Press
Rafiq Andani is a family physician and an assistant professor in the Department of Family Medicine at the University of Manitoba.
For a generation of Canadians, buying a house has transformed from a symbol of stability into a crushing financial burden. Over the past decade, affordability evaporated as population growth vastly outpaced supply.
Today, we are witnessing the same kind of supply-constrained policy failure inside Canada’s publicly funded health-care system.
In 2025, the Canadian Institute for Health Information’s (CIHI) National Health Expenditure forecast puts Canada’s spending on physician services at roughly $55-billion. That massive figure consumes nearly 14 per cent of the country’s health-care budget. To put that in perspective, physician services cost more than public health ($22.2-billion) and provincial and territorial home and community care ($17.4-billion) combined, and about one-and-a-half times the 2025-26 departmental budget for National Defence and the Canadian Armed Forces ($35.7-billion).
The Canadian Medical Association projects physician spending to reach a new high. At the same time, a staggering 5.9 million Canadian adults, about 15 per cent of adults, still do not have a regular primary care provider.
Most Canadians do not experience health care through abstract debates over jurisdiction. They experience it through the frantic attempt to find someone who will renew a prescription or assess a chronic illness before it spirals into an emergency room visit.
Opinion: Canada’s approach to recruiting internationally educated health workers has a global price
As access to primary care tightens, the cost of maintaining the system continues to rise. CIHI’s 2023-24 National Physician Database payments data put Canada’s average gross clinical payment for family medicine physicians at $324,000 per physician.
International comparisons are imperfect but revealing. NHS Digital reported average general practitioner income before tax in England at £120,200 in 2023-24, or roughly $220,000. The Canadian gross-payment figure is about 32 per cent higher.
Australia points to the other half of the problem: supply. It registered more than 5,400 international medical graduates that same year.
Canada, by contrast, continues to spend heavily while leaving too much medical labour trapped outside practice.
This does not mean Canadian physicians are overpaid. Of those gross clinical payments, doctors must cover the soaring overhead costs of running a clinic. Rather, these figures reveal that Canada has engineered a deeply dysfunctional medical labour market.
In theory, a single-payer health care system should be able to operate as a monopsony: a single dominant buyer, with the market power to dictate prices. In practice, because the unemployment rate for a fully licensed family physician is functionally zero, provincial governments have surrendered that power. They negotiate from a position of scarcity.
When supply is bottlenecked, injecting more money into the system simply does not reliably buy more care. Instead, it can create rent-like effects: incumbents gain bargaining power because entry is constrained. Governments no longer act as dominant purchasers in the tightest parts of the physician labour market; they have become price-takers, paying ever-increasing premiums just to prevent the system from collapsing.
This scarcity is hollowing out the profession from the inside. Raw physician head counts mean little if accessible clinical supply is not keeping pace with population need. While family physician head counts have grown, the supply per population decreased from 11.8 per 10,000 in 2020 to 11.5 in 2024. The few available doctors are forced to absorb massive, highly complex patient rosters while fragmented bureaucracies shift endless administrative work onto their shoulders.
Other sectors would diagnose this immediately. In real estate, we know that a million-dollar mortgage now buys a fraction of the square footage it used to. Prices rose because demand structurally outpaced supply, inherently increasing the value of existing assets while locking out new entrants.
Health care operates under a similar supply-constrained logic. Governments continue to increase physician expenditures because the access pressures are real. The production pipeline for independent medical practice remains tightly constrained. Most frustratingly, thousands of internationally trained medical graduates already living in Canada spend years sidelined by bureaucratic bottlenecks, even when they have practised safely and independently abroad.
Practice-ready assessment programs offer a rational and faster off-ramp for experienced candidates who can demonstrate competence. Rather than assuming every experienced international physician must repeat years of basic residency, programs such as Saskatchewan’s 12-week clinical field assessment and Manitoba’s three-month family-practice assessment evaluate candidates through supervised workplace-based assessment. We need to measure clinical competence, supervise carefully, and deploy them to underserved areas.
We vastly underinvest in nursing, long-term care, and home care, but the fundamental math of our primary care deficit remains undeniable. We finally realized that pumping subsidies into a supply-starved housing market only inflates real estate prices without housing a single new family. It is time we learned the same lesson in health care: you cannot buy your way out of a policy-induced shortage.