A recent CBC article chronicled the excessive wait times in Canada’s healthcare system for women suffering from endometriosis. One of the women profiled in the article was advised of a 30-40 month wait to see a specialist regarding her condition (Barrera, 2026). The CBC article by Jorge Barrera, chronicles how the patient finally gave up and spent her savings on seeking private care in Mexico. It was in Mexico, she was informed of a large mass that was in danger of blocking her bowels and was about to send her into sepsis, which is life threatening. If she had waited another two weeks, the result would have been an emergency surgery, Barrera writes. The angering thing is that no one in Canada’s health system would have been accountable for the damage to this person’s life nor the expense to the taxpayers for emergency surgery over minimal preventive care, nor for the wait that this patient was forced to endure before spending her own money abroad.
The CBC article also specifically mentions that there are “not enough specially trained gynecologists in Canada” (Barrera, 2026, para. 44). These specialist and general physician shortages have been a policy choice by Canada. A policy choice by a nation that somehow spent nearly $400 billion in healthcare expenditures in 2025 yet still only has a ratio of 2.8 physicians per 1000 people (National Health Expenditure Trends | CIHI, n.d.; World Bank Open Data, n.d.-a). This policy dates back to the Barer-Stoddart Report that was commissioned in 1991. The supply of physicians into the market is controlled by provincial governments and shows the pitfalls of state-managed supply restriction (Office of the Auditor General of Ontario, 2025). From a political economy perspective, state-managed supply restriction is commonly found in command economies, like our comparison point, Poland used to be.
The Barer-Stoddart Report, commissioned by provincial health ministers in 1991, reported that since the 1960s the number of practicing physicians had increased by 108 percent and more medical schools were added into the pool for students (Marchildon & Di Matteo, 2023). These bureaucrats came to the conclusion that eventually physician supply would outstrip demand for health services (Marchildon & Di Matteo, 2023). Two observations jump out immediately when this outcome is considered:
- Demographic Aging: The Baby Boom generation was not accounted for. By the year 2006, the first of the ‘boomers’ would be reaching sixty years old and therefore would have increasing health needs
- Migration: The massive number of immigrants Canada would welcome in the years after the report was commissioned (1991): 1.5 million people from 1991 until 2000, then nearly 2 million people from 2001 to 2010 and approximately 2.5 million people from 2011 to 2021 while simultaneously decreasing the number of physicians available (Government of Canada, 2022).
Having an oversupply of physicians is an absurd theory even to the layperson. It assumes that every person in the country could easily get into medical school, complete nearly a decade of rigorous training and residency exams, and somehow endure the immense financial cost. The barriers to entry to become a doctor in Canada are quite high for the average Canadian. This artificial fear of oversupply persists in Canada because it is actively reinforced by lobby groups and social movements that defend the status quo. These groups and movements refuse to entertain the idea of privatizing medically necessary services or even look to other nations as an example of how it could be done affordably and efficiently. While social movements can be a powerful tool for positive change, they can also be powerful obstacles to innovation or change.
Canadian Doctors for Medicare, one of these lobby groups, bills itself as “a group of physicians and friends [who] became concerned about the increased privatization in Canadian health care, and about the development of a two-tiered health care system that would allow the wealthy to buy private insurance for private care at the expense of the vast majority of Canadians.” (Canadian Doctors for Medicare, 2022). This group does not even consider the implementation of a system that would let a consumer pay the provider directly – because that would mean some of these doctors would make less and their cartel-like existence would be blown wide open by an actual free market. This group prefers the monopoly the state has on healthcare as opposed to neoliberal reforms. Canadian Doctors for Medicare do not explore the option of opening the market, creating more spaces for residents and allowing them to train in the private healthcare space as well as the public one. Keep everything the same and things will be fine –except things are not fine.
Physician shortages resulting in wait times and lack of care are not Canada’s only issue with its single-payer healthcare system. There are difficult barriers to becoming a physician in Canada besides the rigorous academic work and the long hours. Canada has eighteen medical schools currently that offer only approximately 2900 new first year spots (AFMC, 2022). The next barrier to entry which would quickly take away any worries of an oversupply problem of physicians is the cost of medical school. Medical school can cost students $16,000 to $27,000 CAD per year and this is after already completing a Bachelor’s degree (AFMC, 2022). According to a questionnaire sent out by The Association of Faculties of Medicine of Canada, “82.5% of Canadian medical graduates reported debt directly related to their medical education and Canadian medical graduates reported an average debt of $84,172 for medical school expenses and $80,516 CAD of non-education related debt” (AFMC, 2022).
The pool of potential medical students is limited to approximately 3000 people (and not all are Canadian citizens). Medical graduates are then saddled with crippling debt. Policy makers will then query why these medical graduates head for the lucrative private sector in the United States to pay off over $100,000 CAD of loans. Our government will inevitably hire a task force to understand why we have physician and specialist shortages in Canada after the initial task force recommended to limit physician supply because “reasons”. Now we have the inevitable contradiction between Keynesian state management and Neoliberal market logic. Under a Keynesian framework, healthcare is treated as a universal public good funded and managed by the state to protect citizens’ welfare. When the state arbitrarily decides to limit supply and create difficult barriers to entry, it can create rationing and shortages. Although, whatever logic the Canadian federal government and provincial governments are using at times is often thought to be beyond comprehension for those of us who enjoy common sense.
I compare our nation to Poland many times for one as our populations have been close for the most part, hovering around 40 Million people, however recent World Bank Data shows a divergence of Poland having 36.5 Million people and Canada having approximately 41 Million people as of 2025 (World Bank, n.d.-b). The two populations last converged in 2020 at approximately 38 Million inhabitants (World Bank, n.d.-b). Since then, Poland has restricted immigration and Canada has welcomed immigration, birth rates have not taken any great divergence between the two nations. Climate is also similar between the two nations as well as education levels and quality of life. I do have somewhat of a bias as my family history and ongoing interest in post-communist Central Europe make Poland a fascinating mirror to hold up to Canadian policy.
Unlike in Canada, domestic medical students in Poland enrolled in full-time public programs pay no tuition, as higher education at state institutions is constitutionally guaranteed as free of charge (Constitution of the Republic of Poland, 1997, Art. 70). Imagine actually getting something a return on your tax dollars, but I digress. Now that the economy has improved, newly minted physicians tend to remain in Poland where they have a choice of working in the private or public sector (Pszczółkowska, 2025). This has been a positive for both the public and private divisions of Polish healthcare. In Canada the state tells you where and how you can practice as a doctor—but as far as financing your medical degree? You’re on your own, and good luck paying off $100,000 when you graduate. Ironically, one of the most unfree nations in the world before 1989 has now told its citizens “We will pay for your medical school, if you pass your exams and your licensing exam and you can practice in the public or private sector it is your choice.” Neoliberal policy can actually succeed when governments allow competitive markets and individual choice to function. While no system is perfect, it at least provides healthcare professionals who have made massive educational investments the freedom to choose how and where they work.
Physician shortages are a big part of Canada’s healthcare problem but other issues are also afoot. In the annual Commonwealth Fund (CMWF) International Health Policy Survey, Canada ranked 9th out of the 10 countries surveyed with long wait times and a “limited availability of care” cited as the main concerns (Zhang, 2025). This institution conducts ongoing surveys of seniors, primary care physicians and the general public in terms of healthcare.
Key findings
- Access to primary care: Older adults (those age 65 and up) were more likely to have a regular primary care provider than adults age 18 to 64 in Canada. However, nearly 8% of older adults in Canada — almost 600,000 — didn’t have a regular primary care provider, and this was the highest percentage among the 10 countries surveyed.
- Timely access: Among older adults in Canada with a primary care provider, only 1 in 4 (25%) could get a same- or next-day appointment when needed. This was lower than the Commonwealth Fund survey average of 39%.
(Canadian Institute for Health Information, 2024)
These issues have been on repeat for decades and appear in populations beyond seniors in Canada. The other main findings were that “Canada fared poorly in affordability, administrative efficiency and equity” (Zhang, 2025). The first ranked country in the survey, the Netherlands, actually spends less on healthcare as a percentage of GDP than Canada. The affordability concerns are raised for areas such as pharmaceuticals, long term care and dental care (Zhang, 2025). The Commonwealth Fund International Health Policy Survey tracks and compares health system performance across 10 high-income countries: Australia, Canada, France, Germany, The Netherlands, New Zealand, Sweden, Switzerland, United Kingdom United States.
Healthcare viewed through a political economy lens goes beyond just looking at healthcare as a science and a service. Political economy refers to “the combined and interacting effects of economic and political structures or processes, and by extension, to the scholarly study of this domain” (Harvey, 2021, p. 181). Political economy also involves questioning the role of government in market economies and where economic redistribution may occur (Barnes, 2017). The political economy of healthcare has evolved due to the study of the “capitalist political-economic system” where a market economy exists with social protections alongside it (Harvey, 2021). Policymakers shaping Canadian and Polish healthcare demonstrate key political economy principles by controlling supply, entry barriers and resources for economic and political purposes. Different models of political economy influence how healthcare is delivered. Canada has chosen a Keynesian option with government intervention and control of the distribution. Policy makers have insisted this will allow for equity amongst the population and access to care but the reports from scholarly sources have said much different. A 2023 article by The Canadian College of Health Leaders indicates in the first line of the abstract “Primary healthcare in Canada is in crisis” (Flood et al., 2023). This is not a ringing endorsement for Canada’s system.
The works of Karl Marx, Friedrich Engels and Marxist political economy were large influences in the early literature of public health and the political economy of health (Harvey, 2021). The notable physician Rudolf Virchow studied these works and believed that having a public health system would fail if the upper class’s political power and the inequalities produced by capitalism were not challenged (Harvey, 2021). Capitalism itself, Virchow argued, produced the social conditions responsible for health inequalities. If medicine were to have a private tier in Canada, lobby groups such as Canadian Doctors for Medicare insist that inequality will be pervasive and it will take away healthcare from marginalized groups especially. Perhaps those in Canadian Doctors for Medicare are not reading journals from their own profession.
The Canadian Institute for Health Information reports in 2023 that one in six Canadians do not have a regular family physician (Flood et al., 2023). Less than half of Canadians can see a primary care physician on the same or the next day (Canadian Institute for Health Information, n.d., as cited in Flood et al., 2023). Racialized and lower income adults report disproportionately that they do not have a primary care doctor (Pham & Kiran, 2023, as cited in Flood et al., 2023). By relying on administrative healthcare rationing and supply restriction, rather than simple supply-and-demand economics, Canada achieves neither efficiency nor equity in its healthcare offerings. It is difficult to call a system in a high-income nation equitable when millions of people cannot participate in its offerings.
As so many infomercials have told us in the past, there has to be a better way!
References:
Association of Faculties of Medicine of Canada. (2022). Future MD Canada. https://www.afmc.ca/strategic-priorities/education/future-md-canada/
Barnes, T. (2017). Political economy. In The Wiley‐Blackwell encyclopedia of social theory (pp. 1–10). John Wiley & Sons. https://doi.org/10.1002/9781118430873.est0276
Barrera, J. (2026, October 12). ‘We can’t deal with it in Canada’: Some women turn to Mexico for endometriosis care. CBC News. https://www.cbc.ca/news/world/endometriosis-canada-health-care-mexico-9.7375759
Canadian Doctors for Medicare. (2022, October 5). Myth: “Privatization” can help everyone access health care. https://www.canadiandoctorsformedicare.ca/myth_privatization
Canadian Institute for Health Information. (n.d.). National health expenditure trends. https://www.cihi.ca/en/national-health-expenditure-trends
Canadian Institute for Health Information. (2024). Commonwealth Fund survey, 2024. https://www.cihi.ca/en/commonwealth-fund-survey-2024
Flood, C. M., Thomas, B., & McGibbon, E. (2023). Canada’s primary care crisis: Federal government response. Healthcare Management Forum, 36(5), 327–332. https://doi.org/10.1177/08404704231183863
Harvey, M. (2021). The political economy of health: Revisiting its Marxian origins to address 21st-century health inequalities. American Journal of Public Health, 111(2), 293–300. https://doi.org/10.2105/AJPH.2020.305996
Marchildon, G., & Di Matteo, L. (2023). Physician workforce planning and boom–bust economic cycles: A retrospective on the Barer–Stoddart report. Canadian Medical Association Journal, 195(4), E162–E165. https://doi.org/10.1503/cmaj.221611
Office of the Auditor General of Ontario. (2025). Performance audit: Oversight of medical education in family medicine. https://www.auditor.on.ca/en/content/annualreports/arreports/en25/pa_OMEFM_en25.pdf
Pszczółkowska, D. (2025, May 14). Do future doctors want to leave Poland? New research from the University of Warsaw’s Centre of Migration Research. Serwis Naukowy UW. https://serwisnaukowy.uw.edu.pl/en/do-future-doctors-want-to-leave-poland-new-research-from-the-university-of-warsaws-centre-of-migration-research/
Statistics Canada. (2022, February 9). Profile table, Census Profile, 2021 Census of Population—Canada (Catalogue No. 98-316-X2021001). https://www12.statcan.gc.ca/census-recensement/2021/dp-pd/prof/index.cfm?Lang=E
World Bank. (n.d.-a). Population, total – Canada. https://data.worldbank.org
World Bank. (n.d.-b). Population, total – Poland. https://data.worldbank.org
Zhang, T. (2025). Troubling diagnosis: Comparing Canada’s healthcare with international peers. C.D. Howe Institute. https://cdhowe.org/publication/troubling-diagnosis-comparing-canadas-healthcare-with-international-peers/
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