Canada is currently in a primary care crisis, with a significant deficit in the supply of physicians in relation to demand. 17% of residents do not have a primary care provider, despite Canada’s policy of universal healthcare . Primary care is the cornerstone of an efficient healthcare system, and provides populations with health education, early detection and screenings, immunizations, management of chronic conditions, and consistent long-term health management.  The preventative care provided by primary care practitioners is important in limiting the prevalence of otherwise preventable ambulatory care sensitive conditions. In this paper, I found that a lack of health literacy, long travel and wait times, and low physician supply are barriers to realizing primary care access. Low physician supply and long travel and wait times are specifically problems in rural remote regions, in which 17.8% of the population lives (Statistics Canada, February 2022). A lack of health literacy and difficulty navigating the system was a problem specifically cited by immigrants, who comprise 23% of Canada’s population (Statistics Canada October, 2022). Shifts to neighborhood based-care can address inequities in the spatial distribution of physicians while team-based care models and higher wages for physicians can address supply issues.

This map depicts the number of primary care physicians per 100,000 residents in Canada, aggregated by health region. Data on the number of physicians per 100,000 residents per health region was available publicly through the Canadian Institute of Health Information. The data was not initially usable in a GIS because it included totals by province and had 3 lines of heading, so I cleaned it in Excel. After cleaning the data, I added it to QGIS and joined it with a shapefile of Canadian health regions. This join was fairly simple to perform since each health region had a unique 5-digit “map code” that I used as the common field to perform the join. After ensuring the join was successful, I created a choropleth map to show the concentration of physicians in each health region. I chose to use Jenks natural breaks as my classification method to show natural clusters in the data and emphasize the differences between groups. Data was aggregated at the health region level, however each provincial government handles much of its respective health planning, so patterns can be observed at the province level as well (additionally several provinces are concurrently health regions.) Note that this data is just concentration of primary care physicians, and not other providers such as nurses, nurse practitioners, or physician’s assistants.

Examining this visualization, primary care physicians are not equally distributed throughout the population. There is higher concentration of primary care physicians on the East and West coasts compared to the central regions of the country. Canada’s least dense provinces (Nunavut and Northwest Territories) both had the lowest concentration of primary care physicians. Low physician concentrations can also be observed on the periphery of major cities such as Montreal and Vancouver. The highest concentration of physicians is observed on the Ungava Peninsula. British Columbia and Quebec both have higher primary care physician concentration overall.

Examining figure 4, several trends can be observed that align with existing literature. Current research shows that neighborhoods with low access to primary care doctors tend to be in close proximity to the urban periphery (Shah et al., 2016). This is the case around both Vancouver and Montreal, which are Canada’s 1st and 4th densest cities, respectively. Rural areas with sparse populations also have a lower concentration of physicians, as is the case with Nunavut, the Northwest Territories, and Newfoundland and Labrador, which comprise 3 of Canada’s least dense provinces. Remote and rural residents often have greater distances to overcome to receive primary care, which is in part due to a lack of physicians in these areas (Schuurman et al., 2010). Interestingly, Yukon, another predominately rural province does not follow this trend, even though current literature shows that the province has been experiencing an ongoing primary care physician shortage (Eggertson, 2006).