We don’t just need more doctors. We need to use physician capacity differently

My oldest daughter turned 38 recentlyWhen she was born, I took two weeks away from my family medicine practice.Not because I thought two weeks was adequate maternity leave. Not because I did not want more time with my new baby. I took two weeks because that was what I believed my practice could tolerate.When my second daughter was born, I managed to take two months—largely because we moved cities, which created an unusual break in my practice.For much of my career, that was simply how medicine worked.When one physician went on holiday, the others scrambled. We covered one another within practices, across cities and in rural communities. We were happy for our colleagues to get away, but if we are truthful, we often hated the additional workload created when they did.And unscheduled life was even harder.A parent died. A child became ill. Someone was injured. A physician themselves became sick. There was pregnancy, parental leave, bereavement, continuing education or a growing leadership responsibility.The physician left.The work did not.For decades, we largely treated that as an individual physician’s problem.I think that is one of the assumptions we now need to change.The physician workforce discussion is too focused on numbersThere is no question that Canada needs more primary-care capacity.In Ontario alone, more than 2.5 million people remain without access to a family physician, and an Ontario Medical Association survey reported that 52% of family physicians were considering retirement or planning to retire within five years.Ontario is responding with a major expansion of primary care. Its current Primary Care Action Plan represents a $3.4-billion four-year investment, with the goal of connecting every Ontarian to a family doctor or primary-care team by 2029.Recruitment, training and team expansion are essential.But workforce planning cannot stop at how many physicians we have.We also need to ask:How much physician capacity do we have, how much of it are we actually using, and what causes us to lose it?Those are different questions.A physician may technically remain part of the workforce while progressively reducing clinical work because the demands of practice have become unsustainable.Another may retire completely because there is no attractive way to work at 20% or 30% of their previous commitment.An early-career physician may choose against comprehensive family practice because they cannot envision how pregnancy, parental leave or family responsibilities will fit within it.A mid-career physician may leave a demanding model of practice because there is no practical way to step back temporarily.And somewhere else, another physician may want flexible work but have no efficient way of discovering where that capacity is needed.This is not simply a supply problem.It is a workforce design problem.We have treated coverage as an afterthoughtHistorically, the locum was someone you found when you went on vacation.The transaction was straightforward in theory:One physician needed to leave. Another physician filled the gap.In practice, it was frequently far from straightforward.Physicians relied on colleagues, word of mouth, email lists, social-media groups and personal networks. Practices searched repeatedly for available doctors. The process could involve separate conversations about schedules, expectations, documentation, contracts, credentialing and payment.None of this was really conceived as health-workforce infrastructure.It was simply something doctors were expected to figure out.That may have been marginally workable when practices were smaller, professional networks were highly local and physicians largely accepted that availability to their practices would take priority over much of the rest of their lives.It is not an adequate workforce strategy for the future.The workforce exists across an entire careerOne of the most important changes we could make is to stop thinking about physicians as simply working or retired.There is enormous territory between 100 per cent clinical practice and zero.Early in a physician’s career, flexible coverage can make parental leave, continuing education and ordinary family life compatible with choosing comprehensive practice.In the middle of a career, it can allow a physician to temporarily reduce workload to manage illness, caregiving, leadership responsibilities or a particularly demanding period without abandoning a practice entirely.Later in a career, it can allow highly experienced physicians to continue contributing without carrying all the obligations of permanent comprehensive practice.That last category deserves much more attention.At this stage of my own career, I increasingly see the possibilities.This week I am stepping in to help cover two palliative-care physician colleagues in my region so that they can take a break. Their roles extend beyond clinical care, so I am also able to assist with some of the academic and medical-leadership responsibilities that accompany their work.I can do this precisely because I am at a different point in my career.I have experience and flexibility.I do not necessarily need or want to build another permanent practice.I still have physician capacity to contribute.There are physicians across this country in similar positions.Our workforce strategy should be trying to find them.Stop asking only how many doctors we can recruitRecruitment remains necessary.But perhaps a better set of questions is:How do we keep physicians practising longer?How do we make comprehensive practice compatible with the lives physicians actually live?How do we make it easier for physicians to reduce and increase their contribution at different points in their careers?How do we identify unused physician capacity and connect it with unmet need?And:How do we make temporary physician work a deliberate part of workforce planning instead of an improvised response to absence?This requires more than a job board.It requires a way to make supply and demand visible.It requires good matching.It requires fewer administrative barriers.It requires information about physician skills, preferences, geography and availability.It requires practices to communicate clearly what they need.And ultimately, it creates the possibility of understanding where shortages repeatedly occur rather than treating every uncovered week as an isolated event.What LOCVM is beginning to demonstrateThis is why I became interested in the work of LOCVM and have chosen to volunteer some of my time with the organization.LOCVM describes itself as a physician locum marketplace, connecting physicians looking for flexible opportunities with clinics and organizations looking for temporary coverage. Its platform is increasingly bringing matching, booking, communication, credential verification, documentation and payment into one place.That is valuable at the transactional level.But I think the more interesting opportunity is what that approach could represent at a workforce level.Today the problem may be:A clinic needs a physician for four weeks.The future question may be:Where does physician capacity exist, where is it needed, and how can we connect those two things efficiently?That is a fundamentally different way of thinking.A physician who wants to work one week a month is capacity.A recently retired physician who would happily work six weeks a year is capacity.A physician who prefers several concentrated rural assignments rather than a permanent urban practice is capacity.A physician with academic commitments who has predictable periods of clinical availability is capacity.A physician who wants to build a portfolio career rather than work in one setting for 30 years is capacity.The healthcare system does not benefit from that capacity unless it can see it and mobilize it.Technology can help us do that in a way our old informal networks never could.There is also a data opportunityOnce coverage becomes visible, another possibility emerges.We can begin to understand the workforce differently.Where are physicians repeatedly difficult to replace?Which communities have recurring coverage gaps?Which specialties generate the greatest unmet demand?How long do positions remain uncovered?Are shortages seasonal?What types of practice attract locum physicians?What prevents physicians from accepting particular opportunities?How many late-career physicians would continue practising if flexible models were easier to access?Those are no longer simply locum questions.They are health-workforce questions.And they could help governments, physician organizations, hospitals, primary-care teams and regional planners understand physician supply in a much more dynamic way.Physician supply is not staticOne of our persistent policy mistakes is treating the physician workforce almost as inventory.Train this many physicians.Recruit this many physicians.Lose this many to retirement.Calculate the difference.But physicians are people, and their capacity changes throughout their lives.A 32-year-old physician may need maternity or parental leave.A 45-year-old may unexpectedly become a caregiver.A 55-year-old may want to pursue leadership or academic work.A 65-year-old may be ready to leave comprehensive practice but very willing to continue working.A 70-year-old may want several carefully chosen clinical assignments each year and nothing more.A sophisticated workforce strategy should be capable of accommodating all of them.Instead, our traditional practice structures have too often forced physicians toward binary choices:Work at the expected intensity.Or leave.We should be able to do better.Coverage is workforce infrastructureThis is why I believe the locum discussion needs to move beyond vacations and temporary vacancies.Reliable coverage can help preserve the primary-care workforce we already have.It can make comprehensive family medicine more attractive to physicians beginning their careers.It can allow established physicians to remain in practice through difficult periods.It can create meaningful and flexible opportunities for highly experienced physicians later in their careers.And it can help move physician capacity to the communities and organizations that need it.The strategic opportunity for organizations such as LOCVM is therefore much larger than becoming the best place to post or find a locum.The bigger question is:Can we create infrastructure that allows Canada to identify, hold, mobilize and preserve physician capacity across an entire career?If we can, we may discover that one important answer to our physician workforce challenge is not only producing more doctors.It is making much better use of the physicians we already have.And underneath all of this is something profoundly human.Coverage is permission.Permission to become a parent.Permission to care for someone you love.Permission to become ill and recover.Permission to learn.Permission to lead.Permission to take a holiday.Permission to reduce your workload.Permission to age.Permission to continue contributing when full-time practice no longer makes sense.And permission to step away temporarily knowing that your patients will still receive care.If we build a physician workforce that provides that permission, we may not only improve coverage.We may keep more physicians practising, preserve more of the capacity we already have, and create a workforce that can respond much more intelligently to the needs of patients and communities.That is not simply a better way to manage locums.It is a different way to think about the physician workforce.Dr. Cathy Faulds is a palliative care physician in London, Ont. and a past head of the board of the Ontario Medical Association. This item originally appeared on her Substack.

We don’t just need more doctors. We need to use physician capacity differently

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