Canadian doctors say they are feeling increasingly frustrated by their inability to properly serve their patients' health needs, a national physicians survey reports.

The National Physician Survey questioned more than 20,000 doctors and doctors-in-training from across the country about their attitudes to the current health care climate.

Seventy-five per cent reported that inadequate funding of the health-care system, an undersupply of physicians and other health professionals, paperwork and bureaucracy are cutting into the level of care they want to provide patients.

The reasons the doctors cited for their frustrations included:

• increasing complexity of patient caseloads (80%);
• management of patients with chronic diseases/conditions (73%);
• increasing patient expectations (70%);
• and the aging population (69% among all physicians, 80% among family physicians)

The survey found timely access to health care remains a serious challenge for Canadians. Despite government investments to achieve reduced wait times in priority areas such as cancer treatment and diagnostic imaging, the progress has been uneven, the survey results suggest.

The doctors also reported that access in other key areas, such as emergency services, is still poor. In fact, ratings for these services have worsened since 2004 when the survey was first conducted.

College of Family Physicians of Canada President Dr. Ruth Wilson says most of the stress that doctors - particularly family doctors - are experiencing can be traced back to the physician shortage that has plagued this country for years.

"We've been hearing for quite a while that we've got a doctor shortage. This new survey shows that although we thought we were making some progress, perhaps we're not," she told Canada AM Wednesday.

"There are 4,000 doctors likely to retire in the next two years, and we're not even able to replace them. So I think the main news is that we need a plan here. We need a Canadian plan."

She notes that part of the shortage problem is that Canada's 17 medical schools have not been training enough doctors to replace all the ageing and retiring doctors.

"Lots of young Canadians want to be doctors, and we have one of the highest ratios of Canadians applying to medical school compared to the number of spots of many countries in the world," she notes.

"But nine people apply for every spot in medical school in Canada. The number of medical school entry positions was cut a number of years ago. It takes a while for that cut to work its way through. And we're still seeing the effects."

Wilson also notes that the face of Canada's medical workforce is changing. Of all the new physicians under 35 years of age replacing baby boomer doctors, 55 per cent are female. And many of those women are choosing to have families and to take time off to be with them.

"We know that women in their child-bearing age who are physicians work fewer hours. That just makes sense," says Wilson.

"Once the children are out of the home, men and women work roughly the same number of hours, but the increasing number of women in medicine, particularly in the younger age groups, is going to affect the ability to deliver services as well."

Dr. Louise Samson, who is president of the Royal College of Physicians and Surgeons of Canada as well as a practicing radiologist in Montreal, notes that it's not just women who want a better work-life balance than previous generations of doctors; it's younger doctors or both genders.

She says that's what she expects to see in a second survey coming out in the spring that will ask younger doctors about what kind of career they want to have.

"It's most possible that the younger people don't want to work as hard as the baby boomer. So it's not only women in medicine, it's the whole new generation as well," she says.

Samson believes that part of the solution to the time crunch that current doctors are facing lies in having other health care professionals take over some of the duties that physicians are now asked to perform.

"We have to do a lot of secretarial work, administrative work, and in my own practice, I have to do tasks outside my expertise that somebody else could do. And then I cannot concentrate on the task I should do, that I've been trained for," she told Canada AM.

"So these are some of the obstacles between patients and physicians."

Wilson says the survey found that despite all the challenges in the health care system that were revealed by the survey, 84 per cent of physicians confirmed they are either somewhat or very satisfied with their relationships with patients.

The National Physician Survey is Canada's largest census survey of physicians and physicians-in-training. It is conducted jointly by The College of Family Physicians of Canada, the Canadian Medical Association and The Royal College of Physicians and Surgeons of Canada.