The Waiting Room

1. What Canada Spends

Canada’s health expenditure has grown from approximately $163 billion in 2007 to a projected $399 billion in 2025, according to CIHI’s National Health Expenditure Database. Per capita, that’s $9,626 per Canadian. Health spending now represents 12.7% of GDP, up from roughly 10% two decades ago.

In international terms, Canada spends $7,301 USD (PPP) per capita on health — 22% above the OECD average of $5,967, according to OECD Health at a Glance 2025. By any measure, this is not a system starved of money. The question is what Canadians receive for that investment.

2. What Canada Gets

The Commonwealth Fund’s Mirror, Mirror 2024 report — the eighth edition of a standardized comparison across 10 high-income countries using 70 performance measures — ranked Canada 7th overall. On the Access to Care domain specifically, Canada placed in the bottom half of all 10 countries surveyed. On Care Process — the quality of clinical care for patients who are actually being treated — Canada performed well, among the top performers.

This gap between access and care quality is the central finding. The system appears to produce reasonable results for patients who reach a provider. The problem is reaching a provider.

Despite spending 22% above the OECD average, Canada has 2.7 practising physicians per 1,000 population — 31% below the OECD average of 3.9. Hospital beds per 1,000 population have declined from roughly 3.2–3.4 in the mid-2000s to 2.49 in 2023. Canada now ranks 35th among 47 OECD countries on hospital beds. The pattern: Canada spends like a top-tier system and is resourced like a bottom-tier one.

3. The 32-Year Wait

The Fraser Institute’s Waiting Your Turn survey has tracked median wait times from GP referral to treatment annually since 1993. It is the only continuous series of its kind in Canada.

The 32-year trend: 9.3 weeks (1993). Approximately 17 weeks (2004, the year First Ministers signed a 10-Year Plan to reduce wait times). Approximately 18 weeks (2010, peak benchmark compliance under that plan). 20.9 weeks (2019, pre-pandemic). 30.0 weeks (2024, all-time record). 28.6 weeks (2025, second-longest ever). The median Canadian now waits more than three times longer for treatment than a Canadian in 1993.

CIHI reported in 2024 that 5.7 million Canadian adults did not have a regular health care provider. The supply of family physicians per 10,000 population has decreased: from 11.8 in 2020 to 11.5 in 2024, even as absolute headcount grew. Population growth consumed the increase.

4. The Practitioners

This is not only a system failing patients. It is a system failing the people who work inside it.

CIHI’s National Physician Database shows that the average number of patients seen per family physician fell from 1,746 per year in 2013 to 1,353 in 2021 — an 18% decline. Physicians are working similar hours but seeing fewer patients. A peer-reviewed CMAJ analysis found that average weekly physician work hours declined by 6.9 hours over three decades, but the decline in patients seen outpaces the decline in hours.

Administrative burden is consuming clinical time. The Commonwealth Fund’s 2022 survey found that 57% of Canadian family doctors were dissatisfied with administrative time. Canadian FPs reported working more hours while seeing fewer patients per week than the international average.

The College of Family Physicians of Canada has stated that over half of family physicians report being likely to reduce or modify their clinical hours. The CMA’s 2021 National Physician Health Survey found that over half of physicians report burnout symptoms. Among nurses, 93%. The proportion of FPs working outside comprehensive primary care rose from 22% (2013) to 29% (2021). Seventy-five family medicine residency seats remained unfilled in 2024.

The same condition observed in The Double Payroll: more resources flowing into the system, more administrative overhead consuming them, less reaching the point of service.