Final Report

Ontario Population Needs-Based Physician Simulation

Model

October 2010

Dan Singh – Ministry of Health and Long-Term Care Hussein Lalani – Ministry of Health and Long-Term Care Boris Kralj – Ontario Medical Association Ed Newman – Ontario Medical Association Jeff Goodyear – Ministry of Health and Long-Term Care Deborah Hellyer – Ontario Medical Association Joshua Tepper – Ministry of Health and Long-Term Care

Table of Contents 1.0 – INTRODUCTION 4

2.0 – RFP PROCESS 5

3.0 – MODEL OVERVIEW 5

4.0 – SUPPLY MODULE 6

4.1 – Physicians in Training and Practice 6

4.2 – Medical School Capacity and Specialization Criteria 7

4.3 – Migration 7

4.4 – Retirement and Attrition 7

4.5 – Physician Productivity 7

4.6 – Hours Worked – Physician Survey 8 4.6.1 – Specialty Groupings 9

4.7 – Determining the Supply of Physician Services 10

5.0 NEEDS MODULE 10

5.1 – Population Demographics 10

5.2 – Socioeconomic and Lifestyle Risk Factors 11

5.3 – Disease Incidence and Prevalence 11

5.4 – Disease Weights – Expert Panels 12

5.5 – Determining the Need for Physician Services 12

6.0 – COMPARING SUPPLY TO NEED AND DETERMINING THE ‘VARIANCE’ 13

7.0 – RESULTS 13

7.1 – Base Case Simulation 0 14

7.2 – Measuring the Current Variance Between Supply and Need for Physicians 14 7.2.1 – Base Case Simulation 1 14

7.3 – Revised Method to Determine Current Variance 16 7.3.1 – Provide Care to Ontario’s Unattached Population – Base Case Simulation 2 16 7.3.2 – Provide Additional Care to Ontario’s Attached Population – Base Case Simulations 3 & 4 16

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7.3.3 – Accounting for Specialist Visits not Generated by Referrals – Emergency Medicine 17

7.4 – Summary of Current Variance Methodologies 17

7.5 – Provincial Results 18

7.6 – LHIN Level Results 19

8.0 – DISCUSSION 21

APPENDIX 1 – LHIN REPORTS BY SPECIALTY 23

APPENDIX 2 – SPECIALTY REPORTS BY LHIN 41

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1.0 - Introduction Ontario previously had limited ability to project the need for and supply of physician services.

Historically, supply-based indicators such as physician to population ratios and utilization data have

been used in attempts to capture need. However, these measures reflect supply only and do not inform

as to whether the supply is appropriate relative to population health need. To support evidence-

informed health human resources (HHR) planning, simulation models that can incorporate both the

supply of and the need for Ontario physicians are beneficial.

A major component of HHR planning is to determine the health needs of the population, both now

and in the future. It is also important to examine how health needs translate into the number of health

professionals required to meet these needs. This needs-based approach to HHR planning is an

important concept that has been identified and discussed in many reports. As noted in the Framework

Report for Collaborative Pan-Canadian HHR Planning1, “planning health human resources based on

system design and population health needs - as opposed to relying primarily on past utilization trends

– will lead to more responsive health systems. This type of planning provides an opportunity to

identify: the services needed, innovative ways to deliver those services, the types of professionals

required, and how to deploy them to make the best use of their skills (i.e., maximize scope of

practice).”

Many reports such as the 2001 George Expert Panel Report proposed that Ontario take a strategic,

system-wide approach to health workforce planning that addresses all factors – including education,

incentives, demographics, public expectations and health policies – that affect where and how health

professionals practise and the types of services they provide.

The Ontario Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Medical Association

(OMA) acknowledged these recommendations. Both organizations had previously engaged in supply-

based physician simulation exercises but had not attempted to incorporate the health needs of the

population. In January 2007, the MOHLTC and OMA decided to jointly initiate a Request for

Proposals (RFP) process for the development of a Population Needs-Based Physician Simulation

Model for Ontario.

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1 Prepared by the HHR Planning Subcommittee of the F/P/T Advisory Committee on Health Delivery and Human Resources (ACHDHR), September 2005

The Population Needs-Based Physician Simulation Model is a planning tool for planners and policy makers to understand the impacts of health population trends and health policies on physician supply and need. This model is one of many pieces of evidence available to support HHR planning and the results should always be combined with other evidence (both qualitative and quantitative) when developing policies.

2.0 - RFP Process An RFP was developed by MOHLTC and OMA staff. The RFP was posted through the MERX

electronic tendering service on April 20, 2007 and remained open for eight weeks, closing on June

18, 2007.

Nine proposals were received in response to the RFP. An evaluation team consisting of one

consultant, two MOHLTC members, two OMA members and one Canadian Medical Association

(CMA) member evaluated each proposal according to the criteria detailed in the RFP. Upon further

discussion, the evaluation team elected to invite the top-scoring vendor, the Conference Board of

Canada (CBoC), to give the team a formal presentation. On July 19, 2007 CBoC presented to the

evaluation team and answered any questions that the evaluation team members had about their

proposal. After scoring the presentation, CBoC was the successful vendor and no other presentations

were necessary.

The MOHLTC notified CBoC that they were the successful respondent to the RFP process on

September 26, 2007. MOHLTC negotiated the terms of the legal agreement with CBoC, which were

finalized on December 19, 2007.

3.0 - Model Overview The model compares various health needs of the population to the supply of physician services,

quantifies the variance and converts the variance into a physician requirement. Reports will be

generated by specialty and Local Health Integration Network (LHIN).

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Figure 1:

4.0 - Supply Module Projecting the supply of physician services is dependant on factors such as current supply of

physicians in training, practising physicians, medical school capacity, specialization criteria, migration,

retirement, attrition, productivity and hours worked. The supply module follows the progression of

physicians from medical school to practice until they exit the practice pool.

Figure 2:

4.1 - Physicians in Training and Practice The Canadian Medical Education Statistics (CMES), published by the Association of Faculties of

Medicine of Canada (AFMC) were used to determine the current number of undergraduate (UG)

medical students in Ontario. Data regarding physicians currently in post-graduate (PG) training and

the current supply of practising physicians was sourced from the Ontario Physician Human

Resources Data Centre (OPHRDC). Two annual reports published by the OPHRDC titled Post-

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Supply of Physician Services

Variance

Physician Requirement

Population Need for Physician Services

Supply Module Needs Module

Supply Module

Education Migration Attrition CurrentSupply Productivity

Supply ofPhysician Services

Hours Worked

Graduate Medical Trainees in Ontario (PMTIO) and Physicians in Ontario (PIO) track physicians in

post-graduate training and practising physicians respectively.

4.2 - Medical School Capacity and Specialization Criteria Medical school capacity and specialization criteria were determined by consultations with the Council

of Ontario Faculties of Medicine (COFM) and by incorporating current and planned MOHLTC policy

interventions for Ontario medical schools, such as the expansion of undergraduate and post-graduate

training positions.

4.3 - Migration Physician migration to, from and within Ontario is incorporated at multiple points in the supply

module. Migration of Ontario physicians after PG training is sourced from the AFMC’s annual

Canadian Post-M.D. Education Registry (CAPER) reports. Data for practising physician migration into

and out of Ontario comes from the Canadian Institute for Health Information’s (CIHI) annual Supply,

Distribution and Migration of Canadian Physicians reports. Migration of Ontario physicians within

Ontario is captured through the OPHRDC’s annual PIO data.

4.4 - Retirement and Attrition Physician retirement in Ontario is also sourced from the OPHRDC’s annual PIO reports. Attrition from

practice for reasons other than retirement is obtained through data from the National Physician

Survey conducted by The College of Family Physicians of Canada (CFPC), The Royal College of

Physicians and Surgeons of Canada (RCPSC) and the Canadian Medical Association.

4.5 - Physician Productivity Minimal evidence exists regarding factors which affect physician productivity. Physician productivity

itself is also a difficult term to define. Ideally, measures to assess patient outcomes and quality of

care would be analyzed to help determine physician productivity. However, the availability of

comprehensive data is low and the complexity of incorporating these factors into the model is very

challenging. For the purposes of this model, physician productivity is defined as the total number of

patients seen by a physician’s practise for a specific time period.

To determine how various factors may affect physician productivity, the CBoC convened topic-

specific expert panels in May 2008. The expert panels focused on how the following four factors are

predicted to impact physician productivity in Ontario:

1) Information and Communication Technology (ICT)

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• e.g. Electronic Health Record

2) Health System Change

• e.g. Family Health Teams and Ontario Wait Times Strategy

3) Non-Physician Clinicians

• i.e. Other non-physician clinicians (NPCs) and new provider roles working with physicians

in Ontario

4) Funding and Compensation Models

• e.g. Fee-for-service, Alternative Payments Plans and blended funding models

For each panel, the CBoC provided each participant with background material and a workbook to use

during panel discussion. A CBoC representative began each session with a presentation of CBoC

findings from the literature review. A facilitator then led the group discussion where participants

estimated whether they believed each factor contributed to physician productivity and if so, how

strongly the factor contributed. This was done for both the short and long-term future.

The results of the productivity expert panels varied. The panel regarding the impact of NPCs

indicated that the inclusion of Nurse Practitioners and Physician Assistants in physician practices

could increase the total number of patients seen by a physician’s practice for a specific time period.

The remaining panels did not yield significant quantifiable input for the simulation model. However,

the structure of the model allows the MOHLTC and OMA to input values regarding productivity as

better evidence becomes available in the future.

4.6 Hours Worked – Physician Survey Supply-based physician projections may predict the number of physicians but may not capture the

services physicians are providing. Measures of Full-Time Equivalents (FTEs) can inform as to how

much physicians are working by specialty, sex and age but again, do not capture the actual services

provided.

A key component to this model was the development of a physician survey. A survey was designed to

ask physicians how much of their time they spent on an annual basis treating each of the 22 World

Health Organization International Statistical Classification of Diseases and Related Health Problems

(ICD-10) codes. The survey also asked physicians to report the number of patient encounters per

week, the average number of hours they work per week, and average number of weeks they work per

year. A separate survey was created for family medicine (FM) physicians and specialists.

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The survey was mailed and sent electronically to all 21,251 OMA members using OMA contact

information. The CBoC followed-up by targeting groups that had low response rates to ensure the

total response was representative by specialty, LHIN and age. Between May 7th and July 3rd, 2008

CBoC received 1,108 responses from FM physicians and 1,779 for specialists. The total of 2,887

survey responses corresponds to a response rate of approximately 14 %. The CBoC determined the

margin of error for the survey responses was in an acceptable range. CBoC contracted Whitehead

Data House (WDH) to facilitate data entry of the survey responses. WDH followed up with phone calls

to target LHINs and specialties with a relatively low response rate. The survey responses were

aggregated by specialty, age, sex and LHIN.

CBoC analysed the survey results to determine the top 10 ICD-10 codes that physicians spend their

time treating. Survey results also reported that these top 10 disease codes comprise approximately

80% of physicians’ time which are described in further detail in section 5.3. To account for the

remainder, CBoC analysed historical data for the additional 12 disease codes.

4.6.1 – Specialty Groupings The model captures most certified physician specialties in Ontario. However, certain specialties have

a relatively low supply of practising physicians. Specialties where the CBoC received at least 20

survey responses are simulated individually. For specialties where CBoC received less than 20

survey responses, groupings were created. Only specialties which are simulated individually will be

reported at the specialty level, grouped specialties will not be reported at the specialty level. The

grouped specialties are as follows:

Internal Medicine (Other) – includes Critical Care Medicine2, Clinical Immunology and Allergy,

Geriatric Medicine, Hematology, Infectious Diseases and Occupational Medicine.

Surgery (Other) - includes Cardiac Surgery, Neurosurgery, Thoracic Surgery and Vascular

Surgery.

Lab Specialties (Other) - includes Medical Genetics, General Pathology, Hematological

Pathology, Medical Biochemistry, Medical Microbiology and Neuropathalogy.

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2 It is recognized that Critical Care Medicine has many pathways but for the purposes of this model, it has been grouped with Internal Medicine.

Pediatrics (Other) - includes Pediatric General Surgery, Pediatric Respirology, Pediatric

Rheumatology, Pediatric Nephrology, Pediatric Infectious Diseases, Pediatric Hematology,

Pediatric Gastroenterology, Pediatric Endocrinology & Metabolism, Pediatric Critical Care,

Pediatric Clinical Immunology, Pediatric Cardiology and Pediatric Neurology.

4.7 – Determining the Supply of Physician Services By applying specialization criteria, migration and attrition factors to the physicians currently in training

and practise, a projection of physician headcount arranged by specialty, age, sex and LHIN can be

created. The survey data and results of the productivity panels are then applied to the headcount to

determine the total number of hours that Ontario physicians are able to provide to treat the 22 ICD-10

categories in the province. This supply of physician services must now be compared to the need for

physician services.

5.0 Needs Module Projecting the population’s need for physician services depends on factors such as disease incidence

and prevalence, socio-economic and lifestyle risk factors (risk factors), and population demographics.

Figure 3:

5.1 – Population Demographics Data from Statistics Canada was used to construct a demographic sub-module. The data was

arranged by LHIN, age, and sex and includes population counts, births, deaths, international

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Needs Module

Disease Incidence and Prevalence

PopulationDemographics

Socio-economic& Lifestyle Risk

Factors

Population Need forPhysician Services

DiseaseWeights

migration, inter-provincial migration, and intra-provincial migration. The demographic sub-module

projects the Ontario population by age, sex, and LHIN.

5.2 – Socioeconomic and Lifestyle Risk Factors CBoC conducted a literature review, consulted with experts and analysed data from the Statistics

Canada Canadian Community Health Survey (CCHS) from 2001-2005 to determine the leading

health risk factors in the Ontario population. The risk factors identified and incorporated into the

model are:

1. Alcohol Consumption

2. Consumption of Fruits and Vegetables

3. Obesity

4. Physical Inactivity

5. Smoking

6. Second Hand Smoke Exposure

7. Income

8. Sense of Belonging

9. Perceived Stress

10. Employment in Mining Industry

The prevalence of each risk factor in Ontario by age, sex, and LHIN was added to the demographic

sub-module.

5.3 – Disease Incidence and Prevalence CBoC conducted a literature review and researched data sources to determine the incidence and

prevalence of the top ten ICD-10 diseases identified in the OMA survey. CCHS data was analysed to

determine the current incidence and prevalence of the top ten ICD-10 broad disease categories by

age, sex and LHIN. Historical data from the National Population Health Survey was also examined to

capture trends in disease incidence and prevalence over the last 20 years before the existence of the

CCHS. The top ten ICD-10 disease categories captured in the model are listed below in order of

percentage of physician time spent in treatment:

1. Mental and Behavioural Disorders

2. Diseases of the Circulatory System

3. Diseases of the Musculoskeletal System and Connective Tissue

4. Neoplasms

5. Diseases of the Respiratory System

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6. Diseases of the Digestive System

7. Endocrine, Nutritional and Metabolic Diseases

8. Diseases of the Genitourinary System

9. Diseases of the Nervous System

10. Diseases of the Skin and Subcutaneous Tissue

5.4 – Disease Weights – Expert Panels Each risk factor was attributed a weighting for its association with the incidence of each of the top ten

diseases identified. To achieve this, CBoC convened a two-day expert panel in June 2008. Similar to

the productivity expert panels, each participant was provided with a package of background material

and a workbook. A discussion group was set up for each of the top ten diseases and each participant

selected a disease group to participate in based on their expertise on the disease.

Each group identified which of the top ten risk factors contributed to the incidence of the disease

category and major sub-disease categories. After each risk factor was identified, the group assigned

a weight to indicate how strongly each factor contributed to the incidence of the disease. An example

of this process is included below for the sub-disease lung cancer in the neoplasm disease group:

Factors Impacting Incidence of Lung Cancer Disease Weight

1. Smoking 75%

2. Exposure to Second-hand Smoke 10%

3. Consumption of Fruits and Vegetables 3%

4. Other 11%

Total 100%

The weights for all risk factors for each disease did not necessarily sum to 100%. In these cases the

remainder was assigned to a risk factor category labelled as ‘Other’. Due to the timing of this expert

panel, many OMA section chairs were unable to attend. An additional session was held with the OMA

section chairs in September 2008 to obtain their input and validate the results of the June 2008 panel.

5.5 – Determining the Need for Physician Services The demographic sub-module contains the current prevalence of population risk factors in the

population and the incidence and prevalence of diseases. The demographic module also contains the

projection of the future population by age, sex and LHIN.

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By comparing the current prevalence of the various risk factors to the future population, a future

estimate of the prevalence of the risk factors can be calculated. The disease weights for each risk

factor can then be applied to estimate the future incidence and prevalence of diseases and the total

number of cases needing treatment.

Matching the total number of disease cases with the physician time spent treating each disease from

the OMA survey results in an estimate of the total need for physician services.

6.0 – Comparing Supply to Need and Determining the ‘Variance’ The supply module estimates the number of hours of physician time available to provide care. The

needs module estimates the number of hours of care needed in Ontario. The difference between the

two is the variance between supply and need. The variance is calculated by specialty and LHIN and

can be converted to headcount by applying the average number of hours worked per year by

specialty.

7.0 – Results Simulating the future in health human resources through modelling is not an exact science. Results

will never be completely accurate; however the direction and magnitude of observed trends can

provide insight into potential future circumstances.

The results of any simulation model ultimately depend on the assumptions used to structure it. These

assumptions are the most critical components to all simulation models and are often the most difficult

components to determine. The power of a simulation model lies in its ability to generate “what-if”

simulations to test the potential effect of policy interventions based on which set of assumptions the

users believe to be most reflective of reality.

In addition, the scope of a simulation model will likely not include every factor that may affect the

results. In some cases, this may be due to lack of evidence but in many cases, the logistics of

incorporating every potentially influencing factor into a model is not practical or appropriate.

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It is important to explain and note the underlying assumptions within a simulation model to

understand its capabilities and limitations.

7.1 – Base Case Simulation 0 The CBoC originally developed the model to capture how supply compares to need in future years,

assuming that the current supply of physician services is appropriate to meet the needs of the

population. However, since patients currently experience access to timely care issues, the current

supply of physician services may not be appropriate to meet the needs of the population.

Both the OMA and MOHLTC believe that a current variance should also be incorporated in the model

and worked with CBoC to develop an appropriate methodology.

7.2 - Measuring the Current Variance Between Supply and Need for Physicians Determining the current or base variance between supply and need for physicians is challenging.

High wait times and access to care issues may indicate that the current amount of care being

provided in Ontario should be increased. However, it is also possible that in some cases the amount

and type of current care being provided in Ontario is not appropriate, needed or effective. As such,

determining the magnitude of this variance is very complex.

7.2.1 – Base Case Simulation 1 The CBoC attempted to develop a method to quantify the current variance. The physician survey

indicated that FM physicians currently spend 5.8% of their time conducting physicals, which

translates into 27% of the population receiving an annual physical.

CBoC research recommended a frequency for periodic health exams by age and sex. These

recommendations are captured in Table 1 below:

Table 1:

The recommended frequencies in the table above translate into 90% of the Ontario population

receiving a physical every year. CBoC then conducted a simulation in the model to increase the

current percentage of the entire Ontario population receiving an annual physical to the recommended

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Age Group Males Females<1 5 times per year 5 times per year1-2 3 times per year 3 times per year3-20 1 time per year 1 time per year21-50 1 time every two years 1 time per year>50 1 time per year 1 time per year

Frequency of Periodic Health Exam

frequencies. The result of this simulation estimated Ontario would require an additional 1,513 FM

physicians to meet the above standards in 2008.

In order to arrive at the current base variance of specialists, current referral patterns (as observed

through Ontario Health Insurance Plan (OHIP) claims data) between FM physicians and specialists

(primary referrals) and from specialists to other specialists (secondary referrals) were applied to the

1,513 FM physicians requirement. Current referral patterns show that there is an average primary

referral rate of 22% and an average secondary referral rate of 34%. When these rates were applied to

the current FM physician requirement, it was determined that an additional 853 specialists are

required for a total of 2,366 additional physicians currently required in Ontario.

The OMA and MOHLTC reviewed the methodology to determine whether it was appropriate. One

issue was the use of the survey response to arrive at the 27% proportion of Ontarians currently

receiving an annual physical. Other evidence shows that the current proportion of the population

receiving annual physicals has been significantly under-estimated by the CBoC physician survey

response. One of the measures the Primary Care Access Survey (PCAS)3 collects is the proportion

of the population that received a regular check-up4 in the past twelve months. According to this data

57.3% of the population aged 16+ and 61.6% of the population aged 0 to 15 received a regular

check-up in 2008. These figures significantly vary from the physician survey response.

,

Upon further investigation, it was discovered that the recommended frequency for periodic health

exams from CBoC’s research actually includes other services in addition to physicals including

immunization, mammography, cancer screening and pre-natal care services. An analysis of OHIP

data to determine the number of visits for all these services also showed a significantly higher

proportion than the 27% from the physician survey.

Another issue with the methodology is that only a small part of an FM physician’s practice is used to

determine the entire current shortage. The annual physical is only one of many elements of a family

physician’s comprehensive primary care practice. As previously mentioned, according to the

physician survey, this one element on average only comprises 5.8% of an FM physician’s time.

3 The PCAS, conducted by the Institute for Social Research at York University, is a telephone survey that began in January 2006 and collects information from over 2,000 Ontario residents every three months. The long term goal of the PCAS is to put in place a program to measure, on an ongoing basis, access to family doctors and primary healthcare in Ontario.

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4 A regular check-up refers to routine physical check-ups as opposed to seeing a doctor for a specific reason such as being sick. It does not include prenatal or post pregnancy care or to monitor an ongoing health issue.

In addition, specialties that generally do not receive primary or secondary referrals would not be

represented appropriately (e.g. Emergency Medicine physicians). This method also assumes that all

specialties are experiencing a current shortage and no specialty is either appropriately supplied or

over-supplied. Moreover, the current observed referral patterns may be too high (for specialties that

are over-worked) or may be too low (for specialties where there are shortages and cannot

accommodate a needed level of referrals). The CBoC was receptive to this feedback and continued

to work with the OMA and MOHLTC to revise the methodology.

7.3 - Revised Method to Determine Current Variance The PCAS also collects and reports data regarding the number of people in Ontario who do not have

a regular family doctor – a group referred to as the ‘unattached patient population’. The number of FM

physicians required to attach the entire unattached patient population was examined as an alternative

method to determine the current variance of FM physicians in Ontario. Referral data could then be

applied to calculate the current variance of specialists. The Ministry and OMA agreed to incorporate

this method into the model and three variations were simulated.

7.3.1 – Provide Care to Ontario’s Unattached Population – Base Case Simulation 2 The PCAS estimates that 820K Ontarians are currently unattached with a confidence interval of

726K-915K5. For the purposes of this analysis, the 915K upper bound was used.

In fiscal 2007-08, FM physicians participating in Primary Care Patient Enrolment Models (PEMs) on

average provided a total of 6,943 visits. Each patient in a PEM on average received 5.1 visits over the

same timeframe. Providing this same level of care (5.1 visits) to each of the 915K unattached patients

results in 4,666,500 additional visits required. It should be noted that current care being provided to

the unattached population was not captured. If the unattached population requires 4,666,500

additional visits and each FM physicians can provide 6,943 visits, approximately 672 additional FM

physicians are currently required (Base Case Simulation 2).

7.3.2 – Provide Additional Care to Ontario’s Attached Population – Base Case Simulations 3 & 4 In addition to providing care to the unattached population, the MOHLTC and OMA examined a

simulation providing additional care to the current attached population to account for timely access

issues. To capture this, the Canadian Institute for Health Information (CIHI) provided the proportion of

the attached population in Ontario reporting difficulty accessing routine/ongoing care in a timely

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5 PCAS Waves 10-13, January to December 2008

fashion. CIHI reported that 7% of Ontarians experienced access issues in 2008, which translates into

approximately 904K people.

Providing each of these people with one additional visit results in 131 additional FM physicians

needed to address the population with access issues. Adding these 131 additional FM physicians to

the 672 additional FM physicians needed to attach the unattached population results in a total of 803

additional FM physicians currently needed in Ontario (Simulation 3).

A simulation was also conducted using 9% instead of 7% of Ontarians experiencing access issues.

This would result in 186 additional FM physicians for the attached population and a total of 840

additional FM physicians currently needed in Ontario (Base Simulation 4).

7.3.3 – Accounting for Specialist Visits not Generated by Referrals – Emergency Medicine As mentioned above, basing the need for specialists on referral patterns is not appropriate for some

specialties. This is especially applicable to Emergency Medicine (EM) physicians.

To determine the current variance of EM physicians, data from the National Ambulatory Care

Reporting System (NACRS) was reviewed. Data for the number of patients who leave emergency

departments without being seen or without receiving complete treatment (Left Without Being Seen -

LWBS) was analysed by LHIN.

The average number of total visits per year for EM physicians and the proportion of practising EM

physicians in each LHIN were applied to the LWBS visits in each LHIN to estimate the number of

additional EM physicians needed. This method results in a provincial current shortage of

approximately 100 EM physicians.

7.4 – Summary of Current Variance Methodologies The referral data and methodology in section 7.3 were applied to the FM physician variances in Base

Case Simulations 2-4 to calculate the additional specialists required. The table below summarizes the

current variances for all of the Base Case Simulations developed.

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Table 2:

For the purposes of this report, only the results of the Base Case Simulation 3 are described in the

following sections.

7.5 – Provincial Results Figure 4 shows a starting shortage of 803 FM physicians and 564 specialists in 2008. The simulation

estimates that the shortage of specialists will end by 2014. However, while the shortage of FM

physicians is estimated to end by 2017, the trend begins to plateau in 2025. The variance of FM

physicians is estimated to remain stable from 2025 to 2030, suggesting future examination for

additional FM physicians during that timeframe.

Figure 4:

Base Case Scenario 3 - Simulation of Physician Variance - 2008-2030

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Family Medicine Specialists While Figure 4 estimates that the shortage of total specialists will end by 2014, Figure 5 demonstrates

that it’s not appropriate to group all specialists together as individual specialty-specific results vary

greatly. The projection of variances for eight individual specialties are illustrated below (these eight

were chosen as examples only).

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Base Case FM physicians Specialists0 0 01 1,559 9022 672 4883 803 5644 840 586

Additional Physicians Required in 2008

Figure 5: Base Case Scenario 3 - Simulation of Select Specialty Variances - 2008-2030

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Cardiology General Surgery Medical Oncology Obstetrics and GynecologyOpthamology Orthopedic Surgery Pediatrics Psychiatry

7.6 – LHIN Level Results The projection of physician variances not only differ by specialty but also by LHIN. Figure 6 simulates

the estimated current physician variance for each LHIN in Ontario.

Figure 6:

Base Case Scenario 3 - Current Variance by LHIN - 2008

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The projected physician shortages by LHIN also differ over time. Figure 7 shows the projected FM

physician variances for six select LHINs in Ontario compared to the provincial projection. For the

purposes of this report, the data for the North East and North West LHINs have been summed and

reported together. The simulation estimates a future shortage of FM physicians for Central and

Central East LHINs. However, the future shortage of FM physicians for Champlain, Toronto Central

and North East/North West LHINs are all estimated to end by 2030.

Figure 7:

Base Case Scenario 3 - Simulation of Family Medicine Variances for Select LHINs - 2008-2030

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Toronto Central Central Central East Champlain NE+NW Ontario These trends are similar for Specialists in these LHINs over time as seen in Figure 8:

Figure 8:

20

Base Case Scenario 3 - Simulation of Specialist Variances for Select LHINs - 2008-2030

-1,000

-500

0

500

1,000

1,500

2,000

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

Year

Phys

ician

Varia

nce

Toronto Central Central Central East Champlain NE+NW Ontario

Figures 5 - 8 present aggregated specialty data for select LHINs. In order to understand the variability of the results, it is important to consider the results for each individual LHIN and specialty over time. Appendix 1 contains reports for each LHIN at the individual specialty level. Appendix 2 contains reports for each specialty at the individual LHIN level.

8.0 – Discussion Depending on the Base Case Simulation being used, projected results will vary. However, it should

be noted that the various Base Case Simulations only differ in their starting variances, the trend over

time for all Base Case Simulations are identical.

The results of the simulations suggest that the distribution and mix of physicians will be a higher

priority in the future than overall physician supply. Policy development should consider further

examination of the specialties and LHINs projected to be in high need in the future. This will require

more in-depth and focused analyses into high need areas to understand all of the factors contributing

to the need for these services.

There are also many other non-HHR related factors in the health care system that impact the access

to and delivery of health services, including but not limited to: availability of diagnostic and laboratory

equipment, physical space to perform surgeries and administer other treatment, physician preference

to become certified in certain specialties and practice in certain locations, and the number of

employment opportunities available across the province. These ‘system capacity’ related factors are

not captured in this model but are important components to HHR planning. Also, although the model

focuses on physicians, it is very important to consider care provided by non-physician clinicians.

Analyses of these factors will also be required to better understand all issues which affect the delivery

of physician services in Ontario.

It is important to note that the model does not measure patient outcomes or the quality and

effectiveness of care delivered, which are also critical components to consider when conducting HHR

planning.

21

The Ontario Population Needs-Based Physician Simulation Model is the first model of its kind in

Canada. It makes use of specific assumptions and data to create Base Case Simulations and

additional “what-if” simulations to test the potential effects of policy interventions. In the future, the

methodology used to build the model can be examined to support the development of simulation

models for other health professions in Ontario.

22

This model is one of many pieces of evidence available to support HHR planning and the results should always be combined with other evidence (both qualitative and quantitative) when developing policies. The assumptions and structure of the model can also be changed to incorporate better quality evidence as it becomes available.

23

Appendix 1 - LHIN Reports by Specialty

Appendix 1 reports the simulation results of Base Case Simulation 3 by specialty for each individual LHIN. Only specialties which are simulated individually are reported, grouped specialties are not reported (see section 4.6.1 for more detail). Grouped specialties include: Internal Medicine (Other) – includes Critical Care Medicine, Clinical Immunology and Allergy, Geriatric Medicine, Hematology, Infectious

Diseases and Occupational Medicine.

Surgery (Other) - includes Cardiac Surgery, Neurosurgery, Thoracic Surgery and Vascular Surgery.

Lab Specialties (Other) - includes Medical Genetics, General Pathology, Hematological Pathology, Medical Biochemistry, Medical

Microbiology and Neuropathalogy.

Pediatrics (Other) - includes Pediatric General Surgery, Pediatric Respirology, Pediatric Rheumatology, Pediatric Nephrology, Pediatric

Infectious Diseases, Pediatric Hematology, Pediatric Gastroenterology, Pediatric Endocrinology & Metabolism, Pediatric Critical Care,

Pediatric Clinical Immunology, Pediatric Cardiology and Pediatric Neurology.

NOTE: A negative number in the table indicates a shortage.

24

Base Case Simulation 3 – Summary of Key Inputs and Assumptions

Medical School 952 students entering medical school by 2011; 43% ♂; 57% ♀

Post-Graduate (PG) Residency Training

1,247 ministry-funded residents entering training by 2014; 43% Family Medicine (FM); 57% Specialists (SP) Resident specialization rates based on previous 3-year observed average. Minimum 15% of internal medicine residents must train in general internal med in 4th year. Maximum 30% of Post-Graduate Year (PGY) 2 FM trainees may train in PGY3, FM-Emergency Medicine positions are

hard capped at 36. 200 International Medical Graduates (IMGs) enter training annually based on historical specialty distribution. All advanced

trainees start at PGY2. 14 practicing physicians re-enter training based on historical specialty distribution and training length.

Fellowship Assumption that the number of trainees entering fellowship is equal to the number exiting fellowship, so this module is

turned off. PG data shows a stable number of Pool D fellowship trainees each of the last several years.

PG Migration Avg 3-year net PG migration out of Ontario after training: Total: -78; FM: +3; SP: -81

Practise Entry Median 3-year age of PG trainee entry into practise: Total: 32; FM: 30; SP: 33; Canadian Medical Graduates: 31; IMGs: 39

Practise Migration Annual net migration of practising physicians: Total: <0.1%; FM : <0.1%; SP: <0.1%

Retirement 3-year avg retirement rate: Total: 0.9%; FM: 0.7%; SP: 1.1%; age 50-65: 0.7%; age 65+: 5.7%

Other Attrition Attrition not covered above: Total: 1.0%; FM: 1.0%; SP: 1.1%; age <65: 0.7%; age 65+: 3.1%

OMA Survey Avg clinical hours per week: Total: 42.6; FM: 42.0; SP: 43.3; ♂: 44.1; ♀: 39.7 Avg weeks worked per year: Total: 45.7; FM: 45.8; SP: 44.8; ♂: 45.1; ♀: 45.4 Avg patients seen per week: Total: 98; FM: 123; SP: 79; ♂: 105; ♀: 82

Productivity Non-Physician Clinicians: projected # of future nurse practitioners enhance FM productivity by 40%. Information & Communication Technology, Health System Change, Funding: no enhancement of physician productivity.

Population Demographics

ON population to grow 13% by 2020: 13.2M to 14.9M; Central West LHIN: 26%; North West LHIN: -1% ON population 65+ to grow 44% by 2020: 1.8M to 2.6M; Central West LHIN: 63%; Toronto Central LHIN: 18%

25

Base Case Simulation 3 – Summary of Key Inputs and Assumptions cntd.

Population Prevalence:

Socio-Economic & Lifestyle Risk Factors Second-hand smoke exposure: ♂: 12% ♀: 11%

Lack of fruits & vegetables: ♂: 59% ♀: 48% Lack of sense of belonging: ♂: 9% ♀: 10% Excessive alcohol intake: ♂: 3% ♀: 1% Mining Industry Employment: ♂: <1% ♀: <1%

Physical Inactivity: ♂: 41% ♀: 47% Perceived Stress: ♂: 4% ♀: 4% Low Income: ♂: 3% ♀: 5% Smoking: ♂: 17% ♀: 13% Obesity: ♂: 15% ♀: 13%

Increase in Prevalence from 2009 to 2030:

Top ICD-10 Diseases

Mental Health & Behavioural: 6.9% Circulatory: 7.4% Musculoskeletal: 9.3% Neoplasms: 12.5% Respiratory: 6.9%

Digestive: 1.7% Endocrine, Nutritional & Metabolic: 5.0% Genitourinary: 1.8% Nervous System: 1.8% Skin and Subcutaneous Tissue: 1.6%

The top ten ICD-10 categories were further divided into sub-disease categories. An example is provided for each:

Disease Weights

Mental Health & Behaviour: Depression: stress: 27%; sense of belonging: 36%; low income: 14% excessive drinking: 9%; other: 14%

Circulatory: Hypertension: excessive drinking: 30%; obesity: 30%; physical inactivity: 20%; smoking: 9%; other: 11% Musculoskeletal: Low Back Pain: obesity: 5%; physical inactivity: 25%; other: 70% Neoplasms: Lung Cancer: smoking: 75%; second hand smoke exposure: 10%: lack of fruits and vegetables: 3%; other:

12% Respiratory: Chronic obstructive pulmonary disease: smoking: 80%; other: 20% Digestive: Irritable Bowel Disease: genetics: 50%; age: 20%; stress: 5%; environmental: 10%; other: 15% Endo: Diabetes: obesity: 50%; age 25%; genetics: 10%; hypertension: 10%; other: 5% Genitourinary: none Nervous: Epilepsy: age: 30%; sex: 5%; neurological development: 15%; excessive drinking: 15%; stress: 20%; neoplasm:

5%; other: 10% Skin: Psoriasis: age: 20%; genetics: 30%; stress: 10%; infection: 15%; trauma: 10%; other: 15%

26

Erie St. Clair Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -51 -48 -46 -46 -44 -42 -37 -33 -28 -24 -20 -16 -12 -9 -6 -3 0 3 7 11 15 20 25Anaesthesia 0 0 -1 0 -1 -1 -1 -1 -2 -1 -2 -2 -2 -2 -3 -3 -3 -4 -3 -4 -4 -4 -4Anatomical Pathology -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -7 -7 -7 -8Cardiology -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -7 -7 -8 -8 -9 -9 -10 -10 -11 -11 -11 -12 -12Dermatology -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1Diagnostic Radiology -12 -12 -13 -13 -13 -14 -14 -15 -15 -16 -16 -17 -17 -18 -19 -19 -21 -21 -22 -22 -23 -23 -24Family Medicine - Emergency Med. -5 0 4 7 10 14 17 20 24 27 30 32 36 38 41 45 48 50 53 55 58 60 62Emergency Medicine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1Endocrinology -1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1Gastroenterology 0 -1 -1 -1 -2 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -7 -7 -7 -8 -8 -9 -9 -9General Internal Medicine -2 -2 -2 -2 -2 -1 0 0 1 1 2 3 4 4 4 5 6 6 7 8 9 9 9General Surgery -1 -2 -2 -2 -3 -2 -2 -1 0 -1 0 1 1 1 1 1 2 2 3 3 4 5 5Medical Oncology -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3Nephrology -1 0 0 0 0 1 1 1 2 2 2 2 3 3 3 4 4 4 4 4 4 5 5Neurology -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -3 -3 -3 -3 -4 -4 -5 -5 -5 -5 -5 -6 -7Obstetrics and Gynecology -1 -1 -1 0 0 1 1 2 3 3 4 5 6 6 7 8 9 10 11 11 13 14 15Ophthalmology -1 -1 0 0 0 0 0 0 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3Orthopedic Surgery -1 -1 -1 0 0 1 1 1 2 2 2 2 3 3 4 4 4 5 5 6 6 6 6Otolaryngology -1 -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 0 0 0 1 1 1 1Pediatrics 0 0 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -6 -6 -6 -6Physical Medicine and Rehab 0 0 0 0 0 1 1 1 1 2 2 2 3 3 3 3 4 4 4 5 5 5 5Plastic Surgery 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 2 2 2 1 2Psychiatry 0 -1 -1 -2 -3 -4 -5 -5 -6 -6 -7 -8 -8 -9 -9 -10 -10 -10 -10 -9 -9 -8 -8Radiation Oncology 0 0 0 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -4Respirology 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 1 1 1 1 1 1 1 1Rheumatology 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -4Urology -1 -1 -1 -1 0 -1 0 -1 0 0 0 0 0 -1 -1 -1 -1 -2 -1 -1 -1 -1 -1

27

South West Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicince -69 -56 -46 -31 -18 -5 14 32 51 69 85 97 109 120 132 143 154 164 173 181 191 200 211Anaesthesia 0 0 2 4 6 7 9 10 12 14 14 14 15 16 16 17 18 18 19 19 20 21 21Anatomical Pathology -1 1 1 3 5 6 7 8 9 9 10 12 12 13 13 14 14 14 14 15 15 16 16Cardiology -2 -1 -1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 -1 -1Dermatology -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -4 -5 -5 -5 -5 -5Diagnostic Radiology -16 -15 -15 -15 -16 -17 -17 -18 -18 -20 -20 -22 -24 -25 -25 -27 -27 -28 -29 -30 -31 -32 -33Family Medicine - Emergency Med. -4 0 3 6 9 11 14 17 20 22 24 26 28 30 33 35 36 38 39 40 42 44 46Emergency Medicine -2 -1 1 3 7 9 12 14 17 20 22 25 28 30 33 35 37 39 41 43 45 47 49Endocrinology -1 -1 -1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2Gastroenterology -1 0 0 1 2 3 3 4 4 4 4 5 5 5 6 6 7 7 8 8 8 8 9General Internal Medicine -3 -2 1 4 8 13 19 25 31 38 45 52 58 64 71 77 83 89 94 100 106 113 119General Surgery -2 -2 -2 -1 0 1 2 4 5 7 8 10 11 12 14 15 16 18 19 20 21 22 23Medical Oncology -1 -1 -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -5 -6 -6 -6 -7Nephrology -1 -1 0 1 1 2 3 4 4 4 5 6 6 6 6 7 8 8 8 9 9 10 10Neurology -1 -1 -2 -3 -2 -3 -3 -3 -2 -2 -2 -2 -2 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Obstetrics and Gynecology -2 -1 0 2 3 5 7 10 12 15 17 20 22 24 25 28 30 33 35 36 38 39 41Ophthalmology -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -8 -9Orthopedic Surgery -1 0 1 2 4 6 8 10 11 14 16 17 19 21 23 24 26 28 29 30 32 33 35Otolaryngology -1 0 -1 0 0 1 1 2 2 3 3 4 5 5 6 6 7 7 8 9 9 10 10Pediatrics -1 0 1 2 3 5 6 6 6 7 7 8 8 8 8 9 10 10 10 10 11 12 13Physical Medicine and Rehab 0 0 1 1 2 2 3 3 4 4 5 6 6 6 7 7 8 8 8 9 9 9 10Plastic Surgery 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 -1 -1 -1 -1 -1Psychiatry -1 -2 -4 -6 -8 -10 -12 -14 -17 -20 -22 -25 -27 -30 -33 -35 -36 -37 -39 -39 -40 -40 -40Radiation Oncology 0 1 2 2 3 3 4 5 5 6 7 7 7 8 9 9 10 11 11 12 13 13 14Respirology 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 -1 -1 -1Rheumatology 0 0 0 -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -5 -5Urology -1 0 0 0 0 0 1 1 2 2 3 3 4 4 4 4 4 5 5 5 5 6 6

28

Waterloo Wellington Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -38 -31 -25 -17 -9 -2 9 17 27 36 44 49 53 58 61 66 69 71 73 74 75 77 79Anaesthesia 0 0 1 1 2 2 2 3 3 3 3 3 3 3 3 3 3 2 2 2 1 1 0Anatomical Pathology 0 0 0 0 0 0 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -5 -6 -6 -7 -8 -8 -9Cardiology -1 -2 -2 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -7 -7 -8 -9 -10 -11 -11 -12 -13 -14Dermatology -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -5Diagnostic Radiology -9 -10 -11 -12 -13 -15 -16 -17 -18 -19 -20 -21 -22 -23 -24 -26 -27 -28 -29 -30 -31 -33 -33Family Medicine - Emergency Med. -5 -2 1 4 7 10 12 15 17 19 22 24 26 29 30 33 35 37 38 40 41 42 44Emergency Medicine -1 0 0 0 1 1 2 2 3 3 4 4 5 5 5 6 6 6 7 7 7 8 8Endocrinology 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Gastroenterology 0 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -5 -5 -5 -6 -6General Internal Medicine -2 -2 -2 -1 -1 0 1 1 2 3 4 5 6 7 7 8 8 9 9 10 11 11 12General Surgery -1 -1 -1 -2 -1 -1 0 0 1 1 2 2 2 3 3 3 4 4 4 4 5 5 5Medical Oncology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -2Nephrology -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3Neurology 0 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4 -5 -5 -6 -6 -6 -7 -7Obstetrics and Gynecology -1 0 0 1 2 2 4 5 6 7 8 8 9 10 11 12 13 13 14 14 15 16 17Ophthalmology 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7Orthopedic Surgery -1 0 0 0 1 2 2 3 3 4 5 5 6 7 7 7 8 8 8 8 8 8 8Otolaryngology -1 0 0 0 0 -1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1Pediatrics 0 -1 0 -1 -1 0 0 0 0 0 0 -1 -1 -2 -2 -3 -3 -4 -4 -4 -5 -6 -6Physical Medicine and Rehab 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -3 -3Plastic Surgery 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1Psychiatry 0 -1 -3 -4 -5 -6 -8 -10 -12 -14 -16 -17 -18 -20 -22 -24 -25 -26 -27 -28 -28 -29 -30Radiation Oncology 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2Respirology 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -2 -2 -3 -3 -3 -3Rheumatology 0 0 0 -1 -1 -1 -1 -2 -2 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -7Urology 0 -1 -1 -1 -1 -1 -1 -1 0 -1 0 0 0 -1 -1 0 0 0 -1 -1 -1 -1 -1

29

Hamilton Niagara Haldimand Brant Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -46 -38 -32 -20 -10 2 19 35 53 69 83 94 102 111 118 126 131 137 142 147 152 160 167Anaesthesia 0 1 2 5 5 7 8 10 10 12 13 13 13 14 14 14 14 15 15 16 16 17 17Anatomical Pathology 0 0 0 1 3 3 2 2 2 2 1 1 1 1 0 -1 -1 -1 -1 -1 -2 -2 -2Cardiology -1 -1 0 1 0 0 0 0 0 0 0 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -7 -7Dermatology -1 -2 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2Diagnostic Radiology -11 -11 -11 -11 -11 -11 -11 -12 -12 -13 -14 -15 -15 -17 -17 -18 -19 -19 -21 -22 -23 -24 -24Family Medicine - Emergency Med. -9 -3 1 5 9 13 16 20 24 27 31 34 37 40 41 44 47 50 52 54 55 57 58Emergency Medicine -3 -1 1 3 7 10 13 16 19 22 26 29 32 35 38 41 44 47 50 53 56 58 61Endocrinology -1 -1 -1 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2Gastroenterology 0 0 0 0 0 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 1General Internal Medicine -2 -1 0 2 5 11 16 20 25 31 36 42 47 53 57 62 67 72 77 81 86 91 95General Surgery -1 -1 -1 1 2 3 6 9 11 13 15 18 18 21 23 26 28 29 30 31 33 33 34Medical Oncology -1 0 0 1 1 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 4Nephrology -1 0 2 3 4 5 6 8 9 10 11 12 14 14 16 17 17 18 19 20 20 21 21Neurology 0 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -4 -5 -5 -6 -6 -6 -7 -7Obstetrics and Gynecology -1 0 2 3 4 6 6 8 9 10 12 13 14 16 17 18 19 20 22 24 25 27 28Ophthalmology -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5 -5 -5 -6 -6 -6 -6 -6 -7 -7 -7 -7 -8Orthopedic Surgery -1 0 1 3 5 6 7 9 11 12 14 16 17 19 20 22 23 25 27 29 30 32 33Otolaryngology -1 -1 -1 -1 -1 -1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1Pediatrics 0 1 4 6 7 11 14 16 18 20 23 26 29 30 32 33 35 37 39 41 42 43 44Physical Medicine and Rehab 0 1 2 3 5 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23Plastic Surgery 0 0 1 1 1 2 2 2 3 3 4 4 5 5 5 5 5 5 5 5 5 5 5Psychiatry 0 -1 -2 -3 -2 -2 0 -1 -1 -1 -1 -1 -2 -2 -1 0 1 0 0 1 3 3 4Radiation Oncology 0 0 1 1 1 2 2 2 2 2 2 2 2 1 2 2 2 1 1 1 0 0 0Respirology 0 1 1 2 2 2 3 3 3 3 3 3 3 3 2 2 2 2 2 2 1 1 1Rheumatology 0 0 0 -1 -1 -2 -3 -3 -3 -4 -5 -6 -7 -8 -9 -9 -10 -11 -12 -12 -13 -14 -15Urology -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -1 -1 -2 -2 -1 -1 -1 -1 -2 -2 -2

30

Central West Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -38 -48 -60 -71 -83 -95 -109 -122 -137 -152 -168 -185 -204 -223 -243 -263 -284 -305 -327 -350 -374 -397 -421Anaesthesia 0 -2 -4 -6 -9 -11 -14 -16 -19 -21 -24 -27 -30 -32 -35 -38 -41 -44 -47 -51 -54 -57 -61Anatomical Pathology 0 -1 -1 -2 -2 -3 -4 -5 -6 -6 -7 -8 -9 -10 -11 -12 -13 -14 -14 -16 -17 -18 -19Cardiology -1 -2 -2 -3 -4 -5 -5 -7 -8 -9 -10 -11 -12 -13 -15 -16 -17 -18 -20 -21 -23 -24 -25Dermatology -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -9 -9Diagnostic Radiology -9 -11 -12 -13 -15 -17 -19 -20 -22 -24 -26 -28 -30 -33 -35 -37 -40 -42 -45 -47 -50 -53 -55Family Medicine - Emergency Med. -4 -3 -2 -1 0 0 0 1 1 1 2 1 1 1 1 0 0 -1 -1 -2 -3 -4 -5Emergency Medicine -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3Endocrinology 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -5 -6 -6 -7Gastroenterology 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 -1General Internal Medicine -2 -3 -3 -4 -4 -4 -4 -4 -4 -4 -3 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -6 -6General Surgery -1 -2 -2 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -10 -10 -11 -12 -13 -14 -15Medical Oncology 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -5Nephrology -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7Neurology 0 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -6 -6 -6 -7 -8 -8 -9 -9 -10Obstetrics and Gynecology -1 -2 -3 -4 -5 -7 -8 -10 -12 -14 -16 -17 -19 -21 -22 -24 -26 -28 -31 -33 -35 -36 -38Ophthalmology 0 -1 -2 -2 -3 -4 -5 -5 -6 -7 -8 -8 -9 -11 -11 -12 -13 -14 -15 -16 -17 -18 -19Orthopedic Surgery -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 -1 -2Otolaryngology -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -7 -8Pediatrics 0 -1 -2 -2 -3 -4 -5 -5 -7 -8 -9 -10 -12 -13 -15 -17 -18 -19 -21 -23 -25 -26 -28Physical Medicine and Rehab 0 0 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -6 -7 -7 -7 -8 -8Plastic Surgery 0 -1 -1 -1 -1 -2 -2 -2 -3 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -9 -10 -10Psychiatry 0 -3 -6 -9 -12 -16 -20 -24 -28 -31 -35 -38 -42 -46 -49 -53 -56 -59 -62 -65 -68 -71 -74Radiation Oncology 0 0 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -9 -10Respirology 0 0 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 -9 -9 -10 -11 -12Rheumatology 0 0 0 -1 -1 -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 -8 -8 -9 -9 -10Urology 0 -1 -1 -1 -2 -3 -3 -3 -4 -4 -5 -5 -5 -6 -7 -7 -8 -8 -9 -9 -10 -11 -12

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Mississauga Halton Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -70 -82 -96 -107 -121 -134 -148 -162 -176 -193 -211 -237 -262 -287 -313 -339 -368 -397 -427 -458 -490 -523 -557Anaesthesia 0 -2 -4 -7 -9 -12 -15 -18 -21 -24 -27 -31 -34 -37 -41 -44 -48 -52 -55 -59 -63 -67 -71Anatomical Pathology -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -8 -9 -11 -12 -14 -15 -17 -19 -20 -21 -23 -24 -26Cardiology -2 -3 -3 -4 -5 -6 -7 -7 -8 -10 -11 -12 -13 -15 -16 -18 -20 -21 -24 -25 -28 -30 -33Dermatology -1 -1 -1 -2 -3 -3 -4 -4 -5 -5 -6 -7 -7 -9 -9 -11 -11 -12 -13 -14 -15 -16 -16Diagnostic Radiology -17 -18 -20 -21 -22 -25 -27 -28 -30 -32 -33 -36 -38 -41 -44 -47 -50 -53 -57 -60 -64 -69 -72Family Medicine - Emergency Med. -5 -1 2 4 7 9 11 13 15 17 18 20 21 22 23 24 25 25 26 26 26 26 25Emergency Medicine 0 -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -7 -8 -9 -10 -10 -11 -12 -13 -13 -14 -15 -16Endocrinology -1 -1 -1 -1 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -5 -5 -5Gastroenterology -1 0 0 1 1 2 2 3 3 4 4 4 4 4 4 4 4 4 4 4 4 3 3General Internal Medicine -3 -4 -3 -3 -2 0 2 4 6 9 12 14 16 17 19 21 24 25 27 28 30 31 33General Surgery -2 -2 -3 -4 -4 -4 -4 -3 -4 -3 -3 -3 -3 -3 -3 -4 -4 -5 -6 -7 -7 -8 -9Medical Oncology -1 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -5 -6 -6 -6 -7 -7Nephrology -1 -1 -1 -1 0 -1 -1 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -4 -4 -5Neurology -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17 -18Obstetrics and Gynecology -2 -2 -3 -3 -4 -5 -5 -5 -6 -7 -7 -8 -10 -11 -12 -13 -14 -16 -17 -19 -20 -21 -23Ophthalmology -1 -1 -2 -3 -4 -5 -6 -6 -8 -9 -10 -11 -12 -14 -15 -16 -17 -19 -20 -21 -23 -24 -26Orthopedic Surgery -1 -2 -2 -2 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5Otolaryngology -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -4 -5 -5 -5 -6 -6 -7 -7 -8 -8 -9 -10 -11Pediatrics -1 -1 -2 -4 -4 -5 -6 -7 -8 -9 -10 -11 -13 -15 -16 -19 -22 -24 -26 -28 -30 -32 -34Physical Medicine and Rehab 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -8 -8 -9 -9 -10 -10Plastic Surgery 0 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -6 -7 -7 -9Psychiatry -1 -4 -9 -14 -19 -24 -31 -37 -44 -49 -56 -62 -68 -75 -80 -86 -92 -98 -104 -110 -115 -120 -125Radiation Oncology 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -7 -7Respirology 0 -1 -1 -3 -3 -4 -5 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17 -19 -20 -21Rheumatology 0 0 -1 -1 -2 -2 -3 -4 -5 -5 -6 -7 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17Urology -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -5 -6 -6 -7 -8 -9 -9 -10 -11 -11 -12 -13 -14

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Toronto Central Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -97 -82 -67 -49 -29 -11 13 38 65 88 110 131 149 167 184 201 219 238 256 272 288 304 323Anaesthesia 0 4 9 17 25 31 37 43 50 56 62 68 73 78 83 88 93 97 101 105 109 113 117Anatomical Pathology -1 4 8 14 21 25 28 32 34 36 40 43 46 49 52 55 57 60 62 64 67 69 71Cardiology -3 -2 -2 -1 0 1 2 3 4 5 5 6 6 6 6 5 5 5 5 5 5 5 4Dermatology -2 -2 -1 -1 1 0 1 1 2 3 3 4 4 4 5 5 5 6 6 7 8 9 9Diagnostic Radiology -23 -19 -18 -14 -11 -8 -6 -5 -4 0 3 5 7 9 11 13 14 15 17 18 18 19 20Family Medicine - Emergency Med. -4 2 6 11 15 19 22 26 30 34 37 40 43 46 49 52 55 57 60 63 66 68 70Emergency Medicine -2 -1 2 5 10 14 18 22 26 30 33 37 41 44 48 51 54 58 61 64 66 69 72Endocrinology -1 0 1 2 3 4 5 6 7 8 9 10 10 11 12 12 13 13 13 14 14 15 15Gastroenterology -1 2 5 8 10 13 16 19 22 24 27 30 33 35 37 39 42 44 46 48 51 54 57General Internal Medicine -4 1 9 20 32 51 66 82 100 119 139 157 174 191 209 226 243 260 278 294 310 326 341General Surgery -3 0 1 5 9 13 18 23 30 36 42 50 57 63 69 76 82 88 94 100 106 112 116Medical Oncology -1 1 2 3 5 6 6 8 9 9 10 10 10 11 12 13 13 13 14 15 16 16 16Nephrology -1 1 3 5 7 10 11 13 15 17 19 21 23 24 26 28 30 31 33 35 35 37 39Neurology -1 -1 0 1 3 4 6 8 9 10 12 13 15 17 18 19 21 23 25 26 27 28 29Obstetrics and Gynecology -2 -2 0 3 6 10 16 21 25 29 33 39 43 47 51 55 58 62 66 71 75 79 84Ophthalmology -1 -1 -1 -1 0 0 0 0 0 1 0 0 0 -1 -2 -1 -1 -1 -2 -2 -3 -4 -3Orthopedic Surgery -2 0 2 5 8 12 15 18 21 24 27 30 33 35 39 41 44 46 49 51 54 57 60Otolaryngology -2 -1 0 0 0 1 2 2 3 3 4 4 5 6 7 8 8 9 9 10 11 12 13Pediatrics -1 4 11 16 22 31 37 43 51 58 65 71 77 83 89 95 101 106 111 116 120 126 130Physical Medicine and Rehab 0 0 1 2 3 4 5 6 6 7 8 9 10 10 10 11 12 13 13 14 14 16 16Plastic Surgery -1 1 2 2 4 5 6 7 8 9 10 11 12 13 14 14 15 16 16 17 17 18 18Psychiatry -1 2 7 13 21 26 36 45 53 62 70 79 87 95 100 106 113 120 127 134 141 148 157Radiation Oncology 0 5 10 14 20 25 30 35 39 44 49 54 59 63 68 72 76 79 84 87 91 95 99Respirology -1 2 3 5 7 8 9 10 11 12 12 13 13 14 15 16 17 17 17 18 18 19 18Rheumatology 0 0 0 -1 -1 -2 -2 -3 -4 -5 -7 -8 -9 -10 -11 -12 -13 -14 -15 -17 -18 -19 -20Urology -1 0 1 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 19 20

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Central Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -69 -71 -79 -81 -85 -90 -89 -91 -90 -91 -96 -104 -114 -126 -138 -153 -169 -184 -202 -224 -245 -266 -284Anaesthesia 0 -2 -4 -6 -7 -10 -11 -13 -16 -19 -21 -24 -27 -30 -34 -37 -40 -43 -46 -49 -52 -55 -58Anatomical Pathology -1 -1 -2 -2 -2 -3 -4 -5 -6 -7 -8 -10 -11 -12 -13 -15 -16 -18 -19 -20 -21 -23 -24Cardiology -2 -3 -4 -5 -7 -9 -10 -12 -13 -15 -18 -20 -23 -25 -27 -30 -33 -36 -38 -41 -45 -48 -51Dermatology -1 -2 -2 -3 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -5 -5 -5 -6 -7 -7 -8 -8Diagnostic Radiology -17 -17 -18 -20 -22 -23 -25 -28 -31 -33 -36 -39 -41 -45 -49 -52 -55 -58 -60 -64 -67 -70 -73Family Medicine - Emergency Med. -7 -4 -1 1 3 5 6 8 9 11 12 13 13 13 13 14 13 14 14 14 13 13 12Emergency Medicine -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -5 -5Endocrinology -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -6 -7 -7 -7 -8 -9 -9 -10 -11 -11 -12Gastroenterology -1 -1 0 0 0 0 1 1 1 2 2 2 2 2 1 0 0 -1 -1 -1 -2 -2 -3General Internal Medicine -3 -4 -4 -4 -3 0 2 4 6 8 12 15 17 18 21 23 25 27 28 30 32 33 34General Surgery -2 -3 -4 -5 -6 -7 -7 -7 -7 -7 -8 -9 -10 -12 -13 -14 -16 -17 -18 -19 -20 -22 -23Medical Oncology -1 -1 -2 -3 -3 -4 -4 -5 -6 -7 -8 -9 -10 -11 -12 -12 -14 -15 -16 -17 -17 -19 -19Nephrology -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -5 -6 -6 -7 -8 -9 -10 -10 -11 -12 -13 -13 -14Neurology -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -3 -3 -4 -4 -5 -6 -6 -7 -8 -9 -10 -10Obstetrics and Gynecology -2 -2 -3 -4 -5 -5 -5 -6 -6 -6 -7 -8 -8 -9 -10 -11 -12 -12 -13 -13 -14 -15 -15Ophthalmology -1 -2 -3 -4 -5 -7 -8 -9 -10 -11 -12 -13 -15 -16 -17 -18 -19 -20 -22 -23 -24 -26 -27Orthopedic Surgery -1 -1 -1 -1 -1 0 1 2 2 3 5 6 7 7 8 8 9 10 10 11 12 12 12Otolaryngology -1 -1 -1 0 0 0 0 1 1 1 1 1 2 2 2 1 1 1 1 1 1 1 0Pediatrics -1 -1 0 0 0 1 2 2 2 2 2 1 -1 -2 -3 -5 -6 -7 -8 -10 -11 -11 -13Physical Medicine and Rehab 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4Plastic Surgery 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5Psychiatry -1 -6 -11 -17 -24 -29 -35 -41 -47 -54 -60 -66 -73 -79 -85 -90 -96 -102 -105 -111 -114 -118 -121Radiation Oncology 0 -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -8 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17 -18Respirology 0 0 1 1 1 1 1 1 1 0 0 0 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4Rheumatology 0 0 -1 -1 -2 -2 -3 -4 -5 -6 -8 -9 -10 -11 -13 -14 -15 -17 -18 -19 -20 -21 -22Urology -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -7 -8 -9 -10 -11 -11 -12 -13 -14 -16 -17 -17 -19

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Central East Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -93 -87 -84 -81 -75 -70 -60 -51 -44 -38 -33 -31 -32 -32 -33 -34 -37 -41 -45 -53 -58 -65 -70Anaesthesia 0 -1 -1 0 -1 -1 -1 -1 -2 -1 -3 -4 -6 -6 -8 -9 -11 -12 -13 -14 -15 -16 -17Anatomical Pathology -1 -1 -1 -1 -1 -2 -2 -3 -4 -4 -6 -6 -7 -8 -9 -10 -11 -11 -12 -13 -13 -14 -15Cardiology -3 -3 -3 -4 -4 -4 -5 -5 -7 -8 -9 -11 -11 -12 -13 -15 -16 -17 -19 -20 -22 -23 -25Dermatology -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -8 -8 -8 -8Diagnostic Radiology -22 -23 -24 -25 -27 -29 -30 -31 -33 -34 -36 -39 -41 -42 -46 -48 -49 -51 -53 -54 -56 -58 -60Family Medicine - Emergency Med. -10 -8 -6 -5 -3 -3 -2 0 0 0 1 2 2 2 3 2 1 1 0 0 0 0 -1Emergency Medicine -1 -1 -1 -1 0 0 0 0 1 1 1 2 2 2 2 3 3 3 3 3 3 3 4Endocrinology -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -8 -9 -9Gastroenterology -1 0 0 1 1 1 2 3 4 4 5 4 5 5 6 6 6 7 7 7 7 7 7General Internal Medicine -4 -5 -5 -5 -5 -3 -2 -1 0 2 4 5 6 7 8 8 10 11 11 12 12 13 14General Surgery -3 -2 -2 -1 0 1 3 4 6 8 9 11 11 13 14 15 16 16 17 18 18 18 19Medical Oncology -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -8 -8 -9 -9Nephrology -1 0 1 2 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 19 20 20 21Neurology -1 -1 -2 -4 -4 -5 -5 -6 -7 -7 -8 -9 -9 -10 -10 -11 -12 -13 -13 -14 -15 -16 -16Obstetrics and Gynecology -2 -2 0 0 0 1 2 2 4 5 5 6 7 7 7 7 8 8 9 9 10 11 11Ophthalmology -1 -2 -2 -2 -3 -4 -4 -5 -6 -6 -8 -9 -9 -11 -12 -13 -13 -14 -15 -16 -17 -18 -18Orthopedic Surgery -2 -2 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 0 1 1 0 0 0 0Otolaryngology -1 -1 -2 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -5Pediatrics -1 -1 -1 -1 -2 -2 -2 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -5 -4 -5 -6 -6Physical Medicine and Rehab 0 -1 -1 -1 -1 -2 -3 -3 -3 -3 -4 -5 -5 -6 -7 -7 -8 -9 -9 -10 -10 -11 -11Plastic Surgery -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -5 -5 -6 -6 -6 -6 -7 -7 -8 -8Psychiatry -1 -4 -9 -13 -17 -23 -28 -34 -39 -45 -50 -56 -61 -66 -71 -76 -80 -84 -88 -91 -94 -97 -100Radiation Oncology 0 -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -8 -8 -9 -10 -11 -12 -13 -13 -14 -15 -15 -16Respirology -1 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3Rheumatology 0 0 -1 -1 -1 -2 -3 -3 -4 -5 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -14 -16 -16Urology -1 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -5 -5 -5 -5

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South East Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -27 -20 -16 -9 0 9 22 32 45 56 66 75 84 92 101 109 117 126 133 141 149 157 167Anaesthesia 0 1 2 4 5 6 7 9 10 12 13 14 15 16 16 17 19 20 21 23 24 25 26Anatomical Pathology 0 0 1 2 3 3 4 4 4 5 5 6 6 7 7 7 7 8 8 8 9 9 9Cardiology -1 -1 -1 -1 -1 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Dermatology -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Diagnostic Radiology -6 -7 -6 -6 -7 -7 -7 -7 -8 -8 -9 -9 -9 -11 -11 -11 -11 -12 -12 -12 -12 -13 -13Family Medicine - Emergency Med. -9 -6 -4 -2 1 3 5 6 8 10 11 13 14 16 17 19 21 22 23 25 27 28 30Emergency Medicine -7 -5 -4 -3 1 3 6 8 11 13 16 18 21 23 25 27 30 32 34 36 38 41 43Endocrinology 0 0 0 -1 0 0 0 0 0 1 1 1 1 1 1 1 2 2 2 2 2 3 3Gastroenterology 0 -1 0 0 1 1 1 2 2 2 3 2 3 3 4 4 4 5 5 5 6 6 7General Internal Medicine -1 -1 0 0 1 3 5 7 8 11 13 14 16 18 20 22 24 26 28 30 32 34 36General Surgery -1 0 0 1 1 2 3 3 4 4 5 6 7 7 8 8 8 9 10 10 11 11 12Medical Oncology 0 0 1 1 2 2 3 3 3 3 4 4 4 4 5 5 5 5 5 5 5 5 5Nephrology 0 0 0 1 2 2 2 3 3 4 4 4 5 5 5 6 6 6 7 7 7 7 7Neurology 0 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 3 3 3 3 3 3 3Obstetrics and Gynecology -1 0 1 2 3 4 6 7 8 9 11 12 13 15 16 18 19 20 21 23 24 25 26Ophthalmology 0 0 0 0 1 1 2 2 3 3 4 4 4 5 5 6 5 6 6 6 6 6 7Orthopedic Surgery 0 0 0 1 2 2 3 4 4 5 5 6 6 7 8 9 9 9 10 10 11 11 12Otolaryngology 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Pediatrics 0 1 1 2 2 3 4 5 6 7 8 9 9 10 12 13 13 14 15 15 17 18 18Physical Medicine and Rehab 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 7 7 8 8 8 8 9Plastic Surgery 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Psychiatry 0 0 1 2 2 3 4 5 5 6 7 8 9 9 11 13 13 15 17 19 21 23 24Radiation Oncology 0 0 0 0 0 0 0 0 0 0 0 0 -1 0 -1 -1 -1 -1 -1 -2 -2 -2 -2Respirology 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2Rheumatology 0 0 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -5Urology 0 0 0 1 1 2 2 3 4 4 5 6 6 7 7 8 9 9 10 11 11 12 12

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Champlain Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -87 -74 -59 -42 -25 -8 10 32 53 72 87 97 107 115 122 129 136 142 147 150 154 158 162Anaesthesia 0 2 5 8 12 15 17 19 21 23 26 27 28 29 31 32 34 35 36 37 39 40 40Anatomical Pathology -1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 1Cardiology -3 -4 -4 -4 -4 -5 -6 -6 -7 -8 -8 -10 -11 -12 -12 -13 -14 -14 -15 -16 -18 -19 -19Dermatology -2 -3 -3 -3 -4 -5 -6 -6 -7 -8 -9 -10 -10 -11 -11 -12 -12 -13 -14 -14 -14 -15 -15Diagnostic Radiology -21 -21 -21 -21 -21 -23 -22 -24 -24 -23 -24 -25 -26 -26 -28 -29 -31 -31 -32 -34 -35 -36 -37Family Medicine - Emergency Med. -7 -2 3 8 13 17 21 24 28 32 35 38 41 45 48 51 53 56 59 62 64 66 68Emergency Medicine -3 -2 1 3 6 8 11 13 16 18 21 24 27 30 33 35 38 41 43 46 49 52 54Endocrinology -1 -1 -1 -1 -2 -2 -2 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -2 -2 -2 -2 -2Gastroenterology -1 0 0 1 1 1 2 2 2 3 3 4 4 4 5 5 5 6 6 6 7 6 7General Internal Medicine -4 -4 -2 0 3 8 12 16 20 26 31 36 40 45 50 54 59 64 68 72 76 79 84General Surgery -2 -3 -4 -5 -6 -6 -6 -6 -6 -6 -5 -5 -5 -5 -4 -4 -4 -3 -3 -3 -4 -3 -3Medical Oncology -1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0Nephrology -1 0 0 1 1 2 3 3 4 4 4 5 5 5 5 5 6 6 6 6 6 6 6Neurology -1 -1 -2 -2 -1 -1 -1 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1Obstetrics and Gynecology -2 -1 0 1 4 6 8 11 13 15 17 19 21 24 25 28 29 30 31 33 34 36 37Ophthalmology -1 -1 0 0 1 1 2 2 2 2 2 3 2 1 2 1 1 1 1 1 1 1 1Orthopedic Surgery -2 -1 0 1 3 5 6 8 10 11 14 16 18 20 23 25 28 30 31 33 35 37 39Otolaryngology -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -5 -5Pediatrics -1 1 4 6 7 10 13 15 17 20 22 24 25 27 29 30 32 34 35 36 37 38 40Physical Medicine and Rehab 0 0 1 1 1 2 2 3 3 4 4 5 6 5 6 6 6 7 7 7 7 6 7Plastic Surgery -1 -1 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -5 -5 -5 -5 -6Psychiatry -1 -5 -9 -12 -16 -17 -19 -24 -27 -31 -33 -37 -41 -45 -47 -51 -52 -55 -57 -58 -60 -60 -62Radiation Oncology 0 0 1 1 2 2 3 3 3 4 3 3 4 4 4 4 5 5 5 5 5 5 5Respirology 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0Rheumatology 0 0 0 -1 -1 -2 -2 -3 -3 -4 -6 -7 -8 -9 -10 -11 -12 -12 -13 -14 -14 -16 -16Urology -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 0 -1 0 0 -1 -1 -1 -1

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North Simcoe Muskoka Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -27 -24 -22 -19 -16 -11 -4 3 10 16 20 24 27 29 31 33 35 37 38 38 39 40 42Anaesthesia 0 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -5 -5 -6 -7 -7 -8 -9 -10 -10 -11 -11 -12Anatomical Pathology 0 -1 -1 -1 -2 -3 -3 -4 -5 -5 -6 -7 -7 -8 -9 -9 -10 -11 -11 -12 -13 -13 -14Cardiology -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -8 -9 -10 -10Dermatology -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3 -4 -4 -4 -4Diagnostic Radiology -7 -7 -7 -7 -8 -8 -9 -9 -10 -10 -11 -12 -12 -13 -13 -14 -15 -15 -16 -17 -19 -19 -20Family Medicine - Emergency Med. -5 -1 2 5 8 10 13 16 18 21 24 26 28 30 32 34 37 38 40 42 44 45 46Emergency Medicine 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1Endocrinology 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Gastroenterology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2General Internal Medicine -1 -1 -1 0 1 3 4 6 7 9 10 12 13 15 16 18 19 21 22 23 24 26 27General Surgery -1 0 -1 0 0 1 2 2 3 3 4 5 5 6 6 6 7 7 7 8 8 9 9Medical Oncology 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -4 -4Nephrology 0 -1 -1 -1 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -5 -6 -6 -7 -7 -8 -8 -8 -9Neurology 0 -1 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -9Obstetrics and Gynecology -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -1 -2 -2 -2Ophthalmology 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4Orthopedic Surgery -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3Otolaryngology 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 3 3 3 3 3 3Pediatrics 0 0 1 2 3 3 4 5 6 7 7 8 8 9 9 10 10 11 11 12 12 13 13Physical Medicine and Rehab 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0Plastic Surgery 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4Psychiatry 0 0 -2 -2 -3 -3 -4 -4 -4 -4 -5 -4 -5 -4 -4 -4 -4 -3 -3 -2 -1 -1 0Radiation Oncology 0 0 0 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -6Respirology 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3Rheumatology 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4 -5Urology 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5

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North East Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -66 -54 -43 -29 -16 0 19 39 59 78 96 112 128 143 159 174 189 205 219 233 248 262 279Anaesthesia 0 0 0 1 2 3 4 5 6 7 8 9 9 11 12 13 14 15 16 17 18 19 20Anatomical Pathology -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3 -3Cardiology -2 -2 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -9 -10 -10 -10 -11 -11 -11 -11 -12Dermatology -1 -1 -1 -1 -1 -1 -1 -2 -2 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2Diagnostic Radiology -16 -16 -16 -16 -16 -16 -16 -17 -17 -16 -16 -16 -16 -16 -15 -15 -15 -15 -14 -14 -14 -13 -12Family Medicine - Emergency Med. -4 0 3 6 9 12 14 17 20 23 24 27 30 32 34 36 38 40 43 45 46 49 51Emergency Medicine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1Endocrinology -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3 -3 -3 -3 -4 -4Gastroenterology -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2General Internal Medicine -3 -3 -4 -4 -3 -2 -1 0 1 3 4 5 7 8 8 10 11 12 14 15 16 18 19General Surgery -2 -2 -3 -3 -2 -2 -1 0 1 2 4 5 6 8 10 11 12 13 15 17 18 20 22Medical Oncology -1 -1 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 3 3Nephrology -1 -1 0 0 0 0 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4Neurology -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -5Obstetrics and Gynecology -1 -2 -1 -2 -1 -1 -1 -1 -1 0 0 0 0 1 1 1 2 2 2 3 3 3 4Ophthalmology -1 -1 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 0Orthopedic Surgery -1 -2 -2 -2 -2 -1 -1 0 0 1 1 2 2 3 3 4 4 5 5 5 5 5 5Otolaryngology -1 -1 -1 -1 0 0 0 0 0 1 0 1 1 1 1 2 2 2 2 2 2 3 3Pediatrics -1 0 1 1 1 2 3 3 4 5 6 6 7 8 9 10 10 11 11 12 13 14 14Physical Medicine and Rehab 0 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4Plastic Surgery 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2Psychiatry -1 0 0 0 1 1 2 2 3 3 3 4 5 6 6 7 7 9 10 10 11 12 14Radiation Oncology 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1Respirology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1Rheumatology 0 0 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3Urology -1 -1 -1 -1 -1 -1 -1 -1 -2 -1 -1 -1 -1 -1 0 -1 0 0 0 0 0 0 0

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North West Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -24 -18 -11 -3 4 11 20 29 39 47 55 62 69 76 83 90 97 104 111 118 124 132 139Anaesthesia 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 2 1 2 2 2 2 2Anatomical Pathology 0 0 0 0 0 1 1 1 1 1 1 1 1 2 1 1 2 2 2 2 2 2 2Cardiology -1 -1 -1 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 1Dermatology 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1Diagnostic Radiology -6 -6 -5 -5 -5 -5 -5 -4 -4 -3 -3 -2 -2 -2 -2 -1 -1 0 0 1 1 2 3Family Medicine - Emergency Med. -2 -1 0 0 1 1 2 3 3 3 4 4 5 5 5 6 6 6 7 7 7 7 8Emergency Medicine -1 0 0 0 1 1 1 1 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5Endocrinology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1Gastroenterology 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1General Internal Medicine -1 -1 0 0 0 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17General Surgery -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -2 -3 -3 -2 -2 -2 -2 -2 -2 -2 -2Medical Oncology 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3Nephrology 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2Neurology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1Obstetrics and Gynecology -1 -1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1Ophthalmology 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1Orthopedic Surgery 0 0 0 0 1 1 1 2 2 3 3 4 4 5 6 6 7 7 8 8 9 9 10Otolaryngology 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2Pediatrics 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 2 2Physical Medicine and Rehab 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Plastic Surgery 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1Psychiatry 0 1 2 3 4 6 7 9 10 12 13 15 16 17 19 19 21 22 23 24 24 25 27Radiation Oncology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1Respirology 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2Rheumatology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Urology 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1

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Ontario

Specialty 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030Family Medicine -802 -732 -686 -603 -526 -446 -320 -201 -74 33 120 167 205 234 257 280 290 298 298 281 266 259 262Anaesthesia -2 0 7 20 27 34 42 46 51 58 59 56 54 53 51 47 44 41 37 34 30 26 20Anatomical Pathology -8 -1 0 9 20 21 22 20 20 18 16 15 13 11 6 2 -1 -5 -7 -10 -13 -16 -21Cardiology -25 -28 -30 -32 -37 -41 -48 -53 -61 -68 -77 -87 -96 -104 -113 -124 -134 -145 -156 -167 -181 -193 -204Dermatology -15 -19 -18 -22 -22 -26 -28 -30 -32 -34 -36 -39 -42 -45 -48 -51 -52 -55 -58 -60 -62 -64 -66Diagnostic Radiology -193 -192 -199 -199 -207 -217 -223 -235 -245 -253 -262 -274 -289 -302 -316 -331 -346 -360 -373 -389 -406 -419 -434Family Medicine - Emergency Med. -78 -29 12 51 87 121 152 185 217 247 275 300 324 349 371 394 414 434 453 471 486 501 514Emergency Medicine -21 -15 -4 5 25 39 55 69 85 100 115 132 146 160 174 188 201 214 227 239 250 262 273Endocrinology -10 -9 -9 -8 -8 -8 -8 -8 -8 -10 -10 -11 -13 -14 -15 -16 -17 -17 -18 -19 -20 -20 -21Gastroenterology -7 -5 1 7 12 17 23 28 33 38 41 44 47 49 52 54 56 60 61 62 64 65 67General Internal Medicine -37 -32 -16 4 31 79 120 162 208 259 315 363 409 453 496 541 586 629 671 712 752 792 832General Surgery -22 -21 -26 -21 -15 -6 9 22 36 50 64 81 92 104 116 127 138 150 159 168 177 186 195Medical Oncology -10 -5 -4 -3 -1 0 0 0 -1 -3 -4 -7 -10 -11 -12 -13 -15 -19 -21 -24 -26 -28 -30Nephrology -11 -6 1 7 13 19 24 30 35 40 45 48 51 54 57 61 63 65 68 70 71 72 72Neurology -8 -11 -16 -19 -18 -20 -21 -21 -22 -23 -25 -27 -29 -30 -31 -33 -38 -39 -43 -46 -49 -55 -58Obstetrics and Gynecology -18 -18 -9 -3 5 16 30 41 54 65 76 88 97 106 114 125 132 142 149 158 168 177 187Ophthalmology -9 -13 -15 -19 -21 -25 -27 -30 -35 -38 -44 -48 -57 -64 -69 -75 -81 -86 -94 -100 -106 -111 -116Orthopedic Surgery -15 -11 -4 2 19 30 42 53 64 77 90 102 115 126 138 148 158 168 177 187 194 202 211Otolaryngology -13 -11 -11 -12 -11 -10 -7 -6 -5 -4 -4 -2 -1 0 -1 -1 -1 0 0 1 1 0 0Pediatrics -6 3 15 26 35 53 67 79 92 105 117 127 133 138 146 148 155 159 164 168 173 177 181Physical Medicine and Rehab -3 0 3 5 9 10 13 16 18 21 23 26 28 30 30 31 32 34 34 34 35 35 36Plastic Surgery -5 -4 -5 -6 -4 -4 -2 0 -1 -1 -3 -3 -3 -4 -5 -6 -7 -8 -11 -12 -14 -16 -19Psychiatry -6 -24 -48 -66 -81 -98 -112 -132 -154 -173 -192 -208 -229 -248 -267 -283 -296 -307 -317 -326 -330 -332 -334Radiation Oncology 0 5 11 12 18 22 26 30 32 36 37 40 42 44 45 47 48 49 50 52 52 53 54Respirology -5 2 3 6 8 9 10 10 10 9 8 6 5 3 1 -1 -4 -8 -10 -12 -16 -19 -22Rheumatology -2 -1 -5 -9 -13 -19 -24 -30 -37 -43 -53 -63 -70 -77 -85 -93 -100 -109 -115 -122 -130 -138 -146Urology -10 -10 -10 -12 -12 -13 -12 -11 -11 -11 -9 -8 -8 -12 -12 -13 -14 -14 -14 -16 -18 -19 -21

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Appendix 2 - Specialty Reports by LHIN Appendix 2 reports the simulation results of Base Case Simulation 3 by LHIN for each individual specialty. Only specialties which are simulated individually are reported, grouped specialties are not reported (see section 4.6.1 for more detail). Grouped specialties include: Internal Medicine (Other) – includes Critical Care Medicine, Clinical Immunology and Allergy, Geriatric Medicine, Hematology,

Infectious Diseases and Occupational Medicine.

Surgery (Other) - includes Cardiac Surgery, Neurosurgery, Thoracic Surgery and Vascular Surgery.

Lab Specialties (Other) - includes Medical Genetics, General Pathology, Hematological Pathology, Medical Biochemistry, Medical

Microbiology and Neuropathalogy.

Pediatrics (Other) - includes Pediatric General Surgery, Pediatric Respirology, Pediatric Rheumatology, Pediatric Nephrology, Pediatric

Infectious Diseases, Pediatric Hematology, Pediatric Gastroenterology, Pediatric Endocrinology & Metabolism, Pediatric Critical Care,

Pediatric Clinical Immunology, Pediatric Cardiology and Pediatric Neurology.

NOTE: A negative number in the table indicates a shortage.

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Base Case Simulation 3 – Summary of Key Inputs and Assumptions

Medical School 952 students entering medical school by 2011; 43% ♂; 57% ♀

Post-Graduate (PG) Residency Training

1,247 ministry-funded residents entering training by 2014; 43% Family Medicine (FM); 57% Specialists (SP) Resident specialization rates based on previous 3-year observed average. Minimum 15% of internal medicine residents must train in general internal med in 4th year. Maximum 30% of Post-Graduate Year (PGY) 2 FM trainees may train in PGY3, FM-Emergency Medicine positions are

hard capped at 36. 200 International Medical Graduates (IMGs) enter training annually based on historical specialty distribution. All advanced

trainees start at PGY2. 14 practicing physicians re-enter training based on historical specialty distribution and training length.

Fellowship Assumption that the number of trainees entering fellowship is equal to the number exiting fellowship, so this module is

turned off. PG data shows a stable number of Pool D fellowship trainees each of the last several years.

PG Migration Avg 3-year net PG migration out of Ontario after training: Total: -78; FM: +3; SP: -81

Practise Entry Median 3-year age of PG trainee entry into practise: Total: 32; FM: 30; SP: 33; Canadian Medical Graduates: 31; IMGs: 39

Practise Migration Annual net migration of practising physicians: Total: <0.1%; FM : <0.1%; SP: <0.1%

Retirement 3-year avg retirement rate: Total: 0.9%; FM: 0.7%; SP: 1.1%; age 50-65: 0.7%; age 65+: 5.7%

Other Attrition Attrition not covered above: Total: 1.0%; FM: 1.0%; SP: 1.1%; age <65: 0.7%; age 65+: 3.1%

OMA Survey Avg clinical hours per week: Total: 42.6; FM: 42.0; SP: 43.3; ♂: 44.1; ♀: 39.7 Avg weeks worked per year: Total: 45.7; FM: 45.8; SP: 44.8; ♂: 45.1; ♀: 45.4 Avg patients seen per week: Total: 98; FM: 123; SP: 79; ♂: 105; ♀: 82

Productivity Non-Physician Clinicians: projected # of future nurse practitioners enhance FM productivity by 40%. Information & Communication Technology, Health System Change, Funding: no enhancement of physician productivity.

Population Demographics

ON population to grow 13% by 2020: 13.2M to 14.9M; Central West LHIN: 26%; North West LHIN: -1% ON population 65+ to grow 44% by 2020: 1.8M to 2.6M; Central West LHIN: 63%; Toronto Central LHIN: 18%

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Base Case Simulation 3 – Summary of Key Inputs and Assumptions cntd.

Population Prevalence:

Socio-Economic & Lifestyle Risk Factors Second-hand smoke exposure: ♂: 12% ♀: 11%

Lack of fruits & vegetables: ♂: 59% ♀: 48% Lack of sense of belonging: ♂: 9% ♀: 10% Excessive alcohol intake: ♂: 3% ♀: 1% Mining Industry Employment: ♂: <1% ♀: <1%

Physical Inactivity: ♂: 41% ♀: 47% Perceived Stress: ♂: 4% ♀: 4% Low Income: ♂: 3% ♀: 5% Smoking: ♂: 17% ♀: 13% Obesity: ♂: 15% ♀: 13%

Increase in Prevalence from 2009 to 2030:

Top ICD-10 Diseases

Mental Health & Behavioural: 6.9% Circulatory: 7.4% Musculoskeletal: 9.3% Neoplasms: 12.5% Respiratory: 6.9%

Digestive: 1.7% Endocrine, Nutritional & Metabolic: 5.0% Genitourinary: 1.8% Nervous System: 1.8% Skin and Subcutaneous Tissue: 1.6%

The top ten ICD-10 categories were further divided into sub-disease categories. An example is provided for each:

Disease Weights

Mental Health & Behaviour: Depression: stress: 27%; sense of belonging: 36%; low income: 14% excessive drinking: 9%; other: 14%

Circ: Hypertension: excessive drinking: 30%; obesity: 30%; physical inactivity: 20%; smoking: 9%; other: 11% Musculoskeletal: Low Back Pain: obesity: 5%; physical inactivity: 25%; other: 70% Neoplasms: Lung Cancer: smoking: 75%; second hand smoke exposure: 10%: lack of fruits and vegetables: 3%; other:

12% Respiratory: Chronic obstructive pulmonary disease: smoking: 80%; other: 20% Digestive: Irritable Bowel Disease: genetics: 50%; age: 20%; stress: 5%; environmental: 10%; other: 15% Endo: Diabetes: obesity: 50%; age 25%; genetics: 10%; hypertension: 10%; other: 5% Genitourinary: none Nervous: Epilepsy: age: 30%; sex: 5%; neurological development: 15%; excessive drinking: 15%; stress: 20%; neoplasm:

5%; other: 10% Skin: Psoriasis: age: 20%; genetics: 30%; stress: 10%; infection: 15%; trauma: 10%; other: 15%

44

Family Medicine LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -51 -48 -46 -46 -44 -42 -37 -33 -28 -24 -20 -16 -12 -9 -6 -3 0 3 7 11 15 20 2502 - South West -69 -56 -46 -31 -18 -5 14 32 51 69 85 97 109 120 132 143 154 164 173 181 191 200 21103 - Waterloo Wellington -38 -31 -25 -17 -9 -2 9 17 27 36 44 49 53 58 61 66 69 71 73 74 75 77 7904 - Hamilton Niagara Haldimand Brant -46 -38 -32 -20 -10 2 19 35 53 69 83 94 102 111 118 126 131 137 142 147 152 160 16705 - Central West -38 -48 -60 -71 -83 -95 -109 -122 -137 -152 -168 -185 -204 -223 -243 -263 -284 -305 -327 -350 -374 -397 -42106 - Mississauga Halton -70 -82 -96 -107 -121 -134 -148 -162 -176 -193 -211 -237 -262 -287 -313 -339 -368 -397 -427 -458 -490 -523 -55707 - Toronto Central -97 -82 -67 -49 -29 -11 13 38 65 88 110 131 149 167 184 201 219 238 256 272 288 304 32308 - Central -69 -71 -79 -81 -85 -90 -89 -91 -90 -91 -96 -104 -114 -126 -138 -153 -169 -184 -202 -224 -245 -266 -28409 - Central East -93 -87 -84 -81 -75 -70 -60 -51 -44 -38 -33 -31 -32 -32 -33 -34 -37 -41 -45 -53 -58 -65 -7010 - South East -27 -20 -16 -9 0 9 22 32 45 56 66 75 84 92 101 109 117 126 133 141 149 157 16711 - Champlain -87 -74 -59 -42 -25 -8 10 32 53 72 87 97 107 115 122 129 136 142 147 150 154 158 16212 - North Simcoe Muskoka -27 -24 -22 -19 -16 -11 -4 3 10 16 20 24 27 29 31 33 35 37 38 38 39 40 4213 - North East -66 -54 -43 -29 -16 0 19 39 59 78 96 112 128 143 159 174 189 205 219 233 248 262 27914 - North West -24 -18 -11 -3 4 11 20 29 39 47 55 62 69 76 83 90 97 104 111 118 124 132 139 Anaesthesia LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 -1 0 -1 -1 -1 -1 -2 -1 -2 -2 -2 -2 -3 -3 -3 -4 -3 -4 -4 -4 -402 - South West 0 0 2 4 6 7 9 10 12 14 14 14 15 16 16 17 18 18 19 19 20 21 2103 - Waterloo Wellington 0 0 1 1 2 2 2 3 3 3 3 3 3 3 3 3 3 2 2 2 1 1 004 - Hamilton Niagara Haldimand Brant 0 1 2 5 5 7 8 10 10 12 13 13 13 14 14 14 14 15 15 16 16 17 1705 - Central West 0 -2 -4 -6 -9 -11 -14 -16 -19 -21 -24 -27 -30 -32 -35 -38 -41 -44 -47 -51 -54 -57 -6106 - Mississauga Halton 0 -2 -4 -7 -9 -12 -15 -18 -21 -24 -27 -31 -34 -37 -41 -44 -48 -52 -55 -59 -63 -67 -7107 - Toronto Central 0 4 9 17 25 31 37 43 50 56 62 68 73 78 83 88 93 97 101 105 109 113 11708 - Central 0 -2 -4 -6 -7 -10 -11 -13 -16 -19 -21 -24 -27 -30 -34 -37 -40 -43 -46 -49 -52 -55 -5809 - Central East 0 -1 -1 0 -1 -1 -1 -1 -2 -1 -3 -4 -6 -6 -8 -9 -11 -12 -13 -14 -15 -16 -1710 - South East 0 1 2 4 5 6 7 9 10 12 13 14 15 16 16 17 19 20 21 23 24 25 2611 - Champlain 0 2 5 8 12 15 17 19 21 23 26 27 28 29 31 32 34 35 36 37 39 40 4012 - North Simcoe Muskoka 0 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -5 -5 -6 -7 -7 -8 -9 -10 -10 -11 -11 -1213 - North East 0 0 0 1 2 3 4 5 6 7 8 9 9 11 12 13 14 15 16 17 18 19 2014 - North West 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 2 1 2 2 2 2 2 Anatomical Pathology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -7 -7 -7 -802 - South West -1 1 1 3 5 6 7 8 9 9 10 12 12 13 13 14 14 14 14 15 15 16 1603 - Waterloo Wellington 0 0 0 0 0 0 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -5 -6 -6 -7 -8 -8 -904 - Hamilton Niagara Haldimand Brant 0 0 0 1 3 3 2 2 2 2 1 1 1 1 0 -1 -1 -1 -1 -1 -2 -2 -205 - Central West 0 -1 -1 -2 -2 -3 -4 -5 -6 -6 -7 -8 -9 -10 -11 -12 -13 -14 -14 -16 -17 -18 -1906 - Mississauga Halton -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -8 -9 -11 -12 -14 -15 -17 -19 -20 -21 -23 -24 -2607 - Toronto Central -1 4 8 14 21 25 28 32 34 36 40 43 46 49 52 55 57 60 62 64 67 69 7108 - Central -1 -1 -2 -2 -2 -3 -4 -5 -6 -7 -8 -10 -11 -12 -13 -15 -16 -18 -19 -20 -21 -23 -2409 - Central East -1 -1 -1 -1 -1 -2 -2 -3 -4 -4 -6 -6 -7 -8 -9 -10 -11 -11 -12 -13 -13 -14 -1510 - South East 0 0 1 2 3 3 4 4 4 5 5 6 6 7 7 7 7 8 8 8 9 9 911 - Champlain -1 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 1 112 - North Simcoe Muskoka 0 -1 -1 -1 -2 -3 -3 -4 -5 -5 -6 -7 -7 -8 -9 -9 -10 -11 -11 -12 -13 -13 -1413 - North East -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3 -314 - North West 0 0 0 0 0 1 1 1 1 1 1 1 1 2 1 1 2 2 2 2 2 2 2

45

Cardiology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -7 -7 -8 -8 -9 -9 -10 -10 -11 -11 -11 -12 -1202 - South West -2 -1 -1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 -1 -103 - Waterloo Wellington -1 -2 -2 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -7 -7 -8 -9 -10 -11 -11 -12 -13 -1404 - Hamilton Niagara Haldimand Brant -1 -1 0 1 0 0 0 0 0 0 0 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -7 -705 - Central West -1 -2 -2 -3 -4 -5 -5 -7 -8 -9 -10 -11 -12 -13 -15 -16 -17 -18 -20 -21 -23 -24 -2506 - Mississauga Halton -2 -3 -3 -4 -5 -6 -7 -7 -8 -10 -11 -12 -13 -15 -16 -18 -20 -21 -24 -25 -28 -30 -3307 - Toronto Central -3 -2 -2 -1 0 1 2 3 4 5 5 6 6 6 6 5 5 5 5 5 5 5 408 - Central -2 -3 -4 -5 -7 -9 -10 -12 -13 -15 -18 -20 -23 -25 -27 -30 -33 -36 -38 -41 -45 -48 -5109 - Central East -3 -3 -3 -4 -4 -4 -5 -5 -7 -8 -9 -11 -11 -12 -13 -15 -16 -17 -19 -20 -22 -23 -2510 - South East -1 -1 -1 -1 -1 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -111 - Champlain -3 -4 -4 -4 -4 -5 -6 -6 -7 -8 -8 -10 -11 -12 -12 -13 -14 -14 -15 -16 -18 -19 -1912 - North Simcoe Muskoka -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -8 -9 -10 -1013 - North East -2 -2 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -9 -10 -10 -10 -11 -11 -11 -11 -1214 - North West -1 -1 -1 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 1 Dermatology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 1 1 0 1 1 1 1 1 1 102 - South West -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -4 -5 -5 -5 -5 -503 - Waterloo Wellington -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -504 - Hamilton Niagara Haldimand Brant -1 -2 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -205 - Central West -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -9 -906 - Mississauga Halton -1 -1 -1 -2 -3 -3 -4 -4 -5 -5 -6 -7 -7 -9 -9 -11 -11 -12 -13 -14 -15 -16 -1607 - Toronto Central -2 -2 -1 -1 1 0 1 1 2 3 3 4 4 4 5 5 5 6 6 7 8 9 908 - Central -1 -2 -2 -3 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -5 -5 -5 -6 -7 -7 -8 -809 - Central East -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -8 -8 -8 -810 - South East -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -111 - Champlain -2 -3 -3 -3 -4 -5 -6 -6 -7 -8 -9 -10 -10 -11 -11 -12 -12 -13 -14 -14 -14 -15 -1512 - North Simcoe Muskoka -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3 -4 -4 -4 -413 - North East -1 -1 -1 -1 -1 -1 -1 -2 -2 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -214 - North West 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 Diagnostic Radiology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -12 -12 -13 -13 -13 -14 -14 -15 -15 -16 -16 -17 -17 -18 -19 -19 -21 -21 -22 -22 -23 -23 -2402 - South West -16 -15 -15 -15 -16 -17 -17 -18 -18 -20 -20 -22 -24 -25 -25 -27 -27 -28 -29 -30 -31 -32 -3303 - Waterloo Wellington -9 -10 -11 -12 -13 -15 -16 -17 -18 -19 -20 -21 -22 -23 -24 -26 -27 -28 -29 -30 -31 -33 -3304 - Hamilton Niagara Haldimand Brant -11 -11 -11 -11 -11 -11 -11 -12 -12 -13 -14 -15 -15 -17 -17 -18 -19 -19 -21 -22 -23 -24 -2405 - Central West -9 -11 -12 -13 -15 -17 -19 -20 -22 -24 -26 -28 -30 -33 -35 -37 -40 -42 -45 -47 -50 -53 -5506 - Mississauga Halton -17 -18 -20 -21 -22 -25 -27 -28 -30 -32 -33 -36 -38 -41 -44 -47 -50 -53 -57 -60 -64 -69 -7207 - Toronto Central -23 -19 -18 -14 -11 -8 -6 -5 -4 0 3 5 7 9 11 13 14 15 17 18 18 19 2008 - Central -17 -17 -18 -20 -22 -23 -25 -28 -31 -33 -36 -39 -41 -45 -49 -52 -55 -58 -60 -64 -67 -70 -7309 - Central East -22 -23 -24 -25 -27 -29 -30 -31 -33 -34 -36 -39 -41 -42 -46 -48 -49 -51 -53 -54 -56 -58 -6010 - South East -6 -7 -6 -6 -7 -7 -7 -7 -8 -8 -9 -9 -9 -11 -11 -11 -11 -12 -12 -12 -12 -13 -1311 - Champlain -21 -21 -21 -21 -21 -23 -22 -24 -24 -23 -24 -25 -26 -26 -28 -29 -31 -31 -32 -34 -35 -36 -3712 - North Simcoe Muskoka -7 -7 -7 -7 -8 -8 -9 -9 -10 -10 -11 -12 -12 -13 -13 -14 -15 -15 -16 -17 -19 -19 -2013 - North East -16 -16 -16 -16 -16 -16 -16 -17 -17 -16 -16 -16 -16 -16 -15 -15 -15 -15 -14 -14 -14 -13 -1214 - North West -6 -6 -5 -5 -5 -5 -5 -4 -4 -3 -3 -2 -2 -2 -2 -1 -1 0 0 1 1 2 3

46

Family Medicine - Emergency Medicine LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -5 0 4 7 10 14 17 20 24 27 30 32 36 38 41 45 48 50 53 55 58 60 6202 - South West -4 0 3 6 9 11 14 17 20 22 24 26 28 30 33 35 36 38 39 40 42 44 4603 - Waterloo Wellington -5 -2 1 4 7 10 12 15 17 19 22 24 26 29 30 33 35 37 38 40 41 42 4404 - Hamilton Niagara Haldimand Brant -9 -3 1 5 9 13 16 20 24 27 31 34 37 40 41 44 47 50 52 54 55 57 5805 - Central West -4 -3 -2 -1 0 0 0 1 1 1 2 1 1 1 1 0 0 -1 -1 -2 -3 -4 -506 - Mississauga Halton -5 -1 2 4 7 9 11 13 15 17 18 20 21 22 23 24 25 25 26 26 26 26 2507 - Toronto Central -4 2 6 11 15 19 22 26 30 34 37 40 43 46 49 52 55 57 60 63 66 68 7008 - Central -7 -4 -1 1 3 5 6 8 9 11 12 13 13 13 13 14 13 14 14 14 13 13 1209 - Central East -10 -8 -6 -5 -3 -3 -2 0 0 0 1 2 2 2 3 2 1 1 0 0 0 0 -110 - South East -9 -6 -4 -2 1 3 5 6 8 10 11 13 14 16 17 19 21 22 23 25 27 28 3011 - Champlain -7 -2 3 8 13 17 21 24 28 32 35 38 41 45 48 51 53 56 59 62 64 66 6812 - North Simcoe Muskoka -5 -1 2 5 8 10 13 16 18 21 24 26 28 30 32 34 37 38 40 42 44 45 4613 - North East -4 0 3 6 9 12 14 17 20 23 24 27 30 32 34 36 38 40 43 45 46 49 5114 - North West -2 -1 0 0 1 1 2 3 3 3 4 4 5 5 5 6 6 6 7 7 7 7 8 Emergency Medicine LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 102 - South West -2 -1 1 3 7 9 12 14 17 20 22 25 28 30 33 35 37 39 41 43 45 47 4903 - Waterloo Wellington -1 0 0 0 1 1 2 2 3 3 4 4 5 5 5 6 6 6 7 7 7 8 804 - Hamilton Niagara Haldimand Brant -3 -1 1 3 7 10 13 16 19 22 26 29 32 35 38 41 44 47 50 53 56 58 6105 - Central West -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -306 - Mississauga Halton 0 -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -7 -8 -9 -10 -10 -11 -12 -13 -13 -14 -15 -1607 - Toronto Central -2 -1 2 5 10 14 18 22 26 30 33 37 41 44 48 51 54 58 61 64 66 69 7208 - Central -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -5 -509 - Central East -1 -1 -1 -1 0 0 0 0 1 1 1 2 2 2 2 3 3 3 3 3 3 3 410 - South East -7 -5 -4 -3 1 3 6 8 11 13 16 18 21 23 25 27 30 32 34 36 38 41 4311 - Champlain -3 -2 1 3 6 8 11 13 16 18 21 24 27 30 33 35 38 41 43 46 49 52 5412 - North Simcoe Muskoka 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 113 - North East 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 114 - North West -1 0 0 0 1 1 1 1 2 2 2 3 3 3 3 4 4 4 4 5 5 5 5 Endocrinology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 102 - South West -1 -1 -1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 203 - Waterloo Wellington 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -104 - Hamilton Niagara Haldimand Brant -1 -1 -1 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -205 - Central West 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -5 -6 -6 -706 - Mississauga Halton -1 -1 -1 -1 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -5 -5 -507 - Toronto Central -1 0 1 2 3 4 5 6 7 8 9 10 10 11 12 12 13 13 13 14 14 15 1508 - Central -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -6 -7 -7 -7 -8 -9 -9 -10 -11 -11 -1209 - Central East -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -8 -9 -910 - South East 0 0 0 -1 0 0 0 0 0 1 1 1 1 1 1 1 2 2 2 2 2 3 311 - Champlain -1 -1 -1 -1 -2 -2 -2 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -2 -2 -2 -2 -212 - North Simcoe Muskoka 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -113 - North East -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -3 -3 -3 -3 -4 -414 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1

47

Gastroenterology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 -1 -1 -1 -2 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -7 -7 -7 -8 -8 -9 -9 -902 - South West -1 0 0 1 2 3 3 4 4 4 4 5 5 5 6 6 7 7 8 8 8 8 903 - Waterloo Wellington 0 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -5 -5 -5 -6 -604 - Hamilton Niagara Haldimand Brant 0 0 0 0 0 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 1 105 - Central West 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 -106 - Mississauga Halton -1 0 0 1 1 2 2 3 3 4 4 4 4 4 4 4 4 4 4 4 4 3 307 - Toronto Central -1 2 5 8 10 13 16 19 22 24 27 30 33 35 37 39 42 44 46 48 51 54 5708 - Central -1 -1 0 0 0 0 1 1 1 2 2 2 2 2 1 0 0 -1 -1 -1 -2 -2 -309 - Central East -1 0 0 1 1 1 2 3 4 4 5 4 5 5 6 6 6 7 7 7 7 7 710 - South East 0 -1 0 0 1 1 1 2 2 2 3 2 3 3 4 4 4 5 5 5 6 6 711 - Champlain -1 0 0 1 1 1 2 2 2 3 3 4 4 4 5 5 5 6 6 6 7 6 712 - North Simcoe Muskoka 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -213 - North East -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -214 - North West 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 General Internal Medicine LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -2 -2 -2 -2 -2 -1 0 0 1 1 2 3 4 4 4 5 6 6 7 8 9 9 902 - South West -3 -2 1 4 8 13 19 25 31 38 45 52 58 64 71 77 83 89 94 100 106 113 11903 - Waterloo Wellington -2 -2 -2 -1 -1 0 1 1 2 3 4 5 6 7 7 8 8 9 9 10 11 11 1204 - Hamilton Niagara Haldimand Brant -2 -1 0 2 5 11 16 20 25 31 36 42 47 53 57 62 67 72 77 81 86 91 9505 - Central West -2 -3 -3 -4 -4 -4 -4 -4 -4 -4 -3 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -6 -606 - Mississauga Halton -3 -4 -3 -3 -2 0 2 4 6 9 12 14 16 17 19 21 24 25 27 28 30 31 3307 - Toronto Central -4 1 9 20 32 51 66 82 100 119 139 157 174 191 209 226 243 260 278 294 310 326 34108 - Central -3 -4 -4 -4 -3 0 2 4 6 8 12 15 17 18 21 23 25 27 28 30 32 33 3409 - Central East -4 -5 -5 -5 -5 -3 -2 -1 0 2 4 5 6 7 8 8 10 11 11 12 12 13 1410 - South East -1 -1 0 0 1 3 5 7 8 11 13 14 16 18 20 22 24 26 28 30 32 34 3611 - Champlain -4 -4 -2 0 3 8 12 16 20 26 31 36 40 45 50 54 59 64 68 72 76 79 8412 - North Simcoe Muskoka -1 -1 -1 0 1 3 4 6 7 9 10 12 13 15 16 18 19 21 22 23 24 26 2713 - North East -3 -3 -4 -4 -3 -2 -1 0 1 3 4 5 7 8 8 10 11 12 14 15 16 18 1914 - North West -1 -1 0 0 0 1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 General Surgery LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -2 -2 -2 -3 -2 -2 -1 0 -1 0 1 1 1 1 1 2 2 3 3 4 5 502 - South West -2 -2 -2 -1 0 1 2 4 5 7 8 10 11 12 14 15 16 18 19 20 21 22 2303 - Waterloo Wellington -1 -1 -1 -2 -1 -1 0 0 1 1 2 2 2 3 3 3 4 4 4 4 5 5 504 - Hamilton Niagara Haldimand Brant -1 -1 -1 1 2 3 6 9 11 13 15 18 18 21 23 26 28 29 30 31 33 33 3405 - Central West -1 -2 -2 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -10 -10 -11 -12 -13 -14 -1506 - Mississauga Halton -2 -2 -3 -4 -4 -4 -4 -3 -4 -3 -3 -3 -3 -3 -3 -4 -4 -5 -6 -7 -7 -8 -907 - Toronto Central -3 0 1 5 9 13 18 23 30 36 42 50 57 63 69 76 82 88 94 100 106 112 11608 - Central -2 -3 -4 -5 -6 -7 -7 -7 -7 -7 -8 -9 -10 -12 -13 -14 -16 -17 -18 -19 -20 -22 -2309 - Central East -3 -2 -2 -1 0 1 3 4 6 8 9 11 11 13 14 15 16 16 17 18 18 18 1910 - South East -1 0 0 1 1 2 3 3 4 4 5 6 7 7 8 8 8 9 10 10 11 11 1211 - Champlain -2 -3 -4 -5 -6 -6 -6 -6 -6 -6 -5 -5 -5 -5 -4 -4 -4 -3 -3 -3 -4 -3 -312 - North Simcoe Muskoka -1 0 -1 0 0 1 2 2 3 3 4 5 5 6 6 6 7 7 7 8 8 9 913 - North East -2 -2 -3 -3 -2 -2 -1 0 1 2 4 5 6 8 10 11 12 13 15 17 18 20 2214 - North West -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -2 -3 -3 -2 -2 -2 -2 -2 -2 -2 -2

48

Medical Oncology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -302 - South West -1 -1 -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -5 -6 -6 -6 -703 - Waterloo Wellington 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -204 - Hamilton Niagara Haldimand Brant -1 0 0 1 1 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 405 - Central West 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -506 - Mississauga Halton -1 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -5 -6 -6 -6 -7 -707 - Toronto Central -1 1 2 3 5 6 6 8 9 9 10 10 10 11 12 13 13 13 14 15 16 16 1608 - Central -1 -1 -2 -3 -3 -4 -4 -5 -6 -7 -8 -9 -10 -11 -12 -12 -14 -15 -16 -17 -17 -19 -1909 - Central East -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -8 -8 -9 -910 - South East 0 0 1 1 2 2 3 3 3 3 4 4 4 4 5 5 5 5 5 5 5 5 511 - Champlain -1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 012 - North Simcoe Muskoka 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -4 -413 - North East -1 -1 0 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 3 314 - North West 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -3 Nephrology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 0 0 0 0 1 1 1 2 2 2 2 3 3 3 4 4 4 4 4 4 5 502 - South West -1 -1 0 1 1 2 3 4 4 4 5 6 6 6 6 7 8 8 8 9 9 10 1003 - Waterloo Wellington -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -304 - Hamilton Niagara Haldimand Brant -1 0 2 3 4 5 6 8 9 10 11 12 14 14 16 17 17 18 19 20 20 21 2105 - Central West -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -706 - Mississauga Halton -1 -1 -1 -1 0 -1 -1 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -4 -4 -507 - Toronto Central -1 1 3 5 7 10 11 13 15 17 19 21 23 24 26 28 30 31 33 35 35 37 3908 - Central -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -5 -6 -6 -7 -8 -9 -10 -10 -11 -12 -13 -13 -1409 - Central East -1 0 1 2 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 19 20 20 2110 - South East 0 0 0 1 2 2 2 3 3 4 4 4 5 5 5 6 6 6 7 7 7 7 711 - Champlain -1 0 0 1 1 2 3 3 4 4 4 5 5 5 5 5 6 6 6 6 6 6 612 - North Simcoe Muskoka 0 -1 -1 -1 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -5 -6 -6 -7 -7 -8 -8 -8 -913 - North East -1 -1 0 0 0 0 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 414 - North West 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 Neurology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -3 -3 -3 -3 -4 -4 -5 -5 -5 -5 -5 -6 -702 - South West -1 -1 -2 -3 -2 -3 -3 -3 -2 -2 -2 -2 -2 -1 -1 -1 -1 -1 -1 -1 -1 -1 -103 - Waterloo Wellington 0 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4 -5 -5 -6 -6 -6 -7 -704 - Hamilton Niagara Haldimand Brant 0 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -4 -5 -5 -6 -6 -6 -7 -705 - Central West 0 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -5 -5 -6 -6 -6 -7 -8 -8 -9 -9 -1006 - Mississauga Halton -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17 -1807 - Toronto Central -1 -1 0 1 3 4 6 8 9 10 12 13 15 17 18 19 21 23 25 26 27 28 2908 - Central -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -3 -3 -4 -4 -5 -6 -6 -7 -8 -9 -10 -1009 - Central East -1 -1 -2 -4 -4 -5 -5 -6 -7 -7 -8 -9 -9 -10 -10 -11 -12 -13 -13 -14 -15 -16 -1610 - South East 0 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 3 3 3 3 3 3 311 - Champlain -1 -1 -2 -2 -1 -1 -1 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -112 - North Simcoe Muskoka 0 -1 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -913 - North East -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -514 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1

49

Obstetrics and Gynecology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 0 0 1 1 2 3 3 4 5 6 6 7 8 9 10 11 11 13 14 1502 - South West -2 -1 0 2 3 5 7 10 12 15 17 20 22 24 25 28 30 33 35 36 38 39 4103 - Waterloo Wellington -1 0 0 1 2 2 4 5 6 7 8 8 9 10 11 12 13 13 14 14 15 16 1704 - Hamilton Niagara Haldimand Brant -1 0 2 3 4 6 6 8 9 10 12 13 14 16 17 18 19 20 22 24 25 27 2805 - Central West -1 -2 -3 -4 -5 -7 -8 -10 -12 -14 -16 -17 -19 -21 -22 -24 -26 -28 -31 -33 -35 -36 -3806 - Mississauga Halton -2 -2 -3 -3 -4 -5 -5 -5 -6 -7 -7 -8 -10 -11 -12 -13 -14 -16 -17 -19 -20 -21 -2307 - Toronto Central -2 -2 0 3 6 10 16 21 25 29 33 39 43 47 51 55 58 62 66 71 75 79 8408 - Central -2 -2 -3 -4 -5 -5 -5 -6 -6 -6 -7 -8 -8 -9 -10 -11 -12 -12 -13 -13 -14 -15 -1509 - Central East -2 -2 0 0 0 1 2 2 4 5 5 6 7 7 7 7 8 8 9 9 10 11 1110 - South East -1 0 1 2 3 4 6 7 8 9 11 12 13 15 16 18 19 20 21 23 24 25 2611 - Champlain -2 -1 0 1 4 6 8 11 13 15 17 19 21 24 25 28 29 30 31 33 34 36 3712 - North Simcoe Muskoka -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -1 -2 -2 -213 - North East -1 -2 -1 -2 -1 -1 -1 -1 -1 0 0 0 0 1 1 1 2 2 2 3 3 3 414 - North West -1 -1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 Ophthalmology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 0 0 0 0 0 0 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -302 - South West -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -8 -903 - Waterloo Wellington 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -704 - Hamilton Niagara Haldimand Brant -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5 -5 -5 -6 -6 -6 -6 -6 -7 -7 -7 -7 -805 - Central West 0 -1 -2 -2 -3 -4 -5 -5 -6 -7 -8 -8 -9 -11 -11 -12 -13 -14 -15 -16 -17 -18 -1906 - Mississauga Halton -1 -1 -2 -3 -4 -5 -6 -6 -8 -9 -10 -11 -12 -14 -15 -16 -17 -19 -20 -21 -23 -24 -2607 - Toronto Central -1 -1 -1 -1 0 0 0 0 0 1 0 0 0 -1 -2 -1 -1 -1 -2 -2 -3 -4 -308 - Central -1 -2 -3 -4 -5 -7 -8 -9 -10 -11 -12 -13 -15 -16 -17 -18 -19 -20 -22 -23 -24 -26 -2709 - Central East -1 -2 -2 -2 -3 -4 -4 -5 -6 -6 -8 -9 -9 -11 -12 -13 -13 -14 -15 -16 -17 -18 -1810 - South East 0 0 0 0 1 1 2 2 3 3 4 4 4 5 5 6 5 6 6 6 6 6 711 - Champlain -1 -1 0 0 1 1 2 2 2 2 2 3 2 1 2 1 1 1 1 1 1 1 112 - North Simcoe Muskoka 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -413 - North East -1 -1 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 014 - North West 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Orthopedic Surgery LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 0 0 1 1 1 2 2 2 2 3 3 4 4 4 5 5 6 6 6 602 - South West -1 0 1 2 4 6 8 10 11 14 16 17 19 21 23 24 26 28 29 30 32 33 3503 - Waterloo Wellington -1 0 0 0 1 2 2 3 3 4 5 5 6 7 7 7 8 8 8 8 8 8 804 - Hamilton Niagara Haldimand Brant -1 0 1 3 5 6 7 9 11 12 14 16 17 19 20 22 23 25 27 29 30 32 3305 - Central West -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 -1 -206 - Mississauga Halton -1 -2 -2 -2 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -507 - Toronto Central -2 0 2 5 8 12 15 18 21 24 27 30 33 35 39 41 44 46 49 51 54 57 6008 - Central -1 -1 -1 -1 -1 0 1 2 2 3 5 6 7 7 8 8 9 10 10 11 12 12 1209 - Central East -2 -2 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 0 1 1 0 0 0 010 - South East 0 0 0 1 2 2 3 4 4 5 5 6 6 7 8 9 9 9 10 10 11 11 1211 - Champlain -1 -1 0 0 1 1 2 2 2 2 2 3 2 1 2 1 1 1 1 1 1 1 112 - North Simcoe Muskoka -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 -3 -313 - North East -1 -2 -2 -2 -2 -1 -1 0 0 1 1 2 2 3 3 4 4 5 5 5 5 5 514 - North West 0 0 0 0 1 1 1 2 2 3 3 4 4 5 6 6 7 7 8 8 9 9 10

50

Otolaryngology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 0 0 0 1 1 1 102 - South West -1 0 -1 0 0 1 1 2 2 3 3 4 5 5 6 6 7 7 8 9 9 10 1003 - Waterloo Wellington -1 0 0 0 0 -1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 104 - Hamilton Niagara Haldimand Brant -1 -1 -1 -1 -1 -1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 105 - Central West -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -7 -806 - Mississauga Halton -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -4 -5 -5 -5 -6 -6 -7 -7 -8 -8 -9 -10 -1107 - Toronto Central -2 -1 0 0 0 1 2 2 3 3 4 4 5 6 7 8 8 9 9 10 11 12 1308 - Central -1 -1 -1 0 0 0 0 1 1 1 1 1 2 2 2 1 1 1 1 1 1 1 009 - Central East -1 -1 -2 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -510 - South East 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -111 - Champlain -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -5 -512 - North Simcoe Muskoka 0 0 0 0 0 1 1 1 1 1 1 2 2 2 2 2 2 3 3 3 3 3 313 - North East -1 -1 -1 -1 0 0 0 0 0 1 0 1 1 1 1 2 2 2 2 2 2 3 314 - North West 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -2 Pediatrics LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -6 -6 -6 -602 - South West -1 0 1 2 3 5 6 6 6 7 7 8 8 8 8 9 10 10 10 10 11 12 1303 - Waterloo Wellington 0 -1 0 -1 -1 0 0 0 0 0 0 -1 -1 -2 -2 -3 -3 -4 -4 -4 -5 -6 -604 - Hamilton Niagara Haldimand Brant 0 1 4 6 7 11 14 16 18 20 23 26 29 30 32 33 35 37 39 41 42 43 4405 - Central West 0 -1 -2 -2 -3 -4 -5 -5 -7 -8 -9 -10 -12 -13 -15 -17 -18 -19 -21 -23 -25 -26 -2806 - Mississauga Halton -1 -1 -2 -4 -4 -5 -6 -7 -8 -9 -10 -11 -13 -15 -16 -19 -22 -24 -26 -28 -30 -32 -3407 - Toronto Central -1 4 11 16 22 31 37 43 51 58 65 71 77 83 89 95 101 106 111 116 120 126 13008 - Central -1 -1 0 0 0 1 2 2 2 2 2 1 -1 -2 -3 -5 -6 -7 -8 -10 -11 -11 -1309 - Central East -1 -1 -1 -1 -2 -2 -2 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -5 -4 -5 -6 -610 - South East 0 1 1 2 2 3 4 5 6 7 8 9 9 10 12 13 13 14 15 15 17 18 1811 - Champlain -1 1 4 6 7 10 13 15 17 20 22 24 25 27 29 30 32 34 35 36 37 38 4012 - North Simcoe Muskoka 0 0 1 2 3 3 4 5 6 7 7 8 8 9 9 10 10 11 11 12 12 13 1313 - North East -1 0 1 1 1 2 3 3 4 5 6 6 7 8 9 10 10 11 11 12 13 14 1414 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 2 2 Physical Medicine and Rehab LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 0 0 0 1 1 1 1 2 2 2 3 3 3 3 4 4 4 5 5 5 502 - South West 0 0 1 1 2 2 3 3 4 4 5 6 6 6 7 7 8 8 8 9 9 9 1003 - Waterloo Wellington 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -3 -304 - Hamilton Niagara Haldimand Brant 0 1 2 3 5 5 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 2305 - Central West 0 0 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -6 -7 -7 -7 -8 -806 - Mississauga Halton 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -4 -5 -5 -6 -6 -7 -8 -8 -9 -9 -10 -1007 - Toronto Central 0 0 1 2 3 4 5 6 6 7 8 9 10 10 10 11 12 13 13 14 14 16 1608 - Central 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -4 -4 -4 -409 - Central East 0 -1 -1 -1 -1 -2 -3 -3 -3 -3 -4 -5 -5 -6 -7 -7 -8 -9 -9 -10 -10 -11 -1110 - South East 0 0 1 1 2 2 3 3 4 4 5 5 6 6 7 7 7 7 8 8 8 8 911 - Champlain 0 0 1 1 1 2 2 3 3 4 4 5 6 5 6 6 6 7 7 7 7 6 712 - North Simcoe Muskoka 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 0 0 013 - North East 0 0 0 0 0 0 0 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 414 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

51

Plastic Surgery LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 2 2 2 1 202 - South West 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 -1 -1 -1 -1 -103 - Waterloo Wellington 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 104 - Hamilton Niagara Haldimand Brant 0 0 1 1 1 2 2 2 3 3 4 4 5 5 5 5 5 5 5 5 5 5 505 - Central West 0 -1 -1 -1 -1 -2 -2 -2 -3 -4 -4 -5 -5 -6 -6 -7 -7 -7 -8 -8 -9 -10 -1006 - Mississauga Halton 0 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -5 -5 -6 -6 -6 -7 -7 -907 - Toronto Central -1 1 2 2 4 5 6 7 8 9 10 11 12 13 14 14 15 16 16 17 17 18 1808 - Central 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -509 - Central East -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -5 -5 -6 -6 -6 -6 -7 -7 -8 -810 - South East 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -111 - Champlain -1 -1 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -5 -5 -5 -5 -612 - North Simcoe Muskoka 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -4 -413 - North East 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -214 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Psychiatry LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 -1 -1 -2 -3 -4 -5 -5 -6 -6 -7 -8 -8 -9 -9 -10 -10 -10 -10 -9 -9 -8 -802 - South West -1 -2 -4 -6 -8 -10 -12 -14 -17 -20 -22 -25 -27 -30 -33 -35 -36 -37 -39 -39 -40 -40 -4003 - Waterloo Wellington 0 -1 -3 -4 -5 -6 -8 -10 -12 -14 -16 -17 -18 -20 -22 -24 -25 -26 -27 -28 -28 -29 -3004 - Hamilton Niagara Haldimand Brant 0 -1 -2 -3 -2 -2 0 -1 -1 -1 -1 -1 -2 -2 -1 0 1 0 0 1 3 3 405 - Central West 0 -3 -6 -9 -12 -16 -20 -24 -28 -31 -35 -38 -42 -46 -49 -53 -56 -59 -62 -65 -68 -71 -7406 - Mississauga Halton -1 -4 -9 -14 -19 -24 -31 -37 -44 -49 -56 -62 -68 -75 -80 -86 -92 -98 -104 -110 -115 -120 -12507 - Toronto Central -1 2 7 13 21 26 36 45 53 62 70 79 87 95 100 106 113 120 127 134 141 148 15708 - Central -1 -6 -11 -17 -24 -29 -35 -41 -47 -54 -60 -66 -73 -79 -85 -90 -96 -102 -105 -111 -114 -118 -12109 - Central East -1 -4 -9 -13 -17 -23 -28 -34 -39 -45 -50 -56 -61 -66 -71 -76 -80 -84 -88 -91 -94 -97 -10010 - South East 0 0 1 2 2 3 4 5 5 6 7 8 9 9 11 13 13 15 17 19 21 23 2411 - Champlain -1 -5 -9 -12 -16 -17 -19 -24 -27 -31 -33 -37 -41 -45 -47 -51 -52 -55 -57 -58 -60 -60 -6212 - North Simcoe Muskoka 0 0 -2 -2 -3 -3 -4 -4 -4 -4 -5 -4 -5 -4 -4 -4 -4 -3 -3 -2 -1 -1 013 - North East -1 0 0 0 1 1 2 2 3 3 3 4 5 6 6 7 7 9 10 10 11 12 1414 - North West 0 1 2 3 4 6 7 9 10 12 13 15 16 17 19 19 21 22 23 24 24 25 27 Radiation Oncology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 0 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -402 - South West 0 1 2 2 3 3 4 5 5 6 7 7 7 8 9 9 10 11 11 12 13 13 1403 - Waterloo Wellington 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -1 -1 -2 -204 - Hamilton Niagara Haldimand Brant 0 0 1 1 1 2 2 2 2 2 2 2 2 1 2 2 2 1 1 1 0 0 005 - Central West 0 0 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 -8 -9 -9 -1006 - Mississauga Halton 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -4 -4 -5 -6 -6 -7 -707 - Toronto Central 0 5 10 14 20 25 30 35 39 44 49 54 59 63 68 72 76 79 84 87 91 95 9908 - Central 0 -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -8 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17 -1809 - Central East 0 -1 -1 -2 -2 -3 -4 -4 -5 -6 -7 -8 -8 -9 -10 -11 -12 -13 -13 -14 -15 -15 -1610 - South East 0 0 0 0 0 0 0 0 0 0 0 0 -1 0 -1 -1 -1 -1 -1 -2 -2 -2 -211 - Champlain 0 0 1 1 2 2 3 3 3 4 3 3 4 4 4 4 5 5 5 5 5 5 512 - North Simcoe Muskoka 0 0 0 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -613 - North East 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 114 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1

52

Respirology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 0 0 0 0 1 0 1 0 0 1 1 1 1 1 1 1 1 1 1 1 102 - South West 0 0 0 0 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 -1 -1 -103 - Waterloo Wellington 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -2 -2 -3 -3 -3 -304 - Hamilton Niagara Haldimand Brant 0 1 1 2 2 2 3 3 3 3 3 3 3 3 2 2 2 2 2 2 1 1 105 - Central West 0 0 -1 -1 -2 -2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 -7 -8 -9 -9 -10 -11 -1206 - Mississauga Halton 0 -1 -1 -3 -3 -4 -5 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16 -17 -19 -20 -2107 - Toronto Central -1 2 3 5 7 8 9 10 11 12 12 13 13 14 15 16 17 17 17 18 18 19 1808 - Central 0 0 1 1 1 1 1 1 1 0 0 0 0 -1 -1 -1 -2 -2 -2 -3 -3 -4 -409 - Central East -1 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -310 - South East 0 0 0 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 2 211 - Champlain 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 0 0 0 0 0 012 - North Simcoe Muskoka 0 0 0 0 0 0 0 -1 -1 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -313 - North East 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 114 - North West 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 2 2 Rheumatology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -402 - South West 0 0 0 -1 -1 -1 -1 -1 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -5 -5 -503 - Waterloo Wellington 0 0 0 -1 -1 -1 -1 -2 -2 -3 -3 -4 -4 -4 -5 -5 -5 -6 -6 -6 -7 -7 -704 - Hamilton Niagara Haldimand Brant 0 0 0 -1 -1 -2 -3 -3 -3 -4 -5 -6 -7 -8 -9 -9 -10 -11 -12 -12 -13 -14 -1505 - Central West 0 0 0 -1 -1 -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -6 -7 -8 -8 -9 -9 -1006 - Mississauga Halton 0 0 -1 -1 -2 -2 -3 -4 -5 -5 -6 -7 -7 -8 -9 -10 -11 -12 -13 -14 -15 -16 -1707 - Toronto Central 0 0 0 -1 -1 -2 -2 -3 -4 -5 -7 -8 -9 -10 -11 -12 -13 -14 -15 -17 -18 -19 -2008 - Central 0 0 -1 -1 -2 -2 -3 -4 -5 -6 -8 -9 -10 -11 -13 -14 -15 -17 -18 -19 -20 -21 -2209 - Central East 0 0 -1 -1 -1 -2 -3 -3 -4 -5 -5 -6 -7 -8 -9 -10 -11 -12 -13 -14 -14 -16 -1610 - South East 0 0 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -511 - Champlain 0 0 0 -1 -1 -2 -2 -3 -3 -4 -6 -7 -8 -9 -10 -11 -12 -12 -13 -14 -14 -16 -1612 - North Simcoe Muskoka 0 0 0 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -3 -3 -3 -3 -4 -4 -4 -4 -513 - North East 0 0 0 0 -1 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -3 -314 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Urology LHIN 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 203001 - Erie St. Clair -1 -1 -1 -1 0 -1 0 -1 0 0 0 0 0 -1 -1 -1 -1 -2 -1 -1 -1 -1 -102 - South West -1 0 0 0 0 0 1 1 2 2 3 3 4 4 4 4 4 5 5 5 5 6 603 - Waterloo Wellington 0 -1 -1 -1 -1 -1 -1 -1 0 -1 0 0 0 -1 -1 0 0 0 -1 -1 -1 -1 -104 - Hamilton Niagara Haldimand Brant -1 -1 -1 -2 -2 -2 -2 -2 -2 -2 -2 -2 -1 -1 -2 -2 -1 -1 -1 -1 -2 -2 -205 - Central West 0 -1 -1 -1 -2 -3 -3 -3 -4 -4 -5 -5 -5 -6 -7 -7 -8 -8 -9 -9 -10 -11 -1206 - Mississauga Halton -1 -1 -2 -2 -3 -3 -4 -4 -5 -5 -5 -6 -6 -7 -8 -9 -9 -10 -11 -11 -12 -13 -1407 - Toronto Central -1 0 1 1 2 3 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 19 2008 - Central -1 -2 -2 -3 -3 -4 -4 -5 -5 -6 -7 -8 -9 -10 -11 -11 -12 -13 -14 -16 -17 -17 -1909 - Central East -1 -2 -2 -2 -2 -2 -2 -2 -3 -3 -3 -3 -3 -4 -4 -4 -4 -4 -4 -5 -5 -5 -510 - South East 0 0 0 1 1 2 2 3 4 4 5 6 6 7 7 8 9 9 10 11 11 12 1211 - Champlain -1 -1 -1 -1 -1 -1 -1 -1 0 0 0 0 0 0 0 0 -1 0 0 -1 -1 -1 -112 - North Simcoe Muskoka 0 0 -1 -1 -1 -1 -1 -2 -2 -2 -2 -2 -3 -3 -3 -4 -4 -4 -4 -5 -5 -5 -513 - North East -1 -1 -1 -1 -1 -1 -1 -1 -2 -1 -1 -1 -1 -1 0 -1 0 0 0 0 0 0 014 - North West 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -1 -1 -1 -1

Physician Human Resources Work Group

Physician Services Committee Secretariat 150 Bloor Street West, 8th Floor Toronto, ON M5S 3C1 Fax: (416) 340-2961 Email: Secretariat@pscs.ca

In order to better understand how many physicians we will need in the future, we must

understand the health needs of the population. Ontario has developed and maintained accurate

supply simulation models in the past but these models are limited in their ability to tell us

whether the supply is appropriate or not in the context of population need.

The Ontario Ministry of Health and Long-Term Care (MOHLTC) in partnership with the Ontario

Medical Association (OMA) hired the Conference Board of Canada to develop a needs-based

simulation model to simulate future supply of and need for physicians in Ontario.

This simulation model is the first of its kind in Canada. The simulation results are only one piece

of evidence to be combined with many others in order to support better physician health human

resources (HHR) planning. For example, the Primary Care Access Survey collects valuable data

from patients regarding access to primary care services and attachment to family physicians.

Also, the Health Care Connect initiative facilitates and tracks patient attachment.

The model compares the supply of physician services to the population's need for health services

to quantify a gap and translate it into a physician requirement. The need for physician services is

based on how various socio-economic and lifestyle risk factors in the population (e.g. smoking)

will contribute to the incidence and prevalence of various conditions in the future (e.g. lung

cancer). The supply of physician services is based on the flow of physicians from the education

system to practise and physician survey response data regarding how much time each practising

physician specialty spends treating these conditions.

A variety of data sources and expertise were used including: the Canadian Community Health

Survey, Canadian Institute for Health Information, Ontario Physician Human Resources Data

Centre, specially formed expert panels and a survey specifically designed for this project of

physicians in Ontario.

Physician Human Resources Work Group

Physician Services Committee Secretariat

The results of the simulation model suggest that certain specialties and geographic areas will be

in high need in the future. The actual numerical values reported for the estimated gap will never

be completely accurate but their relative trends over time provide important guidance.

We thank all stakeholders who participated in project meetings and/or expert panels for their

time and valuable input. The MOHLTC and OMA are committed to improving the simulation

model over time with better evidence and assumptions as they become available.

Sincerely,

__________________________ __________________________ Jeff Goodyear Dr. Deborah Hellyer MOHLTC Co-Chair OMA Co-Chair Physician Human Resources WG Physician Human Resources WG

150 Bloor Street West, 8th Floor Toronto, ON M5S 3C1 Fax: (416) 340-2961 Email: Secretariat@pscs.ca