Healthcare experts have been talking about both a real and potential a shortage of primary care doctors in the U.S. for a few years. Apparently the situation in Canada is even worse.

According to a report in the Wall Street Journal, several Canadian doctors, faced with lengthening work days and case loads in the thousands, have held lotteries to pare their patient populations. Some Canadian doctors have used this random-chance method to cut as many as 500 patients from their practice.

The lottery system highlights the magnitude of the doctor shortage north of the border, where 5 million Canadians, about one in four, are without a primary care physician. One cause, according to some observers, is the low salaries and the salary cap that are imposed on Canadian doctors.  As a result, they say, Canadian physicians are overworked and underpaid. With limits on their income and the prospect of long work hours, it’s not surprising that one out of every nine Canadian-trained doctors are now practicing in the U.S. For every U.S. doctor who chooses to go north, 19 Canadian doctors opt to move to the States.

Unlike our federal Medicare program, the national health system in Canada is run by the individual provinces, which set physician salaries. Several provinces, including Ontario, have raised salaries in an effort to lure more doctors and to reduce waiting times. According to a 2006 report from the Fraser Institute, Canadian patients wait an average of 18 weeks to see a specialist after being referred by their primary care physician, about 90% longer than they did 15 years ago.