Accounting for the Family Physician Workforce in Newfoundland and Labrador: A Stock and Flow Analysis, 2014-2024

IntroductionNewfoundland and Labrador (NL) faces persistent difficulty attaching its residents to primary care. We undertook a stock and flow analysis to represent how inflows and outflows of family physicians (FPs) shape effective capacity and to provide a reconciled estimate of FP supply for 2024. This approach clarifies drivers of change, exposes intervention points, and supports timely planning. MethodsWe assembled a multi-year headcount series and linked it to CIHIs "entering/leaving direct care" flows, harmonizing definitions and time frames across sources. We compared observed year-to-year stock change with net flows to identify timing and classification gaps. Stakeholder consultations informed key parameters (graduates and retention, internationally trained entrants, migration, retirement, and scope shift). Because confirmations are released with a lag, we produced a reconciled 2024 estimate using the CIHI headcount as baseline and these validated inputs. FindingsFP headcount changed from 680 (2014) to 666 (2023) (-2.1%) after peaking at 728 (2017); the ratio fell from 129 to 124 per 100,000 population. The workforce became more urban (rural 255[->]203; urban 424[->]460) and more Canada-trained (417[->]466) while foreign trained decreased (261[->]199). Net interprovincial migration averaged -24/year, with pronounced losses in 2019 (-57) and 2022 (-42). CIHI entry-exit data point to marked volatility in the FP workforce: entries/exits were 110/96 (2019), 62/88 (2020), and 71/117 (2021), with residuals versus stock change indicating definitional/timing differences. The 2024 reconciliation yielded {approx}658 FPs (net -8.5 from 2023), {approx}507 FTE at 0.77 FTE/head, and {approx}122 per 100,000 population. ConclusionInflows from local graduates and IMGs did not fully offset exits from migration, retirement, and scope/burnout in 2024. Recruitment alone is unlikely to close access gaps; retention-first strategies, scaleup of team-based care with role optimization, targeted rural supports, and routine monitoring of flows are needed to stabilize and grow effective primary care capacity in NL.