Difficulties accessing specialist care among middle-aged and older Canadians

Canada’s population is rapidly aging. Indeed, in 2023, the median age of Canadians was 40.6 years. In other words, half of the total population was over the age of 40. 

A recent study found that older adults (65 years or older) were more likely to use specialist care than middle-aged adults (45 to 64 years) and were less likely to report experiencing difficulties accessing care.

In 2023, just over two-thirds (about 5.0 million people) of older Canadians were living with two or more chronic conditions. Over one in six older Canadians (about 1.1 million people) reported having a disability.

Having multiple chronic conditions or a disability is associated with both specialist care use and greater difficulty accessing specialist care among middle-aged and older adults. Experiencing difficulties accessing specialist care is strongly associated with a higher likelihood of having unmet health care needs among middle-aged adults (6.2 times higher) and older adults (14.0 times higher) than those who do not experience difficulties accessing specialist care.

In 2024, almost 4 in 10 Canadians aged 45 or older (about 6.6 million people) used specialist care for an initial consultation in the past 12 months. Use was higher among older adults (42.9%) than middle-aged adults (35.1%), even after adjusting for demographic, socioeconomic, geographic and health-related factors.

Among middle-aged adults, women (37.7%) were more likely to use specialist care than men (32.5%), whereas among older adults, women were less likely to do so. 

People with a primary health care provider were more likely than those without one to see a specialist, and this difference remained significant for middle-aged adults (1.6 times higher) and older adults (1.3 times higher).

In 2024, primary health care providers were the most common source of referral for initial consultations with a medical specialist, followed by another specialist and then another health professional, for both age groups. 

Almost all (90.0%) middle-aged and older adults consulted a medical specialist in person. 

The most common reasons for the initial consultation with a medical specialist included a heart condition or stroke, cancer, a skin condition, a urological or gynecological condition, and an orthopaedic condition. 

About two-thirds of middle-aged adults and older adults waited less than three months between the referral and the initial consultation with a medical specialist. 

Older adults were more likely to be satisfied with the wait time and less likely to be affected by the wait time. 

For most middle-aged and older adults, the effect of the wait time was worry, anxiety or stress.

In 2024, 27.8% of Canadians aged 45 or older—about 4.5 million people—reported experiencing difficulty in accessing specialist care for an initial consultation. 

Older adults (24.6%) were less likely to experience difficulty than middle-aged adults (30.2%). 

Among middle-aged adults, a higher percentage of women (33.4%) than men (26.9%) experienced difficulty. 

The top two difficulties experienced in accessing specialist care among middle-aged and older adults were difficulty getting an appointment and waiting too long between booking an appointment and the visit. Older adults were more likely than middle-aged adults to experience appointment cancellation or deferral, whereas middle-aged adults were more likely to report experiencing difficulty getting an appointment or obtaining a referral. 

Both middle-aged and older adults used various coping strategies to manage these difficulties, such as seeking medical care from a different health care professional or location (19.7% of middle-aged adults compared with 17.7% of older adults), increasing the use of over-the-counter drugs (20.1% compared with 17.3%), seeking medical information through the Internet (29.2% compared with 19.9%) and seeking advice or care from family or friends (20.1% compared with 16.9%).

In 2024, 18.0% of Canadians aged 45 or older (2.9 million people) reported having unmet health care needs (20.7% among middle-aged adults and 14.2% among older adults). 

Among middle-aged adults, unmet health care needs were more likely for those who experienced difficulty accessing primary health care only (23.6%), specialist care only (27.3%) or both (54.4%) than for those reporting no difficulty. This pattern of unmet health care needs was similar among older adults.