Data tells the story: Canada’s medical workforce is changing

Andrew Padmos
December 7, 2016 | Author: Dr. Andrew Padmos
4 MIN READ

Dear colleagues,

We’ve heard repeated calls to produce a physician workforce that has the right number, mix and distribution of specialists to meet the needs of Canadians. But, until recently, little had been done to integrate all available data in one place to help us understand what the medical workforce looks like today, how it’s shifting and how it’s likely to look in the future.

That’s why I’m so pleased to announce that our Medical Workforce Knowledgebase (MWK)© is now available for viewing on our website.

Knowledgebase brings key workforce indicators together

The MWK is the result of an intensive effort by the Royal College. Still in its early stages, it helps piece together a complex puzzle by providing a high-level snapshot of what’s happening with Canada’s physician workforce. It unites fragmented medical workforce data from five key sources yielding several indicators of physician supply, including

  1. the number of residency positions,
  2. the number of physicians entering residency training,
  3. data on newly-certified specialists,
  4. supply data, and
  5. age data.

Taken together, these indicators provide snapshots over five years of the state of the Canadian physician workforce supply chain across 31 entry-level specialties.

Fascinating finds: early data from the MWK

  • Overall, physician supply is increasing. For example, the MWK says that Psychiatry has seen a 19 per cent increase in the number of residency positions, a 13 per cent increase in the number of entry level trainees, and an 11 per cent increase in the size of the active Psychiatrist workforce.
  • At the same time, the MWK tells us that 16 of 30 medical, surgical and lab specialties show signs of a decreasing workforce, and the total number of surgical residency positions and new trainees has sizably decreased since 2010. As one specific example, the number of Orthopedic Surgery residency positions has declined 23 per cent since 2013 and the number of first year General Surgery trainees has gone down 21 per cent since 2010. Meanwhile, almost one in five surgeons were aged 65 or older in 2014.

This data signals change for Canada’s medical workforce. A decrease in surgical trainees coupled with a relatively older workforce foreshadows fewer surgical specialists in the future. This information has clear implications for young physicians planning their careers. It also holds value for medical schools and governments who grapple with issues of funding while ensuring sufficient training spots to meet future demand for specialists.

Building on the work of others

The MWK builds on the work of many other organizations and initiatives. It integrates key data elements from authoritative data sources, including

  • the Canadian Institute for Health Information (CIHI),
  • the Canadian Post-M.D. Education Registry (CAPER),
  • the Canadian Resident Matching Service (CaRMS),
  • the College of Family Physicians of Canada (CFPC) and
  • the Royal College itself.

It was developed to complement the important statistical information published by these and other organizations, like the Canadian Medical Association. A number of jurisdictions have also independently developed sophisticated needs-based models that produce future physician workforce scenarios. The Physician Resource Planning Advisory Committee is escalating these efforts to the pan-Canadian level. By looking back at recent physician workforce supply trends, and focusing on a subset of key indicators, the MWK aims to provide a complementary data resource that can be readily accessed by all data users.

Please share this new tool within your networks (+ quick links)

I would like the MWK to be seen as widely as possible and I urge you to view it yourself. To date, we have presented the MWK to our Regional Advisory Committees, introduced it in writing to the National Specialty Societies and made the data available publicly. When you visit our website, you’ll find a medical workforce supply overview that highlights physician workforce changes that cut across the four data snapshots. You can also find separate highlight sections for residency positions, PGY1 trainees, newly certified specialists and the practising physician population. At the bottom of each section you can download the data, which feature colour-coded charts that identify increasing and decreasing supply trends.

Next steps: Our plans to expand and evolve this tool

The MWK is a considerable undertaking and we’re just getting started. As a next step, we will deepen our understanding of medical workforce issues by partnering with experts who can tell us a more fulsome story of the realities and forces acting within their medical communities. Already, experts in Internal Medicine have worked closely with us to produce charts that they will present at their annual meeting. Subspecialties like the Canadian Geriatric Medical Society have also expressed interest in working with us on the data that pertain to their areas of expertise.

As we expand this important new tool, we will continue to work with our partners to find new data sources. For example, we intend to include subspecialty data, and province and faculty-level views in a future iteration of the MWK. We also have a firm plan to keep the existing data current. Typically, data from our five sources becomes available in the fall of each year, and we will be diligent on updating the MWK accordingly.

I invite you to examine the MWK and see what information it yields for your professional situation and future goals. I also welcome your general feedback or suggestions for ways we can improve upon this first offering.

Sincerely,

Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer

 

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Avatar Shalini | January 6, 2017
Dr. Andrew Padmos I would like to ask you why medical graduates who do a residency in the United States are so unfairly treated in almost every policy that RCPSC, Health Canada, etc. makes. Getting residency and fellowship slots are equally tough in the United States for international medical graduates as in Canada. Moreover, unlike Canada, residency/fellowship spots in the US are open to everyone in the world and not just American citizens. There must be some reason that United States is doing that through various programs such as J1 Physician Exchange program, H1B etc. I will give you an example, United States trains outsiders on j1 visa but then US gives them backdoor through waivers like NIW and hardly anyone goes back. My husband is doing his fellowship in one of the world's renowned institution and they will file his green card through EB1 category. He wanted to work in Canada but was heartbroken by Canadian system's unfairness towards him.
Avatar Royal College Fellow hanging out in Starbucks on a Monday afternoon | January 23, 2017
That's interesting. Some fields, and I won't name them, give their practitioners ample opportunity to practice in Canada despite training in the USA, and despite their residencies being deficient in many so-called "core compentencies" that the Royal College is eager to emphasize for us Canucks. This is one of the reasons why some graduates in this field that I won't name have difficulty finding employment, even in remote centers.
Avatar Ian Slayter | December 7, 2016
Hi Andrew, regarding the psychiatry numbers, I agree that the supply is increasing. However, one also needs to look at where the numbers are increasing and how the numbers break down between general and subspecialist psychiatrists. What I see happening in Nova Scotia is that we are training more psychiatrists almost all of whom stay in urban settings and at least half of whom go on to subspecialty fellowships. Rural Nova Scotia is losing psychiatrists and seldom gets new graduates. We are seeing geographic maldistribution and, I think, a coming shortage of generalists. I suspect that current university training overemphasizes academic aspirations ( I am not criticizing high standards of clinical knowledge and skills but the focus on learning to teach and do research, and on practising in a university setting which then require subspecialization). Ian Slayter Antigonish, NS
Avatar Dr. Andrew Padmos | December 14, 2016
Hi Ian, You raise a good point. The College is actually finalizing a Generalism Project that I hope I’ll be able to share more about in 2017. As you point out, it is important to have a balance. Right now, the MWK only covers our 31 primary specialties not yet subspecialty data, but that is part of our longer-term strategy (in fact, we expect to have that data included by next spring). Once we have that data, we’ll be able to tease out the balance of general to subspecialist psychiatrists (and other specialists) which I agree is important data. I’m hopeful that the information generated from this tool will help us all make informed decisions that will improve effectiveness, including the distribution of physicians (geographically and by discipline) and ultimately patient care. This release is a step forward, but there’s more work yet to be done. – Andrew Padmos, CEO