UPDATE – Poor health system planning often to blame for unemployed docs

May 7, 2019 | Author: Royal College Staff
1 MIN READ

An updated report has been released (December 2019). It includes revised 2017 and new 2018 data collected for the Employment Study longitudinal surveys. Changes to the 2017 revised data are outlined in greater detail in the appendix to the report.

For some medical specialists, it feels like everything is working against them in their search for employment:

  • the job market is highly competitive,
  • too many late-career physicians aren’t ready (or willing) to retire,
  • hospitals/care centres don’t have funding for more resources, and
  • the job listings that exist are extremely difficult to access.

But are these individual hurdles actually symptoms of larger failings in the health care system? New data suggests that may be the case.

Employment Study report cover

Study highlights Canada’s shortcomings in workforce and health care planning

On May 1, 2019, the Royal College of Physicians and Surgeons of Canada released new findings from its employment study. This is the highly anticipated follow-up to their 2013 report that alerted the country to the employment challenges faced by many new specialists.

Since the Royal College began gathering employment data in 2011, between 11 and 18 per cent of new specialists have reported problems securing a job right after they have been certified. The latest study findings show that these challenges are in large part a by-product of shortcomings in workforce and health care planning.

As one recently certified otolaryngologist said,

“There are very few, if any, jobs in Otolaryngology at the present time. This is despite the fact that we graduate over 30 new otolaryngologists per year. The hospitals and potential employers currently have the upper hand as there are many applicants for few jobs.”

While workforce planning is currently focused on aligning physician supply with the health care needs of society, it is missing a number of important elements. These include, for example, the link between practice resources (including personnel and infrastructure) and employability. Other factors also come into play when looking at employment patterns, like family obligations and access to/ transparency of job postings.

Read more findings in the Royal College Employment Study (Updated Dec. 2019)



Note:

  • The title of this article has been amended to enhance clarity (May 9, 2019)
  • This article originally reported that between 14 and 19 per cent of new specialists reported problems securing a job right after certification. This data has been corrected to 11 and 18 per cent. A new version of this report replaces the version that was posted in May 2019 (December 12, 2019)

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Frederick Matzinger | June 25, 2019
Aligning physician supply with health care needs of society is a responsibility that must be shared by the deans of Post Graduate training at all medical schools.Ultimately the deans decide the allocation of residency training positions among family medicine and other specialty residencies.What oversight is there for their allocation of training positions to verify that they are committed to workforce planning? How are the post graduate deans addressing the undersupply of specialists in areas such as psychiatry, rheumatology, dermatology, etc.
John Malcolm | June 8, 2019
Hello Royal College Many provinces in Canada like Ontario is loosing several anesthesia specialists jobs to Family doctors ( who are trained for 10 months excluding weekends ) in anesthesia and working totally unsupervised, putting patients at risk. The domino effect of this practise is that these family doctors give up their family practise to become full time FPA when several thousand Canadians have no family doctor to look after them. No other western countries except Canada allow this practise of letting unqualified ( in anesthesia ) , extremely limited trained ( 10 months at the most ) , totally unsupervised Family doctors providing anesthesia. Hope the Royal College would stand up and root out this practise and protect the patients . The very least provide additional training of another 2-3 years and provide credentialing exams to this group of physicians who are totally working under the radar with little oversight. Also stop allowing these physicians to provide full time anesthesia and insist that they provide family practice service.
Rajn Vashisht | June 5, 2019
Reports of long waiting list to see a specialists. Long list of Medicine Specialist from India waiting approval to practice. If Long experience has no scope in Canada health system how it can run without doctors. It is purely imagination that experienced doctors from OUTSIDE CANADA ( IMG) are best tested by MCCQE. MCCQE is for just passouts and after getting specialisation degree and long practice how a specialist can think of preparing basic subjects again after 10-15 years. Practice can be assessed by allowing them supervised and grading them accordingly without MCCQE it will be more rewarding and practical.
Karina Caicedo | May 27, 2019
I am a pathologist and i have difficulties in getting jobs in Canada. Also, my husband is a pathologist. Now, we are leaving Canada to the USA since my husband is going to star more training. But it is not easy, because I am an IMG I have to do the America Boards or USLME. fortunately my husband did those exams (took 2 years to pass them). My greatest hope is to get to do the same process my husband did and get a job in the land where the sky is the limit. I think Canada is wasting resources training people that them have to leave, and killing hopes. As an IMG, I will recommend other IMGs to don’t go for specialty since Canada market is a like the waves in the ocean. Next time when a report like this is elaborated please include pathology and indicate the amount of education a pathologist has to do in order to get a job. Also, that American trained IMGs are preferred over the Canadian IMGs because they have something that we don’t have in Canada certified fellowship programs in Canada. Basically, Canadian fellowships are a joke.
Ian Woolfson | May 11, 2019
Frankly I think it is appalling that so many of our older specialists won't step down (at least 'slow down') to allow younger doctors join the workforce. In my hospital two of us did this so we could bring a young surgeon in. We have a GI physician who is 73 and needs money! Doctors need to save more and spend less so they can slow down or retire earlier. I enjoy walking through our doctors parking lot everyday so I can see the expensive, new, flashy cars the doctors are wasting their money on. Perhaps if the specialists were a bit more careful with their $$ they would be able to bring younger people in sooner. Specialists are too protective of their domain. Lack of operating time and endoscopy time can make it a bit hard to bring in a new surgeon, but the benefits to all (including the patients) outweighs the drop in salary. And their is othe rwork that you can do(Medical legal/ college/ assisting etc). I see this nonsense happening to a well trained family member who is presently doing a locum while she struggles to find a permanent job. Unfortunately she does not want to go to the USA where she would have a great job tomorrow if she wanted.
Jerry McGrath | May 10, 2019
Many of the people finishing up as specialists and subspecialists are looking for jobs in large urban areas. We have openings for three Gastroenterologists in Newfoundland. There hasn't been any inquiries. There are jobs out there but not many in the GTA/905 area code or lower mainland!
JOHN GOLBERG | May 10, 2019
Some things never change. As an orthopaedic specialist leaving training a few years back (1979) I was hoping for a community hospital position almost anywhere in Canada. Unless you had a personal connection (old boys network), there was no way to know what communities had the need and the resources. At the same time, recruiters from south of 49 were calling daily. I did not have the resources to wait; I had an instant job waiting in the U.S...I have no regrets but I am sad that after all the" brain drain" this has not been resolved.
John LeBlanc | May 10, 2019
As one recently certified otolaryngologist said, “There are very few, if any, jobs in Otolaryngology at the present time. This is despite the fact that we graduate over 30 new otolaryngologists per year. The hospitals and potential employers currently have the upper hand as there are many applicants for few jobs.” Our regional hospital is actively searching for interested qualified candidates to fill at least 2 positions to re-boot what was once a thriving service. Basically a turn-key operation, established patient base, provincial referral centre for cochlear implants, in a hospital undergoing a major expansion and in an area known for its great quality of life; the only drawback (not to us) is that we're not in a major urban center.....
Scott murray | May 10, 2019
This dialogue is long overdue..........So many elephants in the room !...............Echo and support the comments of Scott Cameron..........
Tim Max | May 9, 2019
Too many older physicians hanging on who are long past their "best before" date and too many chiefs of department/staff who don't feel the need to offer full-time positions to new grads when they could just offer them locum positions and jerk said new grads around as they see fit when it comes time for renewal since they are banking on the idea that these new grads really have nowhere else to go for jobs. That said, new grads need to realize that they are valuable and have a great deal to offer any staff that they join and have some respect for themselves- if they feel that they are getting jerked around, then they need to go somewhere that will appreciate them, which, unfortunately, may not be the major centre that they have their heart set on. There is some to be given from both sides, but I agree with the ENT quoted in the original article who said that the hospitals and potential employers ultimately own the upper hand. The more flexible that new grads can be, the better, but that said, have respect for yourselves. Not every backwater community that happens to have a hospital warrants having a specialist for every service on its staff.
William Canham | May 9, 2019
For what this comment is worth. Perhaps little...probably never to be read. Residents are very cheap labor for the Canadian Government health system. The senior docs want this inexpensive labor as they can do more cases and consults and get wealthy. Senior docs are in a position to exploit their younger colleagues and get wealthy. Canada is mostly fee for service so residents are essential. Perhaps the system is corrupt. They (The senior docs) don't seem to have an interest if after years of brutal exploitative work these young people (residents) are not employable ... these youth are just expendable. Young Canadians will pick up on this and the profession will not attract highly motivated and smart students. Corruption never ends well. Canada also needs to be concerned as waiting lists get long and service is restricted .......deeper corruption then occurs. On one and only one occasion a wealthy patient told me if I got his case expedited quickly, One of my children's bank accounts( if I provided the number) would have money deposited in that account. I told him I could not do that. However; that is how corruption works throughout the world. The College needs to guard against this. That form of corruption is everyday practice in Ukraine today and perhaps in other jurisdictions also, I will never forget getting up one morning (25 years ago) and while shaving to get ready for work the Premier of Nova Scotia came on the CBC and said the most a Nova Scotia doctor could do for the province of my birth was to leave. Doctors, he said, provided little to the province. I took his advice and moved to the USA and it was the best advice I was ever given. I went to the US where I was welcomed and appreciated. I practiced there for 25 years doing surgery at a level NS would never have supported. Great hospitals and state of the art equipment. Nobody ever sued me or even tried.... an issue Canadian docs often fear. It is not easy to get to the US now so Canadian residents now I understand are just ejected from the system. They after years of exploitation are unemployed. The college should resist this corrupt exploitation of the young. Sad ...... by any ethical standard. William Canham MD FRCS(C) Retired Fellow; FACS (Retired Fellow) and ( former president of my state Surgical Society); FAAOS(Retired Fellow); Former President of the Nova Scotia Medical Society. Happily retired in the US with three well-employed sons .... practicing Orthopedic surgeons and a daughter comfortably employed as an Internist at the Mayo Clinic. Corruption is always endemic but you must always fight it. My view for what is worth. An old man that perhaps has some insight but you can always disagree and perhaps I am wrong. I truly hope I am wrong as I do love Canada. However; be on guard for thee.
Peter Thornback | May 9, 2019
Part of the problem, if not the whole, relates to practice location. Far too many physicians want to hang around major centres where there may already be an oversupply and, therefore, a shortage of available positions or OR time. The NHS got it right when determining distribution of physician/surgeon resources. One may only apply to areas where there is a need. The same should apply in Canada, methinks.There are underserviced communities crying out for physicians, principally in the northern regions. We are, after all, public servants, paid for by the taxpayer and owe it them to provide service where necessary. Would it not be reasonable to insist upon a similar system to the UK’s whereby new physicians could practise only where there are insufficiencies? Would not this help solve the shortages where they exist and provide employment for those struggling to find opportunity? Having practised in North Bay for several years I found the experience highly rewarding. There are inducements. That’s my observation, anyway! Peter Thornback, MBBS, FRCPC, retired consulting paediatrician
mo ali | May 9, 2019
there are many factors, but we should focus on the most important factor, 1- communucation between the demand which is the real health service Data(not the expected retirees) and the supply which is the medical school. once we accept extra students, we make the problem worse where these student could have secure their future in different carreer away from health service. 2- limit the number of certain service residency program to match tese services demands 3- Jop protection, recrutment should be controled by the physician group of the service not by their cheif, also posting should be transperant and enough time and should be mandated that it has to be posted for at least 2months on the cpso web sit before any interviw offered
Aaron Johnson | May 9, 2019
"The latest study findings show that these challenges are in large part a by-product of shortcomings in workforce and health care planning." Maldistribution of specialists has more to do with poor planning by Canada's health care authorities than by the specialists themselves. The howling about the retirement tsunami composed of the previous generation of specialists has not yet come to pass, but it eventually will, while the Canadian population grows larger and many rural and First Nations communities go without specialty care. In the meantime many overworked specialists will continue to defend their brief patient encounters, inadequate followup care and delayed consultations ...as well as their income by convincing health authorities that additional specialists aren't needed...as Canadians wait weeks to months for a specialist referral. Limiting opportunities for MDs outside of the public system is also contributing to unreasonable wait times and pushing patients to see family docs ill equipped to provide specialty care.
Teong lam gooi | May 9, 2019
I wish to have more Info , all the medical and surgical specialties and sub-specialties with respect to employment, not just a select sample. Who do I contact
Scott Cameron | May 9, 2019
It seems like the problem is very slowly being studied, and there are no guides for how to fix this issue. This is a system problem, not a 'you picked to train in the wrong field' problem. I think what really needs to happen with the system is a simple standard policy: you don't get to train a Canadian graduate in your field unless you can show there is a job for them at your center (meaning you have to have an advertised job opening in the province before you can train a surgeon, specialist or sub-specialist), or you (in writing) guarantee there will be one that is posted (that they can compete for). Funneling graduated medical students into specialties, or graduated residents into subspecialties when there is almost no hope for a job is irresponsible, and wastes the investment the provinces have put into training physicians. This policy will instantly make the surgical specialties short of residents and fellows for in hospital tertiary care center work. The training hospitals will then need more staff to cover the same work load, because the staff surgeons or specialists won't be able to function without the indentured labour of a trainee. This will result in more staff hires, and less dependence on trainee labour. This will break the conflict of interest that these specialties face when they take on trainees: " I know we won't be able to give you a job, but we really need your help in hospital to run our service, so please train here!" Most importantly, this strategy would funnel many more applicants towards family medicine, where they are needed, rather than highly competitive sub-specialties where they are not. To those that argue this should be a free market- that is reasonable only if our education expenses are entirely paid by us. Instead our training is mostly provincially funded. Lets stop wasting money training people who don't have a general licence. Some of the shortage of family physicians across the country can be traced to the loss of the rotating internship year, which resulted in a much-too-early pressure on medical students to choose their rotations so they could apply for the specialty they thought they wanted. How many unemployed specialists or surgeons right now would go back and do it differently if they knew they couldn't find a job, or wished they could get a general licence? Did their training programs during medical school rotation electives make medical students sign an agreement that stated that the job situation in the field across Canada, and % of grads from their program in the last year were not employed in their specialty before they were allowed to arrange electives? That would be the responsible thing to do. In fact, this discussion (about workforce needs) should be a mandatory part of med-school training, BEFORE medical students need to arrange electives. If rules about offering a spot to train only if there is a job are not employed, then all physicians in Canada should still first obtain a general licence, so at least if there are no jobs in their chosen field that can still pay off their debt, be employed, and find some job satisfaction in medicine. Lets not blame the unemployed newly graduated specialists who where following a dream career. Lets blame the program directors and mentors that facilitated training people in unemployable disciplines, and a system that has taken away the general practitioner's licence, while not guaranteeing unmatched medical graduates training in a family medicine program. None of these actions help ensure well trained physicians can practice as GP's or family physicians if other opportunities don't work out.
Ioana Bratu | May 9, 2019
New US study predicts there will be a major shortage of generalists and specialists for 2032 ... Canadian waitlists are getting longer ... Are there really too many physicians in Canada? Are the findings of unemployed physicians in Canada a symptom of a chronic illness with our healthcare delivery/planning?
Sherif Shams | May 9, 2019
Cut down on medical school admissions , otherwise Docs. will be like lawyers !!
Rosemary Lubynski | May 9, 2019
The hospital in Sarnia that I work in has been trying to recruit 2 ENT surgeons with no success. Possibly at least some of the problem is no jobs in the "right" areas.
Harry Hogan | May 9, 2019
Central planning is ultimately a fool's errand. Physician training should operate on free market principles.
Frank Finkelstein | May 9, 2019
If you have to wait a month or 6 months for a procedure, or a month for an appointment, by whose standards are we overdoctored?
Frank Finkelstein | May 9, 2019
Blaming the victims.