Poor health system planning often to blame for unemployed docs

Royal College Staff
May 7, 2019 | Author: Royal College Staff

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 14 and 19 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

Note: The title of this article has been amended to enhance clarity (May 9)

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Avatar 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
Avatar 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
Avatar 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.
Avatar 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
Avatar 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.
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