Employment opportunities of specialties

[strawberryjams]

Hi everyone I am trying to understand the job opportunities for different specialties in Canada. Jobs are not the only criteria for choosing a specialty. It is still one of the most important points influencing my decision.

Questions:

1) What specialties in Canada are recognized in USA and make it easier to find jobs south of the border? As far as I know, Canadian residencies are considered equivalent to US training. (Are there lots of hurdles to move south)

2) Is it true that surgical specialties in Canada have very little jobs because of limited funding in the public system? (Neurosurgery, ENT, Cardiac surgery etc)

3) For specialties like plastic surgery, Cardiac surgery and Orthopaedic surgery, is it best to just rule them out because no jobs are available in Canada? Or should one still shadow to see if they are interested in them with the goal of moving to USA for jobs (if the residency training is considered equivalent). 

4) The general consensus is that family medicine has most jobs (is FM getting saturated in cities?),

5) How is the job market for Internal medicine and emergency medicine (fm+1). Internal medicine has many subspecialties (so I am curious whether job market changes based on the subspecialty one pursues?).

6) Lastly, general surgery seems to have jobs in rural areas. Anesthesiology has great job opportunities. Is this true?

What are some specialties that are worth exploring? 

[ZBL]

The rule of thumb for going to the US is that the years of residency training needs to match. This means for any Canadian residency other than FM, it is allowable in the US (FM needs an extra year of training to go to the US). USMLEs and Visa’s are a separate issue which I won’t get into. 

 

Ot is hard to nail down exactly what is in demand and what isn’t as there’s some regional variation, but here are my thoughts from my experience and discussions with staff and classmates:

 

Surgical specialties are are very difficult to find jobs in Canada. The worst are CV, neuro and ortho - you are basically required to have 2 fellowships +/- grad school and even then there is absolutely no guarantees on where or if you work. Many orthos are forced to the US and I think neuro is to some extent as well. CV sucks everywhere.

 

For plastics fellowship is required. There are jobs, but you can’t just pick a city - you go where the job is. Starting a cosmetics practice is very challenging for plastics. 

 

Not sure where vascular fits  

 

For Urology, gen surg, ENT and for sure ophtho, I think job opportunities are better but I don’t know enough to say for sure or to what extent. 

 

Pretty sure obgyn can work wherever they want  

 

For non-surgical specialties, ones with a heavy procedure focus are tough for jobs. This includes GI, interventional cardiology. 

 

Things like ICU, resp, nephro, heme have jobs available, but not as easy to pick your practice spot. Some easier than others.

 

Things with the most job flexibility in terms of location are rheumatology, Endo, derm, FM, geriatrics - outpatient things. EM also probably has reasonable flexibility.

 

For the lab/imaging based specialties, and other rare things like genetics, I have no idea. 

 

EDIT: forgot psychiatry and anesthesia. These are also good for jobs in my experience. 

[GrouchoMarx]

1. Most all but in terms of pathology, basically only gp is recognized in the USA. Most practices require that the pathologist to be able to run the clinical lab in addition to doing anatomical pathology duties. It's not like that in Canada. However, our Royal College pass rate for General pathology is very low, so entering General pathology is risky.

 

2. True.

 

3. I can't speak for cardiac, but Plastics and Ortho I think are equivalent. If this is what you like to do then going in with that mindset is appropriate, but there are more important considerations about the nature of the work than the job market. all of those residencies are brutal.

 

4. That's true, and your second point is as well.

 

5. It depends on the subspecialty for internal. For instance Nephrology has a very poor job market because the Old Guard does not want to relinquish their positions in dialysis centers. Or as the FM plus one for emergency medicine is very flexible aside from some academic emergency medicine departments. I recall there being FM plus ones working at St Michaels in Toronto, but that might not be the case now.

 

6. I don't know how to answer these ones.

 

You should explore Psychiatry, Dermatology, Radiology, anesthesiology, and Ophthalmology. If I had my day over again I would do that. I'm sad I can't recommend pathology because of the current state of the job market and political situation in the field.

[jumbocup]

6 minutes ago, GrouchoMarx said:

1. Most all but in terms of pathology, basically only gp is recognized in the USA. Most practices require that the pathologist to be able to run the clinical lab in addition to doing anatomical pathology duties. It's not like that in Canada. However, our Royal College pass rate for General pathology is very low, so entering General pathology is risky.

2. True.

3. I can't speak for cardiac, but Plastics and Ortho I think are equivalent. If this is what you like to do then going in with that mindset is appropriate, but there are more important considerations about the nature of the work than the job market. all of those residencies are brutal.

4. That's true, and your second point is as well.

5. It depends on the subspecialty for internal. For instance Nephrology has a very poor job market because the Old Guard does not want to relinquish their positions in dialysis centers. Or as the FM plus one for emergency medicine is very flexible aside from some academic emergency medicine departments. I recall there being FM plus ones working at St Michaels in Toronto, but that might not be the case now.

6. I don't know how to answer these ones.

You should explore Psychiatry, Dermatology, Radiology, anesthesiology, and Ophthalmology. If I had my day over again I would do that. I'm sad I can't recommend pathology because of the current state of the job market and political situation in the field.

Are you able to elaborate a bit on the part about pathology? Admittedly I know little about that field, but am interested in hearing about the political situation?

[strawberryjams]

14 minutes ago, GrouchoMarx said:

1. Most all but in terms of pathology, basically only gp is recognized in the USA. Most practices require that the pathologist to be able to run the clinical lab in addition to doing anatomical pathology duties. It's not like that in Canada. However, our Royal College pass rate for General pathology is very low, so entering General pathology is risky.

 

2. True.

 

3. I can't speak for cardiac, but Plastics and Ortho I think are equivalent. If this is what you like to do then going in with that mindset is appropriate, but there are more important considerations about the nature of the work than the job market. all of those residencies are brutal.

 

4. That's true, and your second point is as well.

 

5. It depends on the subspecialty for internal. For instance Nephrology has a very poor job market because the Old Guard does not want to relinquish their positions in dialysis centers. Or as the FM plus one for emergency medicine is very flexible aside from some academic emergency medicine departments. I recall there being FM plus ones working at St Michaels in Toronto, but that might not be the case now.

 

6. I don't know how to answer these ones.

 

You should explore Psychiatry, Dermatology, Radiology, anesthesiology, and Ophthalmology. If I had my day over again I would do that. I'm sad I can't recommend pathology because of the current state of the job market and political situation in the field.

Thank you! That was helpful. So far I was considering orthopaedic surgery, general surgery and ophthalmology for surgical specialties. Opthalmology is very hard to match so I was leaning towards orthopaedic surgery with the goal of going to USA. I also wanted to rotate in FM because it seems like the best specialty in Canada arguably because of lifestyle, jobs and also opportunity to add + 1

[strawberryjams]

18 minutes ago, ZBL said:

The rule of thumb for going to the US is that the years of residency training needs to match. This means for any Canadian residency other than FM, it is allowable in the US (FM needs an extra year of training to go to the US). USMLEs and Visa’s are a separate issue which I won’t get into. 

 

Ot is hard to nail down exactly what is in demand and what isn’t as there’s some regional variation, but here are my thoughts from my experience and discussions with staff and classmates:

 

Surgical specialties are are very difficult to find jobs in Canada. The worst are CV, neuro and ortho - you are basically required to have 2 fellowships +/- grad school and even then there is absolutely no guarantees on where or if you work. Many orthos are forced to the US and I think neuro is to some extent as well. CV sucks everywhere.

 

For plastics fellowship is required. There are jobs, but you can’t just pick a city - you go where the job is. Starting a cosmetics practice is very challenging for plastics. 

 

Not sure where vascular fits  

 

For Urology, gen surg, ENT and for sure ophtho, I think job opportunities are better but I don’t know enough to say for sure or to what extent. 

 

Pretty sure obgyn can work wherever they want  

 

For non-surgical specialties, ones with a heavy procedure focus are tough for jobs. This includes GI, interventional cardiology. 

 

Things like ICU, resp, nephro, heme have jobs available, but not as easy to pick your practice spot. Some easier than others.

 

Things with the most job flexibility in terms of location are rheumatology, Endo, derm, FM, geriatrics - outpatient things. EM also probably has reasonable flexibility.

 

For the lab/imaging based specialties, and other rare things like genetics, I have no idea. 

 

EDIT: forgot psychiatry and anesthesia. These are also good for jobs in my experience. 

Thank you! I was wondering why anesthesia has good job opportunities. I ask because isnt anesthesia also resource intensive specialty? What difference exists between that and surgery, I mean both need resources.

[ZBL]

6 minutes ago, strawberryjams said:

Thank you! I was wondering why anesthesia has good job opportunities. I ask because isnt anesthesia also resource intensive specialty? What difference exists between that and surgery, I mean both need resources.

Anesthesia is shift work. They clock in and out then someone takes over, unlike surgery where you have a lone surgeon plowing through 18 hours of work. 

[strawberryjams]

1 minute ago, ZBL said:

Anesthesia is shift work. They clock in and out then someone takes over, unlike surgery where you have a lone surgeon plowing through 18 hours of work. 

oh I see. Does that mean there is poor lifestyle? I think emergency is also shift work right?

[ZBL]

6 minutes ago, strawberryjams said:

oh I see. Does that mean there is poor lifestyle? I think emergency is also shift work right?

Poor lifestyle is in the eye of the beholder. For EM and anesthesia, yes it’s shift work but usually that’s at the trade of fewer overall hours per week. For some people, that’s preferred over 65 hours M-F. For others, like myself, I’d rather work longer hours overall by day than do shifts.

Anesthesia is more slack for shifts than EM though - you need a few EMs available at 3am whereas you don’t need many anesthesiologists at that time. Same deal for weekends (where ORs are closed except for on call cases). So between the two, anesthesia is probably the better lifestyle from a shift work perspective (usually less busy and usually fewer evening/weekend shifts) - all irrelevant if you don’t enjoy the content though. 

[Rahvin13]

3 hours ago, ninja7292 said:

Is there worry about midlevel-creep from CRNAs in the field of anesthesia in Canada?

CRNA is not a thing in Canada. There are a handful of NPs with an “Anesthesia” specialization but it’s not the same thing at all.

[Edict]

11 hours ago, strawberryjams said:

Hi everyone I am trying to understand the job opportunities for different specialties in Canada. Jobs are not the only criteria for choosing a specialty. It is still one of the most important points influencing my decision.

Questions:

1) What specialties in Canada are recognized in USA and make it easier to find jobs south of the border? As far as I know, Canadian residencies are considered equivalent to US training. (Are there lots of hurdles to move south)

2) Is it true that surgical specialties in Canada have very little jobs because of limited funding in the public system? (Neurosurgery, ENT, Cardiac surgery etc)

3) For specialties like plastic surgery, Cardiac surgery and Orthopaedic surgery, is it best to just rule them out because no jobs are available in Canada? Or should one still shadow to see if they are interested in them with the goal of moving to USA for jobs (if the residency training is considered equivalent). 

4) The general consensus is that family medicine has most jobs (is FM getting saturated in cities?),

5) How is the job market for Internal medicine and emergency medicine (fm+1). Internal medicine has many subspecialties (so I am curious whether job market changes based on the subspecialty one pursues?).

6) Lastly, general surgery seems to have jobs in rural areas. Anesthesiology has great job opportunities. Is this true?

What are some specialties that are worth exploring? 

I wouldn't let job prospects rule you out of any specialties this early on in the game. Explore specialites based on your interest first because job prospects will change for every specialty between now and the time you actually finish training. 

However, with that being said, if you are someone who knows they are not interested in doing graduate degrees or fellowships, there are a few specialties where these are likely the defacto requirement going forward (i.e. neurosurgery, cardiac surgery, sub-specialty general surgery, academic sub-specialty IM). Much of this is part job market but also partly due to increasing standards and evidence in surgery/medicine.

A lot of these job market discussions are much easier had once you know what you want. No one can predict the future on this forum, everything anyone will tell you is all hearsay and much of this information, by the time it trickles down to you, is years old, often rendering it obsolete. 

 

[NLengr]

ENT and urology are also tight on jobs. According to the last Royal College report anyway. 

Pretty much just assume that:

1. Any academic job will be hard to get

2. Any surgical job will be hard to get 

[GrouchoMarx]

On 6/21/2018 at 12:58 PM, jumbocup said:

Are you able to elaborate a bit on the part about pathology? Admittedly I know little about that field, but am interested in hearing about the political situation?

Pathologists are prohibited from billing OHIP. That's the crux of it.

[ArchEnemy]

13 hours ago, GrouchoMarx said:

Pathologists are prohibited from billing OHIP. That's the crux of it.

Would this apply to all pathologists? If this is the case, how do private labs like DynaCare or LifeLabs get paid?

[GrouchoMarx]

15 minutes ago, ArchEnemy said:

Would this apply to all pathologists? If this is the case, how do private labs like DynaCare or LifeLabs get paid?

It doesn't apply to them, but very few pathologists work at those labs. Most are hospital based. So for all intents and purposes, pathologists can't bill OHIP for their work.

[GrouchoMarx]

32 minutes ago, ninja7292 said:

So do they get paid a fixed salary? I notice that pathologists are the only medical specialty on the Sunshine List

Yes. This is almost always a disadvantage

[GrouchoMarx]

On 6/21/2018 at 4:50 PM, Rahvin13 said:

CRNA is not a thing in Canada. There are a handful of NPs with an “Anesthesia” specialization but it’s not the same thing at all.

AFAIK its still a requirement that one pt gets one anesthesiologist in Canada. In the USA its 4 nps on 4 pts to one anesthesiologist

[ArchEnemy]

2 hours ago, GrouchoMarx said:

It doesn't apply to them, but very few pathologists work at those labs. Most are hospital based. So for all intents and purposes, pathologists can't bill OHIP for their work.

What is stopping pathologists from joining these private labs? 

[GrouchoMarx]

57 minutes ago, ArchEnemy said:

What is stopping pathologists from joining these private labs? 

there are a very limited number of positions. those that have them never relinquish them.

[GrouchoMarx]

Here's an interesting story about pathologists wanting to get paid fair value, and health authorities balking at the idea.

 

http://publications.gov.sk.ca/documents/13/105162-Dr-Kirk-Ready-v-Saskatoon-RHA-August-3-2012.pdf

 

TLDR: SK had a massive backlog of cases. Dr Ready offered to work through the backlog if he could bill for them. The health authority refused to pay for it. Ready vindictively pointed out the head of the lab as a non-physician, which was against the books, and caused media scrutiny. Health authority fired Ready.

 

Here is a historical take on the dismantling of the Ontario laboratory sector in the nineties. 

 

https://ir.library.dc-uoit.ca/bitstream/10155/360/1/Bourne_Lavern.pdf

 

TLDR: govt prohibited billing away from pathologists in hospitals. tried it with radiology but they fought back hard and won. a few northern pathologists sued the government and won the verdict, but the government just started paying $0 for hospital based lab services. the northern pathologists, for whatever reason, ceased legally pursuing this (though i think that if they kept at it they would have been successful as $0 is not fair value for services). 

 

Here is the prospectus of the ontario association of pathologists 2018 annual general meeting:

 

https://ontariopathologists.org/ontario-pathologists/wp-content/uploads/2017/03/OAP-Program-Final.pdf

 

Note pathologist "workload", which means that there has been a 10% compounded increase in specimen volume (Aka patients seen) over the last decade, and an unmeasured but subjectively significant increase in complexity (receptor testing and other histologic features that were once only curiosities) without an increase in income or available positions. This is a big problem everywhere and nothing has been done to correct it in over 20 years. Our representatives have decided it is worth talking about for FIFTEEN MINUTES. Meanwhile the government organizations CCO and QMPLS have 2.5 hours devoted to their edicts where they come to pathologists and tell us what synoptic reports we have to fill out, and other such quality-metric bullshit. The specialty is not in control of itself.

 

Poor political situation = think twice.

[ArchEnemy]

1 hour ago, GrouchoMarx said:

Here's an interesting story about pathologists wanting to get paid fair value, and health authorities balking at the idea.

 

http://publications.gov.sk.ca/documents/13/105162-Dr-Kirk-Ready-v-Saskatoon-RHA-August-3-2012.pdf

 

TLDR: SK had a massive backlog of cases. Dr Ready offered to work through the backlog if he could bill for them. The health authority refused to pay for it. Ready vindictively pointed out the head of the lab as a non-physician, which was against the books, and caused media scrutiny. Health authority fired Ready.

 

Here is a historical take on the dismantling of the Ontario laboratory sector in the nineties. 

 

https://ir.library.dc-uoit.ca/bitstream/10155/360/1/Bourne_Lavern.pdf

 

TLDR: govt prohibited billing away from pathologists in hospitals. tried it with radiology but they fought back hard and won. a few northern pathologists sued the government and won the verdict, but the government just started paying $0 for hospital based lab services. the northern pathologists, for whatever reason, ceased legally pursuing this (though i think that if they kept at it they would have been successful as $0 is not fair value for services). 

  

Here is the prospectus of the ontario association of pathologists 2018 annual general meeting:

 

https://ontariopathologists.org/ontario-pathologists/wp-content/uploads/2017/03/OAP-Program-Final.pdf

 

Note pathologist "workload", which means that there has been a 10% compounded increase in specimen volume (Aka patients seen) over the last decade, and an unmeasured but subjectively significant increase in complexity (receptor testing and other histologic features that were once only curiosities) without an increase in income or available positions. This is a big problem everywhere and nothing has been done to correct it in over 20 years. Our representatives have decided it is worth talking about for FIFTEEN MINUTES. Meanwhile the government organizations CCO and QMPLS have 2.5 hours devoted to their edicts where they come to pathologists and tell us what synoptic reports we have to fill out, and other such quality-metric bullshit. The specialty is not in control of itself.

 

Poor political situation = think twice.

Thanks for the insight. I am surprised that Pathologists would not try to fight it off, much like Radiologists.