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[yonas]

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[IMislove]

Few years back, but I think they have more recent stuff.

[yonas]

Wondering if there is any changes now in 2019. Does it seem to be getting better or worse? 

[IMislove]

From what I’ve read in the surgery threads, you’ll still see the same sentiment that it’s bad for ortho. Best to ask residents and docs. Always hard to say how it’ll be in 10 years.

[yonas]

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[IMislove]

https://nationalpost.com/health/untrained-and-unemployed-medical-schools-churning-out-doctors-who-cant-find-residencies-and-full-time-positions?fbclid=IwAR1aWV4rFviDBmrY9ay0UMFtQaWewYxg-REI8xWILoWhlWgfyvQZAyfrUo8

Back in 2015, "A “whopping” 178 fully trained orthopedic surgeons in Canada are currently unemployed, says the Canadian Orthopedic Association.  "

I'm sure every year where graduates keep entering the work-force, that number is not dwindling down faster than it's increasing. Just like in any job market, when supply exceeds demand, and the supply doesn't drop substantially, you're going have an unemployed work-force in that field :(.

[insomnias]

Here's what I've wondered: why not just go to the US, where they're in demand? Certainly, there's a decent number who are stuck in Canada for personal reasons; however, I don't see why the unattached wouldn't just move south. Ortho here is PGY5; to qualify for the US boards it's 5 years, so...

[shematoma]

2 hours ago, insomnias said:

Here's what I've wondered: why not just go to the US, where they're in demand? Certainly, there's a decent number who are stuck in Canada for personal reasons; however, I don't see why the unattached wouldn't just move south. Ortho here is PGY5; to qualify for the US boards it's 5 years, so...

Ortho pays bank in the US too, so it really doesn't make sense why more don't move. I think there's a general reluctance these days for Canadians to head south (the president, general unfriendly climate towards immigrants, the USMLE). But if you're jobless most of those considerations should go out the window.

[NLengr]

Job market is shit. Will likely be shit for many years to come. You have dozens, if not hundreds of overqualified, underemployed ortho surgeons in the country. Then you will likely see the government reducing OR times and positions in the future (we can't afford our healthcare system anymore).

You should be prepared to:

1. Do at least 1 fellowship. Every ortho I know has done 2 in recent years.

2. Take ANY community job in the country, no matter how undesirable the location or the hospital itself is. Rural Newfoundland, Northern Ontario, Northern Alberta, Rural Saskatchewan? Terrible hospital admin, too much call, bullying coworkers? Family and friends nowhere near you? That's the type of job you have to prepare yourself for if you are determined to stay in Canada. You would be lucky to get a shit job.

3. Move to the US. Lots of jobs, you are in demand (aka probably will be treated well) and they pay well too. 

[peace2014]

7 hours ago, shematoma said:

Ortho pays bank in the US too, so it really doesn't make sense why more don't move. I think there's a general reluctance these days for Canadians to head south (the president, general unfriendly climate towards immigrants, the USMLE). But if you're jobless most of those considerations should go out the window.

That’s what I don’t understand... is there significant barrier preventing orthos from getting a job in the us?

[yonas]

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[JohnGrisham]

Not everyone is willing to move and leave their social networks. Many hope that if they do 1-2 fellowships they can eventually stay in their city of choice, or at least work their way back after 4-5years. Jumping ship to the US would help tremendously in the short-term, but wouldn't necessarily be helping them on that pathway to their desired city. 

[jlkhhylyiluh6]

6 hours ago, yonas said:

Exactly what I am wondering. What is the barrier stopping all these unemployed orthopods from moving to the US?

families, spouses (and their job/networks/etc), kids, community ties, social networks, political/social differences in the US...lots of people have a lot more important things in their life than their jobs.

[blah1234]

People's partners might also not be able to easily find work depending on their profession or visa status. Although geographic limitations due to your partner's profession also exist in Canada. 

[yonas]

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[Edict]

It seems like ortho is eligible for board certification in the US. So i don't see any issues with applying for US jobs. 

[Edict]

On 2/5/2019 at 1:38 AM, NLengr said:

Job market is shit. Will likely be shit for many years to come. You have dozens, if not hundreds of overqualified, underemployed ortho surgeons in the country. Then you will likely see the government reducing OR times and positions in the future (we can't afford our healthcare system anymore).

You should be prepared to:

1. Do at least 1 fellowship. Every ortho I know has done 2 in recent years.

2. Take ANY community job in the country, no matter how undesirable the location or the hospital itself is. Rural Newfoundland, Northern Ontario, Northern Alberta, Rural Saskatchewan? Terrible hospital admin, too much call, bullying coworkers? Family and friends nowhere near you? That's the type of job you have to prepare yourself for if you are determined to stay in Canada. You would be lucky to get a shit job.

3. Move to the US. Lots of jobs, you are in demand (aka probably will be treated well) and they pay well too. 

I've also seen an ortho who via CBME finished residency in 4 years, did one year of fellowship and got a community job in the GTA in the last few years, so i think there are jobs but i guess they will be given to the talented and good networkers. 

[NLengr]

48 minutes ago, Edict said:

I've also seen an ortho who via CBME finished residency in 4 years, did one year of fellowship and got a community job in the GTA in the last few years, so i think there are jobs but i guess they will be given to the talented and good networkers. 

Or just lucky. There is always some lucky person who the circumstances just work out for.

[blah1234]

1 hour ago, Edict said:

I've also seen an ortho who via CBME finished residency in 4 years, did one year of fellowship and got a community job in the GTA in the last few years, so i think there are jobs but i guess they will be given to the talented and good networkers. 

I wonder how much of that was skill and how much if that was luck. I think I personally wouldn't want to go into a field if I needed to outcompete or outnetwork a group of smart hardworking doctors to get a "good" job. 

I hope that's a sign things are getting better for Ortho though. 

[Edict]

2 hours ago, blah1234 said:

I wonder how much of that was skill and how much if that was luck. I think I personally wouldn't want to go into a field if I needed to outcompete or outnetwork a group of smart hardworking doctors to get a "good" job. 

I hope that's a sign things are getting better for Ortho though. 

The unfortunate thing is, the competition doesn't really end after you match to residency. The incentives change, but in reality, most fields these days are going to be competitive for the desirable positions and its true, some people get these spots because they are great with people and networking, others get it because they are in the right place at the right time, others get it because they have the hardwork and skillset needed etc. Theres a lot of reasons for sure, but again i think if you are afraid of the competition, ortho probably isn't the right field for you rn. 

[blah1234]

47 minutes ago, Edict said:

The unfortunate thing is, the competition doesn't really end after you match to residency. The incentives change, but in reality, most fields these days are going to be competitive for the desirable positions and its true, some people get these spots because they are great with people and networking, others get it because they are in the right place at the right time, others get it because they have the hardwork and skillset needed etc. Theres a lot of reasons for sure, but again i think if you are afraid of the competition, ortho probably isn't the right field for you rn. 

I'm very lucky to be finished residency in a field where there is decent job opportunity and flexibility. I ruled out surgery once I realized how bad things were and I'm sad to see that not much has changed in the years since.

I will agree that the competition and grind never truly ends. It changes compared to residency but there will always be forces that pull at you.

[Edict]

6 minutes ago, blah1234 said:

I'm very lucky to be finished residency in a field where there is decent job opportunity and flexibility. I ruled out surgery once I realized how bad things were and I'm sad to see that not much has changed in the years since.

I will agree that the competition and grind never truly ends. It changes compared to residency but there will always be forces that pull at you.

I genuinely think that it won't ever change. At the end of the day, the issue remains that the current resident selection system isn't really suited to select good surgeons. We don't really look at knowledge or technical skills in our applications, we look mostly at electives and interest which have their flaws. Part of the issue remains that some people who get into the program, are probably not suited to becoming a staff surgeon for various reasons.

I think many of the staff surgeons in Canada silently believe that some attrition even at the resident level is necessary to 1. keep the remaining residents on their toes 2. weed out the ones who couldn't have been weeded out through the residency selection process. 

The issue with surgery is that it carries defined outcomes. It is hard to know if you are a good or bad internist/psychiatrist because the waters are muddy in these fields. This makes it easier to say a certain surgeon is better than another. The other issue is that surgery often carries life changing outcomes and patients care. Which means surgeons are watched much more closely than other specialists are. This means that to become a staff you need to be at a high level of performance and keep it up or someone will find out and address your issue for you. 

 

[blah1234]

2 minutes ago, Edict said:

I genuinely think that it won't ever change. At the end of the day, the issue remains that the current resident selection system isn't really suited to select good surgeons. Part of the issue remains that some people who get into the program, but not actually be that suited to becoming a staff. I think many of the staff surgeons in Canada silently believe that some attrition even at the resident level is necessary to 1. keep the remaining residents on their toes 2. weed out the ones who couldn't have been weeded out through the residency selection process. 

That's an unfortunate analysis to hear from a surgical resident as you're probably closest to the issue. 

I know many residents that find out that the match doesn't necessarily mean they're a good fit for the specialty (or maybe even medicine as a whole). I'm not sure what the solution is given the fact that there really isn't a road out for many people due to debt. The removal of the general internship and the decreasing flexibility of FM transfers is also very disconcerting. 

I hope things change for the better but I think many of the doctors who think like myself are too far removed from positions of authority and decision making. 

[Edict]

6 minutes ago, blah1234 said:

That's an unfortunate analysis to hear from a surgical resident as you're probably closest to the issue. 

I know many residents that find out that the match doesn't necessarily mean they're a good fit for the specialty (or maybe even medicine as a whole). I'm not sure what the solution is given the fact that there really isn't a road out for many people due to debt. The removal of the general internship and the decreasing flexibility of FM transfers is also very disconcerting. 

I hope things change for the better but I think many of the doctors who think like myself are too far removed from positions of authority and decision making. 

The issue is that the medical school selection process selects for bright, hardworking, intelligent, empathetic individuals and this is fantastic for the physician workforce. However, one skill that is missing from that equation is technical skill and hand-eye coordination and an extra dose of willingness to bear hardships. These factors plus the aforementioned ones are probably what surgeons are looking for. The issue is, we don't really test for technical skill/hand-eye coordination much and it really is hard to simulate the willingness to bear hardships with a few electives. Elective students these days will mostly get to suture/staple skin and not much else while 2-3 week electives can't really simulate the difficulties of doing the same for 5-10 years. 

If we want to reduce attrition, i would probably start with developing better evaluation tools so that surgical residency admission processes can be more effective.

[blah1234]

13 minutes ago, Edict said:

The issue is that the medical school selection process selects for bright, hardworking, intelligent, empathetic individuals and this is fantastic for the physician workforce. However, one skill that is missing from that equation is technical skill and hand-eye coordination and an extra dose of willingness to bear hardships. These factors plus the aforementioned ones are probably what surgeons are looking for. The issue is, we don't really test for technical skill/hand-eye coordination much and it really is hard to simulate the willingness to bear hardships with a few electives. Elective students these days will mostly get to suture/staple skin and not much else while 2-3 week electives can't really simulate the difficulties of doing the same for 5-10 years. 

If we want to reduce attrition, i would probably start with developing better evaluation tools so that surgical residency admission processes can be more effective.

That's very interesting to hear. Whenever I brought up my average technical abilities my surgical preceptors and senior residents always said that they could teach a monkey to operate and that the decision making of when to operate was much more difficult to teach and the more important skill.

I'm not sure how we can test for willingness to bear hardship. I would argue for many medical and surgical specialties the amount of sacrifice someone has to make during residency (and possibly staff life) is just inconceivable by undergrad students. Even my peers and I who worked as other professionals before medicine were shocked by the working conditions during our training.