Royal College Report on Employment Prospects of Specialists

[insomnias]

The Royal College released a report today on specialists' employment here: http://www.royalcollege.ca/rcsite/health-policy/employment-study-e

A lot of the worst specialties are surgical, but there are also some IM (medical biochem, heme, nephro, GI) specialties in there. Unfortunately, they didn't list statistics for all specialties, only 14 of them. It was interesting to read the testimonials though: one anesthesiologist reported that the market in anesthesia is saturated (though in the absence of data on anesthesiology, which wasn't one of the "worst" specialties for employment prospects, it's difficult to determine how accurate that claim is).

[LittleDaisy]

57 minutes ago, insomnias said:

The Royal College released a report today on specialists' employment here: http://www.royalcollege.ca/rcsite/health-policy/employment-study-e

A lot of the worst specialties are surgical, but there are also some IM (medical biochem, heme, nephro, GI) specialties in there. Unfortunately, they didn't list statistics for all specialties, only 14 of them. It was interesting to read the testimonials though: one anesthesiologist reported that the market in anesthesia is saturated (though in the absence of data on anesthesiology, which wasn't one of the "worst" specialties for employment prospects, it's difficult to determine how accurate that claim is).

I am surprised to see plastic surgery is listed as one of the specialty. It is understandable that it is hard to secure a job in an academic hospital or community hospital. In the worst scenario, they can open up private practice? I assume that clients prefer plastic surgeons with more experience than freshly graduated surgeons? 

[chiynadoll]

8 minutes ago, LittleDaisy said:

I am surprised to see plastic surgery is listed as one of the specialty. It is understandable that it is hard to secure a job in an academic hospital or community hospital. In the worst scenario, they can open up private practice? I assume that clients prefer plastic surgeons with more experience than freshly graduated surgeons? 

Yeah but how likely is a fresh plastics grad to have the funds to open up private practice? And that is only if they want to do cosmetics or whatever falls under private... can't imagine a hand or burns specialist having that option easily.

[insomnias]

10 minutes ago, LittleDaisy said:

I am surprised to see plastic surgery is listed as one of the specialty. It is understandable that it is hard to secure a job in an academic hospital or community hospital. In the worst scenario, they can open up private practice? I assume that clients prefer plastic surgeons with more experience than freshly graduated surgeons? 

I suspect that the problem with plastics is that opening your own clinic has a high barrier to entry: you need both equipment+staff (=high start-up costs + ongoing costs) and patients. Private patients would have to seek you out directly, so unless you have something like a residency from Harvard/UCLA, it would be difficult to get revenue > costs. Supposedly the market for cosmetics is pretty saturated in Canada.

[JohnGrisham]

1 hour ago, insomnias said:

I suspect that the problem with plastics is that opening your own clinic has a high barrier to entry: you need both equipment+staff (=high start-up costs + ongoing costs) and patients. Private patients would have to seek you out directly, so unless you have something like a residency from Harvard/UCLA, it would be difficult to get revenue > costs. Supposedly the market for cosmetics is pretty saturated in Canada.

This is it. A close colleagues mother is a local big shot plastic surgeon, not easy in private practice.

[hero147]

Do plastic surgeons have to build and staff their own private ORs? I have seen many plastic surgeons do elective cosmetic surgery at the hospital they have privileges at.

[hamham]

I am surprised ICU, ENT and Cardiology did not make that list. I know many pursuing these specialties who kept doing fellowships to boost their chances of landing permanent employment.

[X Æ A-12]

This is what happens when resident quotas are set with ability to service the call schedule instead of the demand of these specialists irl

[X Æ A-12]

.

[blah1234]

Very sad to hear that things are still looking bad for many specialties. Surprised at some parts as some of the quotes seem to go against what I have been hearing down the grapevine but I suppose this is a more comprehensive study across all of Canada. 

[ChemPetE]

Just sad for medical specialists anywhere. Geographic restrictions make job hunts dismal. For example, there have been only 2 postings so far for my specialty that really would apply for my grad year, and 2 people I know got unlisted spots, and not sure of others across the country. But those 2 spots will go to other years grads first. It’s just a terrible cycle for the well being of new doctors, and really with the anticipated wave of retirements, smart management practices would be to hire them to help facilitate the knowledge transfer for in practice attendings (we cant pretend you learn everything in residency, but that also doesn’t make us incompetent, either). The whole thing is a shit show all around.

[yonas]

On 5/2/2019 at 4:19 AM, ChemPetE said:

Just sad for medical specialists anywhere. Geographic restrictions make job hunts dismal. For example, there have been only 2 postings so far for my specialty that really would apply for my grad year, and 2 people I know got unlisted spots, and not sure of others across the country. But those 2 spots will go to other years grads first. It’s just a terrible cycle for the well being of new doctors, and really with the anticipated wave of retirements, smart management practices would be to hire them to help facilitate the knowledge transfer for in practice attendings (we cant pretend you learn everything in residency, but that also doesn’t make us incompetent, either). The whole thing is a shit show all around.

What specialty are you in?

[ZBL]

I guess this suggests that despite the common theme here that “you can’t predict the future”, past history suggests job prospects are not good for numerous specialties, mostly surgical. That should likely weigh in at least to some extent to future CaRMS decisions. 

[ArchEnemy]

10 hours ago, ZBL said:

I guess this suggests that despite the common theme here that “you can’t predict the future”, past history suggests job prospects are not good for numerous specialties, mostly surgical. That should likely weigh in at least to some extent to future CaRMS decisions. 

Agreed. Yet plastic surgery continues to the most popular specialty. Among the top 10 "most competitive" specialties, 5 of those are surgical specialties despite limited OR time and job prospects. I think medical schools should do a better job at explaining to students the reality of the situation, since most residency programs will not due to an inherent conflict in interest.

[GrouchoMarx]

The surgical subspecialty fields all have the option of going to the USA, where they're in high demand.

 

Pathology, and on that list hemepath and biochem,do not have that option due to the oversupply down there.

[ZBL]

1 hour ago, GrouchoMarx said:

The surgical subspecialty fields all have the option of going to the USA, where they're in high demand.

 

Pathology, and on that list hemepath and biochem,do not have that option due to the oversupply down there.

That’s true, but it’s an unfortunate reality to consider that the only way you might have a job in a surgical field is to leave your home country. 

[ZBL]

2 hours ago, ArchEnemy said:

Agreed. Yet plastic surgery continues to the most popular specialty. Among the top 10 "most competitive" specialties, 5 of those are surgical specialties despite limited OR time and job prospects. I think medical schools should do a better job at explaining to students the reality of the situation, since most residency programs will not due to an inherent conflict in interest.

Also agree with you that med schools should do more on the career education aspect. There needs to be more discussion about what different career setups look like, job prospects, moving to the US/USMLE considerations, how the financials work, and of course CaRMS matching so that students are properly informed. Maybe more would choose FM that way.

It really is insufficient to select a career based on interest alone - at least some practical aspects are necessary for consideration. While many physicians do not regret their choice of doing medicine as a career, I’m sure many would have rather done something else if all else was equal (eg. Pay, job security, clarity of career trajectory, respect, autonomy etc). Same deal should apply when deciding on a medical specialty. 

[BernieMac]

On 5/4/2019 at 11:14 AM, ZBL said:

Also agree with you that med schools should do more on the career education aspect. There needs to be more discussion about what different career setups look like, job prospects, moving to the US/USMLE considerations, how the financials work, and of course CaRMS matching so that students are properly informed. Maybe more would choose FM that way.

It really is insufficient to select a career based on interest alone - at least some practical aspects are necessary for consideration. While many physicians do not regret their choice of doing medicine as a career, I’m sure many would have rather done something else if all else was equal (eg. Pay, job security, clarity of career trajectory, respect, autonomy etc). Same deal should apply when deciding on a medical specialty. 

-

[ZBL]

3 minutes ago, YesIcan55 said:

lol if "Pay, Job security, clarity of career trajectory, respect, status, autonomy" etc were equal in other fields, medical schools would be empty tomorrow 

Exactly my point. Few are here for interest alone, so that shouldn’t be the only driver of residency choice.  

[JohnGrisham]

17 minutes ago, ZBL said:

Also agree with you that med schools should do more on the career education aspect. There needs to be more discussion about what different career setups look like, job prospects, moving to the US/USMLE considerations, how the financials work, and of course CaRMS matching so that students are properly informed. Maybe more would choose FM that way.

It really is insufficient to select a career based on interest alone - at least some practical aspects are necessary for consideration. While many physicians do not regret their choice of doing medicine as a career, I’m sure many would have rather done something else if all else was equal (eg. Pay, job security, clarity of career trajectory, respect, autonomy etc). Same deal should apply when deciding on a medical specialty. 

Theres already a large amount of people choosing FM, and that said, its not as if there are loads of leftover FM spots, definitely not in the big cities. 

[ArchEnemy]

2 minutes ago, JohnGrisham said:

Theres already a large amount of people choosing FM, and that said, its not as if there are loads of leftover FM spots, definitely not in the big cities. 

I think the main point is that universities should consider reducing the number of specialist positions (especially those with high unemployment rates)  and increase the number of FM positions. Despite the large number of FM positions, there remains a significant shortage of Family MDs overall.

[freewheeler]

1 hour ago, ArchEnemy said:

I think the main point is that universities should consider reducing the number of specialist positions (especially those with high unemployment rates)  and increase the number of FM positions. Despite the large number of FM positions, there remains a significant shortage of Family MDs overall.

With respect to the shortage of FM physicians I think that has more to do with geographic distribution of physicians than the absolute number. To take your point a step further I think that if they really want to make headway it would make sense to recruit more students from rural backgrounds to medical school. Efforts towards reducing (but not eliminating) the disparity of earning potential between medical disciplines should also assist in driving more students into FM. The challenge from that point is having people actually practice full-scope primary care instead of a niche practice.

[la marzocco]

44 minutes ago, freewheeler said:

With respect to the shortage of FM physicians I think that has more to do with geographic distribution of physicians than the absolute number. To take your point a step further I think that if they really want to make headway it would make sense to recruit more students from rural backgrounds to medical school. Efforts towards reducing (but not eliminating) the disparity of earning potential between medical disciplines should also assist in driving more students into FM. The challenge from that point is having people actually practice full-scope primary care instead of a niche practice.

Also, some studies using CIHI data have shown that 1.3-1.5 new family doctors is required to replace a retiring one. This was attributed to the growing feminization of medicine and the fact that more young physicians are not looking to spend every living second of their lives at work (culture shift). I agree that we need to do better in recruiting more students from rural backgrounds. NOSM is a great success story in that regard. Pay relativity will also help shepherd more students towards FM.

[NeuroD]

5 hours ago, ArchEnemy said:

I think the main point is that universities should consider reducing the number of specialist positions (especially those with high unemployment rates)  and increase the number of FM positions. Despite the large number of FM positions, there remains a significant shortage of Family MDs overall.

Most services are already operating above census. Fewer residents would make it impossible to handle current patient loads, unless they higher more mid-tiers. Hiring more mid-tiers requires more funding from governments. Governments are (mostly) in a deficit and are trying to spend less, not more.

The only way specialty services get by caring for as many patients as they do, is on the backs of hopeful MDs. Ignorance is bliss (in med school and residency).

[NeuroD]

3 hours ago, freewheeler said:

With respect to the shortage of FM physicians I think that has more to do with geographic distribution of physicians than the absolute number. To take your point a step further I think that if they really want to make headway it would make sense to recruit more students from rural backgrounds to medical school. Efforts towards reducing (but not eliminating) the disparity of earning potential between medical disciplines should also assist in driving more students into FM. The challenge from that point is having people actually practice full-scope primary care instead of a niche practice.

I don't by the geographical distribution part. I'm sure it contributes to a degree...but my wife and I literally phoned 50 female FM doc offices to try to find one for my wife, with no luck. We're well connected and live in a major med-school city. You could argue that it's her fault for wanting a female FM, but still....50? That experience just makes me doubt the distribution part of the argument.