Surgical specialties with good job prospects?

[Cuttlefish]

a lot of questions about the GTA, but can anyone chime in on the job market for surgical specialties in London and further south?

[1D7]

The answer is going to be the same basically across Ontario and any major Canadian city: bad or terrible. There are a ton of surgical specialists Ontario who would love to work in London; it's not some godforsaken wasteland.

Finding a job where you want as a surgical specialist will come down to mostly luck (right place, right time, right person to retire) on top of being a great candidate with the right credentials. When someone says it's looking up for a certain surgical specialty, it means there's a wave of retirements but the long-term outlook will still be poor once those spots are filled. In fact if you hear such news as a medical student it might be even worse for when you complete residency since there will be new young blood in the group who have long careers ahead of them.

Because of pressure to reduce healthcare costs and the fact that surgical residency spots have not contracted, things will continue to worsen overall. Some specialties are better/worse off than others but it still comes down to being either bad or terrible.

If your question is if you will have a job period, then yes you will be able to find some job somewhere in Canada if you're willing to work anywhere and do anything. It may mean you might practice in a way you don't enjoy or practicing in a location you dislike +/- doing additional pointless years of working as a fellow while job searching (depends on how bad the market is for your specialty, e.g. ortho will be 2 yrs of fellowship).

[Cuttlefish]

21 hours ago, 1D7 said:

The answer is going to be the same basically across Ontario and any major Canadian city: bad or terrible. There are a ton of surgical specialists Ontario who would love to work in London; it's not some godforsaken wasteland.

Finding a job where you want as a surgical specialist will come down to mostly luck (right place, right time, right person to retire) on top of being a great candidate with the right credentials. When someone says it's looking up for a certain surgical specialty, it means there's a wave of retirements but the long-term outlook will still be poor once those spots are filled. In fact if you hear such news as a medical student it might be even worse for when you complete residency since there will be new young blood in the group who have long careers ahead of them.

Because of pressure to reduce healthcare costs and the fact that surgical residency spots have not contracted, things will continue to worsen overall. Some specialties are better/worse off than others but it still comes down to being either bad or terrible.

If your question is if you will have a job period, then yes you will be able to find some job somewhere in Canada if you're willing to work anywhere and do anything. It may mean you might practice in a way you don't enjoy or practicing in a location you dislike +/- doing additional pointless years of working as a fellow while job searching (depends on how bad the market is for your specialty, e.g. ortho will be 2 yrs of fellowship).

How are the job prospects this bad? So basically if you prefer to work in any Ontario city (doesn't have to be GTA, but something smaller or mid-sized >150,000 pop), surgery is out of the question? Why is it so competitive if the job market sucks lol

[1D7]

1 hour ago, Cuttlefish said:

So basically if you prefer to work in any Ontario city (doesn't have to be GTA, but something smaller or mid-sized >150,000 pop), surgery is out of the question?

If your only criteria is >150,000 (or within 45 minutes of such a place) and you're looking all across Canada you can likely find a community job or at least get paid doing locums until you find a position, assuming you pick from the specialties with better job markets (bad instead of terrible).

I meant that if you're focusing on only a few Canadian cities (e.g. GTA+Hamilton+Vancouver+Calgary) then you're setting yourself up for bitterness and disappointment. Most people won't be one of the lucky ones at the right place right time so you just gotta expand your scopes and accept that you will be looking very broadly.

Quote

How are the job prospects this bad?

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Why is it so competitive if the job market sucks lol

Cardiac surgery's job market has been bad enough that some years you could literally only find jobs across the border in America and yet it fills every year.

If competitiveness was based on job availability or happiness then family medicine would be top or top 3 every year.

[IMislove]

32 minutes ago, Cuttlefish said:

How are the job prospects this bad? So basically if you prefer to work in any Ontario city (doesn't have to be GTA, but something smaller or mid-sized >150,000 pop), surgery is out of the question? Why is it so competitive if the job market sucks lol

Because we’re told don’t look at the job market, because it’ll be 9-11 years from start start to finish. Just be okay with going to small (50k or less) and potentially not in Ontario, otherwise well, may the odds be ever in your favour.

[NeuroD]

23 minutes ago, IMislove said:

Because we’re told don’t look at the job market, because it’ll be 9-11 years from start start to finish. Just be okay with going to small (50k or less) and potentially not in Ontario, otherwise well, may the odds be ever in your favour.

Come to think of it, we're too often told not to consider any of the key factors that most people use to decide on a career (other than interest in theoretical subject matter).

[NLengr]

24 minutes ago, PhD2MD said:

Come to think of it, we're too often told not to consider any of the key factors that most people use to decide on a career (other than interest in theoretical subject matter).

Because we are total shit in medicine when it comes to human resources planning, finances, mentoring etc.

[rmorelan]

15 minutes ago, NLengr said:

Because we are total shit in medicine when it comes to human resources planning, finances, mentoring etc.

and on top of that those are all really hard problems. Too many variables, too many unknowns and so little flexibility in the system. No obvious solution either. 

plus people quite often ignore the evidence even if the are told it - after all med students as rules literally have been "winning" at things for so long they almost cannot imagine that not happening. I have had many people not even blink when they are presented the odds of getting something (who cares, odds don't mean anything to them in effect). We all know people that in the end didn't get that residency position/fellowship/or job in the end though. It is a bitter pill to swallow. 

and I am what almost staff now, and many others on the forum are well beyond that point. I haven't been trained anywhere along the way about any of those those topics above - it is somehow assumed you know about them just by going through the process. That is rather insane I think. Cannot do the same things we have been doing for years and expect a different outcome. It would be actually nice on some level if a training program was punished in some fashion if its grads didn't get a job in a particular field in a particular time - something to remind them what the point of a publicly funded training program is.   

[1D7]

1 hour ago, Cuttlefish said:

Why is it so competitive if the job market sucks lol

To expand on this...

• Usually an element of naivety/ignorance exists. Attendings rarely let med students know the full reality of what it's like. Plus attendings have an incentive to draw you in (an unmatched surgical program = ton more work for everyone = higher attrition rates = more headaches/work for attendings). Yeah the job market is probably going to improve in 10 years hahaha
• Lots of overly optimistic med students. This potentiates with the big egos found in medicine in general. Unmatched? No way, I work harder than the rest. Not matching to top 3? No way, I am more likeable than the rest. Not finding a job in Toronto? No way, I am more talented than the rest. Etc.
• Competitiveness in and of itself draws students.
• Surgery or at least the idea of it is genuinely cool. For some that is enough to make them truly happy. For others it is just enough to trick them into thinking they'll be happy. 
• Many medical students invest in identities very early on. If you identify with being a surgeon, it will be difficult for you to pick any other specialty as you progress.

And yeah, everything NLengr said.

[Lactic Folly]

1 hour ago, rmorelan said:

haven't been trained anywhere along the way about any of those those topics above

Who would, or should, conduct this training? Since as NLengr said, many physicians are not well versed in business concepts (and often those with more business interests would prefer community over academic)... a self perpetuating cycle.

[distressedpremed]

13 minutes ago, 1D7 said:

To expand on this...

• Usually an element of naivety/ignorance exists. Attendings rarely let med students know the full reality of what it's like. Plus attendings have an incentive to draw you in (an unmatched surgical program = ton more work for everyone = higher attrition rates = more headaches/work for attendings). Yeah the job market is probably going to improve in 10 years hahaha
• Lots of overly optimistic med students. This potentiates with the big egos found in medicine in general. Unmatched? No way, I work harder than the rest. Not matching to top 3? No way, I am more likeable than the rest. Not finding a job in Toronto? No way, I am more talented than the rest. Etc.
• Competitiveness in and of itself draws students.
• Surgery or at least the idea of it is genuinely cool. For some that is enough to make them truly happy. For others it is just enough to trick them into thinking they'll be happy. 
• Many medical students invest in identities very early on. If you identify with being a surgeon, it will be difficult for you to pick any other specialty as you progress.

And yeah, everything NLengr said.

I feel like residency sometimes for surgical subspecialties is that they need people to take call for them. And quite honestly, apart from one or two people, I haven't really gotten much mentorship about the topic above. There are grads who haven't been able to find a job yet in our city for general jobs, let alone find OR time. I find that the subspecialties remaining are things that people don't really want to do/aren't profitable/take a long time per patient, so what happens is that sure you graduate and possibly find a job, and then what happens is that the staff just offload the patients onto you and focus on what's more lucrative instead. 

[rmorelan]

2 hours ago, Lactic Folly said:

Who would, or should, conduct this training? Since as NLengr said, many physicians are not well versed in business concepts (and often those with more business interests would prefer community over academic)... a self perpetuating cycle.

while sure in general but while rare in the grand scheme of things there are enough with interest/training to be useful I think. It isn't that unusual for a doctor to have a MBA for instance - there were 2 of them alone in my old radiology department on a personal example. They are an accessible resource if needed - a lot of those MBA types are looking for senior admin positions in hospitals for instance. Mentoring is something you would think is more common in academia than elsewhere - yet we don't talk about that much either.

what we don't have is the willing or foresight to add it to residency programs and so on.  Ha instead as I recall I had a 3 hour lecture on recycling of all things, a 2 hour lecture on using excel and word and using pubmed basic searches (required lecture for some stupid reason), and some questionable wellness lectures (something that annoyed me because that subject is very important but so poorly done). Somehow we can get that stuff in but cannot talk about how to actually get a job, personal finances, or realities of our specialities in actual practice - stuff that we all actually have to do. 

 

 

 

[NLengr]

5 hours ago, rmorelan said:

while sure in general but while rare in the grand scheme of things there are enough with interest/training to be useful I think. It isn't that unusual for a doctor to have a MBA for instance - there were 2 of them alone in my old radiology department on a personal example. They are an accessible resource if needed - a lot of those MBA types are looking for senior admin positions in hospitals for instance. Mentoring is something you would think is more common in academia than elsewhere - yet we don't talk about that much either.

what we don't have is the willing or foresight to add it to residency programs and so on.  Ha instead as I recall I had a 3 hour lecture on recycling of all things, a 2 hour lecture on using excel and word and using pubmed basic searches (required lecture for some stupid reason), and some questionable wellness lectures (something that annoyed me because that subject is very important but so poorly done). Somehow we can get that stuff in but cannot talk about how to actually get a job, personal finances, or realities of our specialities in actual practice - stuff that we all actually have to do. 

 

 

 

Our division head during residency had an MBA and a passion for administration. He started doing a couple half days a year on business topics (incorporation, finances, practice set up etc) which were well received. But that involves someone having to take the initiative to do those kind of lectures and unfortunately, all programs don't have such a person. 

Personally, I think the RC and CCFP need to step in and require X amount of business training per year (say 6 hours or something). Then leave it up to the programs to figure out how to supply it. 

As for the lack of human resources knowledge, part of it is probably due to the fact that the academic programs and universities are the major players in allocating residency seats. First, they have no major interest in making sure our human resource supply meets our needs. Second, academia does a terrible job of putting people with business type skills into leadership positions. At my residency university, the main criteria for getting promoted in the administration was publications and research. It was so bad, our division head had to fight the university to get promoted to the leadership position, despite an MBA, experience creating and running a journal and experience leading our national specialty organization. But he wasn't churning out esoteric research papers, so the university couldn't see how he would make a good leader. You end up with guys who are really good at research being put into leadership roles for which they have little to no skillset (or interest in developing that skill set) and as a result, the leadership is ineffective much of the time.

[NLengr]

5 hours ago, rmorelan said:

 Ha instead as I recall I had a 3 hour lecture on recycling of all things

I could use that now. Everytime I sort the recycling I end up asking my spouse at least once "do we recycle this here?"

[rmorelan]

5 hours ago, NLengr said:

Our division head during residency had an MBA and a passion for administration. He started doing a couple half days a year on business topics (incorporation, finances, practice set up etc) which were well received. But that involves someone having to take the initiative to do those kind of lectures and unfortunately, all programs don't have such a person. 

Personally, I think the RC and CCFP need to step in and require X amount of business training per year (say 6 hours or something). Then leave it up to the programs to figure out how to supply it. 

As for the lack of human resources knowledge, part of it is probably due to the fact that the academic programs and universities are the major players in allocating residency seats. First, they have no major interest in making sure our human resource supply meets our needs. Second, academia does a terrible job of putting people with business type skills into leadership positions. At my residency university, the main criteria for getting promoted in the administration was publications and research. It was so bad, our division head had to fight the university to get promoted to the leadership position, despite an MBA, experience creating and running a journal and experience leading our national specialty organization. But he wasn't churning out esoteric research papers, so the university couldn't see how he would make a good leader. You end up with guys who are really good at research being put into leadership roles for which they have little to no skillset (or interest in developing that skill set) and as a result, the leadership is ineffective much of the time.

yeah we need to so a better job at creating different pathways of advancement (education, research, management/leadership (and start calling it) etc.). Just because you are good at any of those doesn't mean you are good at the rest ha. 

Part of the problem is it is all academic positions are designed for the full time researcher etc in terms of promotion. Well doctors have other things to do - like treating patients ha. Even our publications don't always count as proper research in their eyes (I know one staff that publishes constantly in our top radiology journal but writing articles explaining how to do our job better isn't original research so she is still an assistant professor despite being highly respected). 

and absolutely - a) the colleges have to make this a priority and b) someone - likely the provinces - have to create a reward/punishment system to force the training programs to consider the HR implications. 

 

[blah1234]

18 hours ago, PhD2MD said:

Come to think of it, we're too often told not to consider any of the key factors that most people use to decide on a career (other than interest in theoretical subject matter).

I agree.

The system isn't designed to consider our job aspirations well. Medical Schools want good match rates but they aren't really held accountable to if their students find jobs at the end of residency.

Another problem with medical training is that what you might love as a medical student may not be what you love as a staff physician. The view of the job is so different at every stage of training (medical student/resident/staff) that I'm not sure if people are making informed decisions. You can love GI physiology and pathology but you might hate the actual day-to-day of being a GI and scoping.

I think this issue might have been alleviated to some extent if there was more flexibility in the system. As it stands you can only end up being one kind of doctor which pigeonholes people. 

[billy55555]

On 6/26/2019 at 10:57 PM, Edict said:

Definitely the incentives to practice in Canada are diminishing. This is really just a natural result of the increased competition for everything unfortunately, but CAs are definitely a thing I see CAs everywhere these days. 

What is CA?

[hero147]

26 minutes ago, billy55555 said:

What is CA?

Clinical Associate

[The Ace of Spades]

On 10/16/2019 at 1:11 PM, blah1234 said:

You can love GI physiology and pathology but you might hate the actual day-to-day of being a GI and scoping.

It's a crappy job, but somebody has to do it

[jnuts]

On 10/16/2019 at 11:41 AM, rmorelan said:

yeah we need to so a better job at creating different pathways of advancement (education, research, management/leadership (and start calling it) etc.). Just because you are good at any of those doesn't mean you are good at the rest ha. 

Part of the problem is it is all academic positions are designed for the full time researcher etc in terms of promotion. Well doctors have other things to do - like treating patients ha. Even our publications don't always count as proper research in their eyes (I know one staff that publishes constantly in our top radiology journal but writing articles explaining how to do our job better isn't original research so she is still an assistant professor despite being highly respected). 

and absolutely - a) the colleges have to make this a priority and b) someone - likely the provinces - have to create a reward/punishment system to force the training programs to consider the HR implications. 

 

Solutions exist but Canadian institutions are either maliciously self interested or moribund.

6 hours a year of business management during training isnt going to change that. 

I hate working in the USA for some reasons but the competitive market does produce some solutions to these problems.

1)advanced practice professionals (PAs and NPs) totally obliviate the need for resident recruitment just to keep up with the busy work.  The time has more than arrived for Canadian MDs to stop protecting their own perceived interest in a professional monopoly on medical services. If there were this type of clinical support in the hospital, residency spots could be reallocated to fill market expectations more effectively and free residents to focus on relevant skills instead of 'right-of-passage' clerical support. Cost of provision of medical services might even drop (but what MD would willing encourage that...)

2)academic/administrative/clinical shared leadership roles--placing the ultimate emphasis on research is idiotic as NLengr states.  However, grants are how the university keeps the lights on and advancement in the Canadian system is based on the academic side.  Some programs are better at this than others, but it's very possible to split leadership responsibilities into shared diads and triads (as some hospitals down here do) with comanagement based on different individuals strengths. 

Anyway, these problems exist not because there aren't well established solutions.  They're maintained because they're profitable to the controlling parties. 

Just like everything else right now, just ask yourself who benefits. You'll see quickly why the training and job market is the way it is and why medical students are misled just enough to consistently make irrational choices.  

And that's provided they have a choice, let's not get into the exploitation in the IMG stream. 

[Cuttlefish]

1 minute ago, jnuts said:

Just like everything else right now, just ask yourself who benefits. You'll see quickly why the training and job market is the way it is and why medical students are misled just enough to consistently make irrational choices.  

Can you elaborate? No idea what u mean as i'm new to the field

[jnuts]

6 hours ago, Cuttlefish said:

Can you elaborate? No idea what u mean as i'm new to the field

Sure. I'll make a few disclaimers. First, my view is through the lens of orthopaedics which may not be universally applicable.  I'll also put in the caveat that I'm trying to be practical and not trying to impugn my training. I'm grateful for my opportunities.  BUT my career path had a practical back-up plan.  If that had not happened I'm not sure where I'd be now. I find it scary and somewhat problematic that the potential of a dead-end career after training in Canada was never frankly discussed when I was initially planning my career path or during residency when the market failed to improve.

Surgical teaching staff generally act as though the relationship they have with residents is mostly educational with optional mentorship aspects. If the teaching staff were acting altruistically towards the latter ideal, training spots in fields with scarce job opportunities would be closed until the market changed as mentoring someone towards harm is ethically unacceptable. It's really not that hard to look five years down the road. To be fair, training spots in ortho have decreased but obviously no where near the level they should. Arguably, there's a freedom of personal choice involved where teaching staff simply fill trainees wish to learn and future extra-academic difficulties are irrelevant to the passing on of knowledge and skill. I'd buy that if there was no financial incentive and at least an open acknowledgement of the inherent risks but there is neither of those things.

In actual fact, the relationship has a strong indirect (and sometimes direct) financial aspect as staff benefit economically through ward, clinic, and call coverage. There is absolutely no way a single provider will get through an 100+ patient clinic day without resident support. There is also secondary benefit to the university to keep residency spots filled to secure provincial funding. 

Given these competing pressures, it's very easy to see which priority has won out.  

I think that at very least, well meaning career advice from our mentors should come with a disclaimer. If I benefit financially from using a certain implant that's something I ethically have to disclose.  How is this different?

Saying "orthopaedics is great!" has a different tone when its followed by "WARNING I will profit off of your underpaid/unpaid labour for the next five years after which I have no further obligation to ensure the marketability of the skill set I'm offering you as compensation and all further risk is solely borne by you the trainee"

[Aurelius]

Maybe it's just me being naive as a pre-clerk, but shouldn't the job market theoretically improve? Canadians are getting older and will require more healthcare while there is already a physician shortage across Canada. Wait times for surgeries are quite long and almost every surgical association expects them to get longer. Wouldn't there come a point in time where jobs would have to be created just so patients get timely care? Also it seems a lot of surgeons are on the older side, for someone entering medical school now, is it naive to expect a large number of surgeons to retire 10 years down the road and jobs opening up?

[1D7]

11 hours ago, Aurelius said:

Maybe it's just me being naive as a pre-clerk, but shouldn't the job market theoretically improve? Canadians are getting older and will require more healthcare while there is already a physician shortage across Canada. Wait times for surgeries are quite long and almost every surgical association expects them to get longer. Wouldn't there come a point in time where jobs would have to be created just so patients get timely care? Also it seems a lot of surgeons are on the older side, for someone entering medical school now, is it naive to expect a large number of surgeons to retire 10 years down the road and jobs opening up?

Quote

• Usually an element of naivety/ignorance exists. Attendings rarely let med students know the full reality of what it's like. Plus attendings have an incentive to draw you in (an unmatched surgical program = ton more work for everyone = higher attrition rates = more headaches/work for attendings). Yeah the job market is probably going to improve in 10 years hahaha
• Lots of overly optimistic med students. This potentiates with the big egos found in medicine in general. Unmatched? No way, I work harder than the rest. Not matching to top 3? No way, I am more likeable than the rest. Not finding a job in Toronto? No way, I am more talented than the rest. Etc.

There is nothing in your post that is unique to surgery nor this current point in time—for the past 10+ years medical students have had those exact thoughts. In fact aside from surgeons retiring, everything else you mentioned (i.e. universal increased demand for medical & surgical services) is worsening the situation. You cannot simply "create more surgeon jobs". For ORs alone you need OR nurses, anesthesia, porters, cleaners, x-ray/fluoro technologists, technicians, equipment, etc. The reality is that OR time is limited by government funding & factors other than having enough surgeons. And things will likely continue to worsen because money is being stretched thinner every year.

[Aurelius]

8 hours ago, 1D7 said:

There is nothing in your post that is unique to surgery nor this current point in time—for the past 10+ years medical students have had those exact thoughts. In fact aside from surgeons retiring, everything else you mentioned (i.e. universal increased demand for medical & surgical services) is worsening the situation. You cannot simply "create more surgeon jobs". For ORs alone you need OR nurses, anesthesia, porters, cleaners, x-ray/fluoro technologists, technicians, equipment, etc. The reality is that OR time is limited by government funding & factors other than having enough surgeons. And things will likely continue to worsen because money is being stretched thinner every year.

I guess I just have a hard time understanding how there can be increasing demand for surgical services and an ageing population but nothing being done to address these needs. Do we just accept patients will forever have to deal with increasingly long wait times? I guess I had a small hope there'd be increased government funding or something to alleviate this problem.