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DocBrown

Unemployed Physicians

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Does anyone here know any really unemployed doctors?

 

Sure. I mean it does happen. I personally know some that are in particular fields of radiology. I know others that have struggled to find work, and had to take multiple fellowships etc. I know others that couldn't find work in their only sub-specialty and had to move around the country doing locums.

 

That doesn't mean they eventually don't find something etc. Or they don't find a string of temporary jobs etc.

 

and that is radiology - not one of fields that routinely gets talked about with respect to the job market.

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Does anyone here know any really unemployed doctors?

 

Truly unemployed, as in no job whatsoever including locums or fellowships? Yes, though I know far, far more underemployed physicians, working unnecessary fellowships, doing strings of unreliable locums, or working part-time. 

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Truly unemployed, as in no job whatsoever including locums or fellowships? Yes, though I know far, far more underemployed physicians, working unnecessary fellowships, doing strings of unreliable locums, or working part-time. 

 

exactly, ha.

 

since we are self-employed for the most part it is often possible to get some reduced position somewhere if needed. It just isn't at all though what you really want to be doing.

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I know a ton of people in my specialty (in fact the majority) who couldn't secure employment after reaidency and are now doing fellowships.

 

Less than 20% of us had job offers during our final year of residency.

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The gatekeepers may well be allowing too many of us to obtain our residencies in any given specialty, thereby keeping us in our place by deliberating creating a buyer's market. In the marketplace of supply and demand, an excess of supply is good for the buyers. :mad:

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The gatekeepers may well be allowing too many of us to obtain our residencies in any given specialty, thereby keeping us in our place by deliberating creating a buyer's market. In the marketplace of supply and demand, an excess of supply is good for the buyers. :mad:

I understand how the first part would be profitable for governing bodies, but wouldn't combined certifications like eureka said would make sense for all parties?

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I understand how the first part would be profitable for governing bodies, but wouldn't combined certifications like eureka said would make sense for all parties?

Not really. They would cost more money and those opportunities already exist in terms of fellowship. There is also the issue of capacity. Most academic centers have too many leaders which dilutes the education for everyone.

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I understand how the first part would be profitable for governing bodies, but wouldn't combined certifications like eureka said would make sense for all parties?

Not really. They would cost more money and those opportunities already exist in terms of fellowship. There is also the issue of capacity. Most academic centers have too many leaders which dilutes the education for everyone.

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Very interesting topic. If the job market is so horrible though, why aren't governing bodies and school address the issue by reducing the number of match and offering "integrated/combined/dual" type degrees in FM?

 

What you have described is basically how things worked up until the early 1990s.  You would get your MD and do a "rotating internship".  At the end of that, you would write your MCCQE2 and then either practice as a GP or go on to do a residency in a medical or surgical specialty.  Once you'd passed your rotating internship, you could practice as a GP even if you went on to train in another field. 

 

Docs rightly pointed out that there's a heck of a lot to know if you want to be a general community doc.  So the two year CCFP Family Medicine residency was born and the rotating internship was done away with (at least as a formal concept.  The PGY-1 year of some programs still looks an awful lot like the old-style rotating internship). 

 

Out of medical school, docs went into a 2-year CCFP residency or a RCPSC residency.   No more "GPs" were produced.  The MCCQE2 survived, although as far as I can tell it's mostly a cash grab with no real value added either to examinees or society.

 

AFAIK the only program that lets you write both Family Medicine and Royal College exams is Public Health.

 

I think it would be difficult-to-impossible to bring the old system back, both for political reasons and because like I said above there's a heck of a lot to know if you want to be a good family doc.

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^More so under employed than unemployed. I doubt a physician who has completed residency+\- fellowship would just sit around at home waiting for a job to pop up whether they're picky about geography or not. They'll likely have gotten some locum position(s) or will start another fellowship. Bills still need to be paid and food still needs to be put on the table

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^More so under employed than unemployed. I doubt a physician who has completed residency+\- fellowship would just sit around at home waiting for a job to pop up whether they're picky about geography or not. They'll likely have gotten some locum position(s) or will start another fellowship. Bills still need to be paid and food still needs to be put on the table

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Wait. why are they unemployed? too competitive or too picky with the jobs?

 

Depends on the specialty. In some, competition for jobs is unreal regardless of where/what the job is. In a fair number of other specialties, jobs exist, but in undesirable locations or doing work that doesn't align with newly graduated residents' clinical interests.

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other things can still happen as well on the upper end of academic specialization as well. For instance the government can decide your centre isn't allowed to do any low priority msk MRIs as the wait list is too long for other more important imaging studies needed on that MRI machine. Thus your suddenly have a bunch of mks rads who cannot do 50% of the work they used to. Let's say some are newly hires and on probation, and the group practise now is in a bad situation - very tempting to let some go.

 

Or they can shift where the cardiac imaging is done with little notice to another hospital - leaving all the cardiac radiologists also stuck.

 

Just too real world examples in my field that have come up very recently.

 

The more specialized you are the more interesting and valuable the work you do can be - BUT the more vulnerable you are to any change in anything.

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Great points Rob, as far as I see the only truly stable job these days is government bureaucracy, so maybe pub health jobs are more stable in the long run? In any case, almost all specialties are experiencing great uncertainty these days, especially with more and more difficult contract negotiations. For example with the negotiations in Ontario there have even been dermatologist who had to significantly alter their practice. Many, like FM, rads, ophtho have all been adversely affected.

 

It's difficult for people to accept this, because we think we've trained so many years just to arrive at the current situation. 

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Great points Rob, as far as I see the only truly stable job these days is government bureaucracy, so maybe pub health jobs are more stable in the long run? In any case, almost all specialties are experiencing great uncertainty these days, especially with more and more difficult contract negotiations. For example with the negotiations in Ontario there have even been dermatologist who had to significantly alter their practice. Many, like FM, rads, ophtho have all been adversely affected.

 

Bottom line is in this day and age and economy, the concept of doctors having stable, well paying "job" is over. We really gotta start thinking about ourselves as business person operating in a competitive business environment.

 

It's difficult for people to accept this, because we think we've trained so many years just to arrive at the current situation. But at the same time we still have great leverage.

 

I'd be open to working overtime, sacrificing the first 10 years of my practice to maximize income from medicine, and during that time keeping my eyes wide open for business and investment opportunities, and use the medical practice as a jump board to build up equity, such that should politics or some other disaster occur, financially there's buffering. Later on I think with significant equity one could easily reduce the amount of medical work and branch into other lighter jobs like government, consulting etc, and take income from both investment as well as work.

 

Bottom line is mobility is more important than ever, if I am searching for a good paying opening these days I'd search Canada, USA, NZ, Australia, Singapore, UK (all which have easily transferable license with Cnada). Heck if there's great opportunity I'd even venture to China, South Asia, Russia, Africa, etc.

 

I don't think it's that bad. I am still positive that it's one of the most stable jobs out there. I just think med students should adjust their expectations in terms of which specialties they choose. Choose one that will always be in demand (hard to predict but I think the more specialized it is the harder it is to find a job, correct me if I'm wrong). Two I can think of is ER and family medicine and don't focus on staying in Toronto. Canada is a big country and not every newly minted doctor can practice there.

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Yeah, I think it's worth keeping the current situation in perspective. True unemployment does exist, typically in a few smaller, very oversupplied/underfunded fields (Neuro Sx, Ortho), most physicians are simply underemployed, earning a solidly middle to middle-upper class income. Given the time spent in training, degree of expertise and debts taken on, these salaries are still inadequate and we should be actively addressing the problem of physician underemployment, but few physicians are outright starving.

 

Likewise, while being mobile is extremely important in medicine for career advancement and employment, realistically most physicians will wind up employed in Canada. It's definitely worth being realistically about geographic preferences and keeping any options you'd find palatable. However, keeping half the world open as an option likely isn't worthwhile for the vast majority of people. Canada-wide +/- the US should be the expectation in most fields, with the US becoming increasingly important to have available.

 

Most important thing for those of us considering a specialty or earlier on in residency is to keep an ear out for information on the job market and where most people are finding employment. Talk to senior residents, fellows, and newly-hired physicians. Especially those who landed jobs that you'd consider desirable, find out what they did and use it as a baseline for what you should be doing to prepare for post-residency life. Even in fields with relatively good job markets, like FM and EM, it's important to be realistic about job options - we've had a rather large, rapid expansion of physicians in Canada, so "in-demand" specialties are also seeing their job markets tighten up a little bit. 

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Ralk, what do you think a middle class income is? Residents make a middle class income. Physicians, even FM, are in a whole new ball game. I hope that nobody here equates being underpaid and underemployed to being poor and chronically unemployed.

I agree, that was meant to be my point - at worst, underemployed physicians are usually earning a fellow's salary, which is slightly above what residents make, giving them a middle class income or better.

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I do know that orthopedic surgery is probably the most affected specialty when it comes to underemployment so while we're on the subject, I had a few quick questions for you guys:

 

1) Do you think the job market will get better in the next 10-12 years (once I'm done with med school, residency, fellowship, etc.) or will it probably stay that bad for a while?

 

2) Would an orthopedic surgeon with a master's degree and 1-2 fellowships (basically what I'd be willing to do) still have a lot of trouble finding a job? How about in an academic center?

 

3) Is the situation any different in Quebec or the US?

 

Thanks!

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