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Residency backlog could triple for medical school grads, report warns


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5 hours ago, medigeek said:

Not exactly true as it depends what type of candidate you are. FM spots will up with a lottt of foreign graduates whereas IM spots tend to fill up with higher scoring foreigners and more US graduates (MD/DO). Ultimately if you want to get into a decent program, you'll have better luck with FM than IM. 

By shear number, yes IM takes more non-US grads. 4000 for IM vs 1800 for FM. Feel free take a look at the numbers.  The number of IM mills in NY alone is a staggering number of training spots. They run off of FMGs and IMGs.

 

My point is, by reducing the IM SONs, someone will feel a crunch as people get diverted to FM, as mathematically they aren't as plentiful as IM. Likely it will be the FMGs perhaps. Who knows. Programs definitely do like fully trained FMGs who hit the ground running a lot of times due to past training. 

Anyways, besides the point.

 

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3 minutes ago, JohnGrisham said:

By shear number, yes IM takes more non-US grads. 4000 for IM vs 1800 for FM. Feel free take a look at the numbers.  The number of IM mills in NY alone is a staggering number of training spots. They run off of FMGs and IMGs.

 

My point is, by reducing the IM SONs, someone will feel a crunch as people get diverted to FM, as mathematically they aren't as plentiful as IM. Likely it will be the FMGs perhaps. Who knows. Programs definitely do like fully trained FMGs who hit the ground running a lot of times due to past training. 

Anyways, besides the point.

 

Well when given the choice they prefer FMGs with prior exp vs. those without exp. But the SGU guy is still seen as being better because they understand western culture which is critical to patient care. 

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7 hours ago, medigeek said:

You're over estimating the difficulty of staying in USA after a J1 and the difficulty of getting an H1. Getting a J1 waiver isn't difficult at all as there are a ton of underserved areas across USA and some of them aren't that undesirable by any measure. A big chunk of people on the J1 plan to indeed stay in USA. 

There is a finite limit to j1 waivers. Conrad 30..is 30 primary care waivers per state.. Then VA, and another program. Either way, there is far more non-US citizens on j1 visas than their are j1 waivers. And unlike Canadians who likely dont mind coming back to canada, the Indians, Pakistanis and Chinese would see a HUGE pay drop leaving the US to go back home...so surely they too would vie for the j1 waivers? Not sure, been a while since I did the research.. I did the math at some point before to get the rough number of potential waivers.. I'll see if I can pull it up again on the j1 waiver pathways. 

When it comes to Canadians, the vast majority on j1s for FM likely will come back given the ease of coming back and better pay in Canada. Its the ones on h1b that are more likely to just stay in the US as they have a more clear and direct route, especially those in non-primary care routes. Even then, many choose h1b for IM nowadays so they can specialize on track, and then come back later if they want(this is referring to USMGs).

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16 hours ago, la marzocco said:

 

Derm is smart to have been so protective of its field. Job prospects are healthy in general. I doubt they would increase derm spots.

You don't go into derm because you love rashes or skin disease. You go into derm because you love printing money. 

 

More people = less money

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2 hours ago, NLengr said:

You don't go into derm because you love rashes or skin disease. You go into derm because you love printing money. 

 

More people = less money

Lots of medical & surgical specialists earn more $$$.  

More people = less jobs (&flexibility).

Derm hasn't really done anything special - it's a small specialty.  It's more like:

few dermatologists -> few residency programs -> few dermatologists...

 

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1 hour ago, marrakech said:

Lots of medical & surgical specialists earn more $$$.  

More people = less jobs (&flexibility).

Derm hasn't really done anything special - it's a small specialty.  It's more like:

few dermatologists -> few residency programs -> few dermatologists...

 

how many of those have next to 0 call, extensive options for private billing if desired, low stress jobs which aren't "messy", flexible practice structures that allow vacations without much work...... ha Plus they actually have a huge impact in peoples' lives.

I would argue they have been pretty smart and in some ways have flown under the radar on the billing side. Not unique but they are doing much better than most :)

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6 minutes ago, rmorelan said:

how many of those have next to 0 call, extensive options for private billing if desired, low stress jobs which aren't "messy", flexible practice structures that allow vacations without much work...... ha Plus they actually have a huge impact in peoples' lives.

I would argue they have been pretty smart and in some ways have flown under the radar on the billing side. Not unique but they are doing much better than most :)

Bingo

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54 minutes ago, rmorelan said:

how many of those have next to 0 call, extensive options for private billing if desired, low stress jobs which aren't "messy", flexible practice structures that allow vacations without much work...... ha Plus they actually have a huge impact in peoples' lives.

I would argue they have been pretty smart and in some ways have flown under the radar on the billing side. Not unique but they are doing much better than most :)

Don't get me wrong - I think it's a great specialty including the reasons you mention.  But fees vary greatly by province - BC dermatologists aren't at all pleased, for example.  OTOH in AB it's a different story (but AB has high cost of living, etc...). 

And if the government could drastically change the number of providers, and possibly create a poor job market, they would.  The Feds are willing sponsor up to 40 Derm SONs/per year.  That's almost double the number of residency spots available in Canada.  In the US it's even harder to match to though, and many Derm keeners take a research year to boost their chances.    

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2 hours ago, marrakech said:

Lots of medical & surgical specialists earn more $$$.  

More people = less jobs (&flexibility).

Derm hasn't really done anything special - it's a small specialty.  It's more like:

few dermatologists -> few residency programs -> few dermatologists...

 

In terms of total income, sure maybe other specialties can make more. But it doesn’t matter what province, few specialties come close to the hourly income that a dermatologist can haul. Maybe ophtho. 

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On 13/2/2018 at 11:45 AM, la marzocco said:
  • Will Quebec be willing to loosen it's foothold on language requirements so that the 50-odd FM spots can be up for grabs? Unlikely?
 

why should QC do it? French is the official language in the province, most of the patients and health professionals communicate in French.

The spots are open to anyone capable of communicating in French. 

It would be the equivalent of asking BC, Alberta, and SK to stop demanding from French schools' graduates to take the IELTS or to provide other evidence they can communicate in English in a healthcare setting. And there's nothing wrong in demanding from applicants to prove they can communicate in English since the training, the history taking, all the communication (or the vast majority of it) will be happening in English. It would even be quite dangerous to have someone who can't communicate in English training as a resident and later be working as a physician. The very same happens in QC, only in French.

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33 minutes ago, marrakech said:

Don't get me wrong - I think it's a great specialty including the reasons you mention.  But fees vary greatly by province - BC dermatologists aren't at all pleased, for example.  OTOH in AB it's a different story (but AB has high cost of living, etc...). 

And if the government could change the number of providers, and likely create a poor job market, they would.  The Feds are willing sponsor up to 40 Derm SONs/per year.  That's almost double the number of residency spots available in Canada.  In the US it's even harder to match to though, and many Derm keeners take a research year to boost their chances.    

Sorry to always be negative, but having less derm is GOOD for the govt. It means less people billing MSP. Having more derms wouldnt mean less billing to MSP. Having fewer providers, yes means those individual providers bill more(assuming they work more to meet demand) but the total amount billed to MSP would still be the same if all the demand was met by 2 derms or 4 derms. Except that in a given fiscal year those 2 derms can't meet the total demand themselves. Which is good. Leftover demand is carried forward(re: wait times) and kept in check.

The only way the govt would benefit is if they had more derms AND cut the reimbursment rate proportionally. 

Replace "derm" with any other speciality

(The SON for EM and DERM is a farce, they know very well at most a handful may match, but its mostly to placate the IMG lobby groups to say " look you have more than just FM as a choice, dont say we restrict your freedom")

Again, derm programs were smart: they resisted expanding, in that they likely knew that having less providers means that they would have the ability to work as much as they want (or not) without the worry of billing dropping..B/c that would be perceived as a blow to a already in demand group.. That as you can see is easily mobile.

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4 minutes ago, MDLaval said:

why should QC do it? French is the official language in the province, most of the patients and health professionals communicate in French.

The spots are open to anyone capable of communicating in French. 

It would be the equivalent of asking BC, Alberta, and SK to stop demanding from French schools' graduates to take the IELTS or to provide other evidence they can communicate in English in a healthcare setting. And there's nothing wrong in demanding from applicants to prove they can communicate in English since the training, the history taking, all the communication (or the vast majority of it) will be happening in English. It would even be quite dangerous to have someone who can't communicate in English training as a resident and later be working as a physician. The very same happens in QC, only in French.

1000% this. 

Instead, it would make more sense to take funding from 10-15 spots that are regularly left unfilled and move it to an English speaking program.

Of course that won't happen with the provincially fragmented system ha.

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13 minutes ago, JohnGrisham said:

Sorry to always be negative, but having less derm is GOOD for the govt. It means less people billing MSP. Having more derms wouldnt mean less billing to MSP. Having fewer providers, yes means those individual providers bill more(assuming they work more to meet demand) but the total amount billed to MSP would still be the same if all the demand was met by 2 derms or 4 derms. Except that in a given fiscal year those 2 derms can't meet the total demand themselves. Which is good. Leftover demand is carried forward(re: wait times) and kept in check.

The only way the govt would benefit is if they had more derms AND cut the reimbursment rate proportionally. 

Replace "derm" with any other speciality

(The SON for EM and DERM is a farce, they know very well at most a handful may match, but its mostly to placate the IMG lobby groups to say " look you have more than just FM as a choice, dont say we restrict your freedom")

Again, derm programs were smart: they resisted expanding, in that they likely knew that having less providers means that they would have the ability to work as much as they want (or not) without the worry of billing dropping..B/c that would be perceived as a blow to a already in demand group.. That as you can see is easily mobile.

I see what you're saying and do appreciate the discussion.  

I think my point of view is simple, though.  

Wait times are bad -> provincial government increases residency positions OR tries to use SONs to greatly bring in more providers -> market is flooded with providers with not enough jobs (despite paradoxically high demand) -> trained residents do endless fellowships locums, emigrate etc.. .  This is a pattern that's happened with other specialties.

I don't see any evidence of derm programs trying to keep the numbers down.  Here's a quote from the article above concerning conditions in BC:

"Dr. Evert Tuyp, the indefatigable Coquitlam dermatologist who heads the BCMA section of dermatology, said he’s been trying for years to raise awareness about the need to boost residency positions at the University of BC (only three finish the five-year training program each year) and to raise MSP fees to make BC more competitive in the recruitment arena."

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9 minutes ago, JohnGrisham said:

1000% this. 

Instead, it would make more sense to take funding from 10-15 spots that are regularly left unfilled and move it to an English speaking program.

Of course that won't happen with the provincially fragmented system ha.

yup, won't happen - they will create a wide net to get as many people as they can knowing likely they won't all get filled. They are ok with that. The province of Quebec like any other will protect its own interests. That is what it is supposed to do

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1 hour ago, MDLaval said:

why should QC do it? French is the official language in the province, most of the patients and health professionals communicate in French.

The spots are open to anyone capable of communicating in French. 

It would be the equivalent of asking BC, Alberta, and SK to stop demanding from French schools' graduates to take the IELTS or to provide other evidence they can communicate in English in a healthcare setting. And there's nothing wrong in demanding from applicants to prove they can communicate in English since the training, the history taking, all the communication (or the vast majority of it) will be happening in English. It would even be quite dangerous to have someone who can't communicate in English training as a resident and later be working as a physician. The very same happens in QC, only in French.

Agreed - my initial thought was meant to be more rhetorical than literal. Completely agreed that in the name of patient safety and clinical application, sufficient command of a language is important. A baseless musing :) 

However, I do see myself as being fortunate to be an Anglophone in a bilingual environment. I have been given the opportunity to bolster my French - still not quite at a level of confidence I'd like in a clinical setting, but slowly getting there. I have always been very pro-bilingualism, so this opportunity was very serendipitous. 

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5 hours ago, marrakech said:

Lots of medical & surgical specialists earn more $$$.  

More people = less jobs (&flexibility).

Derm hasn't really done anything special - it's a small specialty.  It's more like:

few dermatologists -> few residency programs -> few dermatologists...

 

I was mostly joking. I'm sure derm people love derm. It's a sweet set up. More power to them if you can tolerate the work. 

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Here's how you fix it.

 

1. Cut medical student spots by 5%

2. Reduce income equality between family medicine/pediatrics/psychiatry AND everything else. Alberta medical association has done a study and found that the gap between highest paid and lowest paid specialty is different by a factor of 3.3 EVEN AFTER ACCOUNTING FOR TRAINING TIME AND OVERHEAD COSTS. This means that the lowest paid specialist has to work a full work week to match 3 half days that a highest paid specialist works. That is the crux of the problem. I'm glad people brought up dermatology as an example. You can actually appreciate how this gap result in wider problems in our healthcare system as well. If a dermatologist can make as much as a full-time pediatrician in 1.5 days, they will. Guess what happens to the wait times? :)

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12 minutes ago, bloh said:

Here's how you fix it.

 

1. Cut medical student spots by 5%

2. Reduce income equality between family medicine/pediatrics/psychiatry AND everything else. Alberta medical association has done a study and found that the gap between highest paid and lowest paid specialty is different by a factor of 3.3 EVEN AFTER ACCOUNTING FOR TRAINING TIME AND OVERHEAD COSTS. This means that the lowest paid specialist has to work a full work week to match 3 half days that a highest paid specialist works. That is the crux of the problem. I'm glad people brought up dermatology as an example. You can actually appreciate how this gap result in wider problems in our healthcare system as well. If a dermatologist can make as much as a full-time pediatrician in 1.5 days, they will. Guess what happens to the wait times? :)

This will never happen.

The guys who make the money attend the same clubs as the politicians that make the decisions. 

On that level it becomes more about rubbing shoulders than evidence or policy. 

fm peds psych path and the other low paid specialties dont get that opportunity. theyre not part of the same class so they have no influence there.

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2 minutes ago, GrouchoMarx said:

This will never happen.

The guys who make the money attend the same clubs as the politicians that make the decisions. 

On that level it becomes more about rubbing shoulders than evidence or policy. 

fm peds psych path and the other low paid specialties dont get that opportunity. theyre not part of the same class so they have no influence there.

Sorry to burst your bubble but the gap is in the process of being remedied. 80% of the working MDs (across all fields) voted in favour of doing something about it and the initiative was began last year. This gap is enormous and has wide-reaching implications in our healthcare system from the early stages of medical school training, to relationships between healthcare professionals and to our system overall. You can actually see a tiny glimpse of the problem just in your comment alone (highlighted in quotes :)).


For comparison, this gap was only 50% 30-40 years ago and it's gotten truly out of hand.

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6 minutes ago, bloh said:

Sorry to burst your bubble but the gap is in the process of being remedied. 80% of the working MDs (across all fields) voted in favour of doing something about it and the initiative was began last year. This gap is enormous and has wide-reaching implications in our healthcare system from the early stages of medical school training, to relationships between healthcare professionals and to our system overall. You can actually see a tiny glimpse of the problem just in your comment alone (highlighted in quotes :)).


For comparison, this gap was only 50% 30-40 years ago and it's gotten truly out of hand.

im skeptical.

there will be many committees established to come up with a way to change it.

then nothing will happen and everyone will quietly forget about it.

that comment you bolded is the way life is. once youre on top like that, with other top people, youre untouchable unless you voluntarily relinquish your good fortune. 

its not just medicine thats like that. its the world. the haves keep having. nothing changes.

fm psych path peds will be underpaid. derm rads ophth will be overpaid. many tiny violins will be played.

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1 hour ago, NLengr said:

I was mostly joking. I'm sure derm people love derm. It's a sweet set up. More power to them if you can tolerate the work. 

Haha - I (mostly) realized that.  I just wasn't sure how many other people did.  People will believe what they want to believe to some extent.  I do try to look into things as much as possible.

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6 hours ago, JohnGrisham said:

1000% this. 

Instead, it would make more sense to take funding from 10-15 spots that are regularly left unfilled and move it to an English speaking program.

Of course that won't happen with the provincially fragmented system ha.

If you consider only Laval, there were 10 FM available in Quebec City after round 2. Not to mention the rural/remote ones that almost nobody wants. By doing that (taking the funding to an English speaking program), the problem would be too easily solved/reduced. That's why they won't/can't do it. Bureaucrats don't think like normal people (if at all :lol:).

One possibility would be for other provinces to sign up some sort of agreement with QC regarding a certain number of positions becoming available to CMG from other provinces, just like some Maritimes provinces have regarding positions in Med school in QC. But I think that would probably be too complicated to sort out and someone would end up challenging it in the Courts. 

Don't know if / how McGill could play a role in offering those unfilled positions to CMGs whose French isn't that good / virtually inexistent.

Indeed, the provincially fragmented system doesn't favour CMGs at all. 

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