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Surgical specialties with good job prospects?


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1 hour ago, Aurelius said:

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.

Because the government only cares about cost-control.  Medicine is expensive to administer, and already takes up a large amount of the governmental $$$ pie.  Yes patients will continue to deal with long wait times, with incremental changes here and there with technological efficiencies etc.

 

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If you are looking at large centers, there are no surgical specialties with good job prospects. Competition for jobs in big cities is intense. Even if you do a fellowship, lots of research and an adva

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

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).

Just in the two Midwest cities that I have lived in the US, I have seen a number of Canadian trained specialist surgeons (mainly ortho) working down here - mainly cause they can’t find appropriate work (even after fellowship) up north. They usually find work in academic places (which can sponsor or sign off on their visas) and which pay significantly less and are thus harder positions to fill with US trained orthos.
 

 

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On 5/11/2020 at 3:02 PM, 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?

The reality though is that theres always an oversupply because we overtrain and on top of that we have a lot of IMGs and others who are kind of waiting in the wings, ready to take a job if there comes an opportunity and so in reality, there will never be a real shortage. Most Canadian jobs pay well in the global scheme of things and academic centers are able to hire foreigners directly if they choose and theres a never ending supply of foreign talent willing to take those jobs. There will never be a shortage of surgeons unfortunately. 

Do a quick calculation and estimate the number of surgeons in any surgical specialty, divide that number by 30 and you estimate the # retiring each year add lets say 3-5% to that number to factor in population growth (1-2% per year) and aging. Compare that to the number of trainees entering both CMG + IMG. I can guarantee you the number of trainees will be higher even after you adjust for attrition. Then you need to factor in the number of foreign fellows (many of whom would love a job in Canada), foreign staff superstars (direct hires into Canada), IMG surgical assistants (may not currently be qualified but would in a pinch be ready) and government funded residents (some of whom would like to stay in Canada of which only a few find loopholes to do so) and you can quickly see that there will never be a shortage. At the end of the day, attendings like this because it keeps residents hungry and hungry residents do more work. 

I will put in a plug for US jobs though. I don't believe that all US jobs are worse. Many are good jobs that Canadians chose to go to over Canadian job offers as well. There are some great jobs in the US and some bad ones but all in all, I think we tend to unfairly negatively portray US jobs as all bad when in many cases they are actually better paid with better hours and/or more research funding etc. In certain specialties, US jobs are paid double with more vacation than Canadian jobs and many mid-career Canadian surgeons have even left cushy secure Canadian jobs for US ones. It really depends on the specific job and the specific specialty, but all in all I wouldn't say one is inferior to the other. 

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On 6/1/2020 at 6:14 PM, Edict said:

The reality though is that theres always an oversupply because we overtrain and on top of that we have a lot of IMGs and others who are kind of waiting in the wings, ready to take a job if there comes an opportunity and so in reality, there will never be a real shortage. Most Canadian jobs pay well in the global scheme of things and academic centers are able to hire foreigners directly if they choose and theres a never ending supply of foreign talent willing to take those jobs. There will never be a shortage of surgeons unfortunately. 

Do a quick calculation and estimate the number of surgeons in any surgical specialty, divide that number by 30 and you estimate the # retiring each year add lets say 3-5% to that number to factor in population growth (1-2% per year) and aging. Compare that to the number of trainees entering both CMG + IMG. I can guarantee you the number of trainees will be higher even after you adjust for attrition. Then you need to factor in the number of foreign fellows (many of whom would love a job in Canada), foreign staff superstars (direct hires into Canada), IMG surgical assistants (may not currently be qualified but would in a pinch be ready) and government funded residents (some of whom would like to stay in Canada of which only a few find loopholes to do so) and you can quickly see that there will never be a shortage. At the end of the day, attendings like this because it keeps residents hungry and hungry residents do more work. 

I will put in a plug for US jobs though. I don't believe that all US jobs are worse. Many are good jobs that Canadians chose to go to over Canadian job offers as well. There are some great jobs in the US and some bad ones but all in all, I think we tend to unfairly negatively portray US jobs as all bad when in many cases they are actually better paid with better hours and/or more research funding etc. In certain specialties, US jobs are paid double with more vacation than Canadian jobs and many mid-career Canadian surgeons have even left cushy secure Canadian jobs for US ones. It really depends on the specific job and the specific specialty, but all in all I wouldn't say one is inferior to the other. 

Agree with the above RE: US jobs (esp in ortho).  Even though academic jobs in the US are less desirable, they pay about the same as a standard Canadian position with the potential for more. Salaries go up by 30-100% in the community with underserved areas paying the high end.  Alternative revenue streams--e.g. surgical center co-ownership, stock and investment options--are also common. I had a conversation with one of my colleagues about leadership track positions and his honest answer was that income potential is equal or better as a surgeon so very few orthopods will bother. 

For anyone entering or considering orthopaedic training in Canada, my current advice is make sure you have an escape plan before you start and jump through the hoops in a time appropriate manner. I had to go back and do the USMLEs late in my residency and it wasn't fun. 

I think the US is reasonable, and increases to desirable if you have immigration rights (and can tolerate living here). 

Some food-for-thought about supply and demand below:

Supply-demand issues are complex and also need to anticipate changes in demand for the service.  The broad consensus in the US is that there is a massive under-supply of orthopods due to the predicted rising demographic demand for geriatric services (hips and knees mostly). I think it's common knowledge, but it bears repeating that elective procedures are revenue generators for hospitals in the US due to procedurally coded insurance reimbursement to hospitals. By contrast, in Canada funding for everything other than the surgeon and possibly the assist comes from the hospitals general fund.  Some alternative funding models exist for some procedures but there is usually capitation and efficiency incentivization which has the same effect as general budgeting. Though there are some cultural differences regarding willingness to undergo surgery, the demographics largely hold true in Canada as well as the US. The primary modulator of demand in Canada is the social willingness to fund surgical procedures filtered through the political lens. 

Access to the US training market is pretty similar to Canada and more Orthopods are trained in the US per capita. IMGs can/are trained more easily here as there is access for visa holders for training though specialty certification is limited to Americans and Canadians in the absence of a domestic residency in surgery.  But there's still a real labour shortage that's anticipated to worsen. Blaming over-training is oversimplifying the larger root cause analysis of over-educated underemployment for surgeons. 

That said, I've written darker posts about why Canada continues to train more surgeons than its willing to employ (not the same as what is needed) and advocated that Canada should decrease the number of trainees or take responsibility for finding other prospects for them.  I've advocated for an increased role for associated health professionals to pick up the gaps currently filled by residents. Certainly the comic disingenuousness of the ROS program needs to end. I'll still stand by most of those points.

However, I'd like to highlight the other side of the demand issue.  There's a market failure in Canada such that the demand for surgical services is moderated by the various governments.  Things could potentially change overnight due to political pressure or structural changes. That may be on the horizon, I don't really keep my finger on that pulse.   I do think the employment market will change in the future due to the underlying demographics but when that will happen is anyone's guess. 

There are lots of other odd things about the Canadian market especially in orthopaedics to factor in.  Average retirement age and work product efficiency jump to mind. All those factors need to be considered to get a real answer and predictive capability over the surgical labour market. 

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On 5/31/2020 at 10:33 AM, Neuro-phys said:

Just in the two Midwest cities that I have lived in the US, I have seen a number of Canadian trained specialist surgeons (mainly ortho) working down here - mainly cause they can’t find appropriate work (even after fellowship) up north. They usually find work in academic places (which can sponsor or sign off on their visas) and which pay significantly less and are thus harder positions to fill with US trained orthos.
 

 

Agreed.  It's not as though we're a significant part of the work force but it's not uncommon.  Permanent immigration status is key to getting out of academics. 

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On 6/22/2019 at 7:56 AM, user123456 said:

I don’t mind going through all the academics (fellowship/msc/phd) and working very hard. Just as long as there is possibility at a GTA/Hamilton/Calg/Vancouver hospital

If you are among the best in your surgical cohort (i.e. you work harder than your other co-residents) and you get along well with people, this is possible. Otherwise its not. Just being willing to go through all the academics is not enough. Doing a PhD is not enough, you need to be very productive during it. 

I think the answer is that it is doable, but you should not expect that if you go through the motions you will get a job there.

Not sure if this is what you are thinking but... if you are hoping to be in a big city because you like city life, I would think again. The people who are in the big city, work so hard they don't enjoy the big city. So either way, you aren't enjoying city life.  

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6 minutes ago, Edict said:

If you are among the best in your surgical cohort (i.e. you work harder than your other co-residents) and you get along well with people, this is possible. Otherwise its not. Just being willing to go through all the academics is not enough. Doing a PhD is not enough, you need to be very productive during it. 

I think the answer is that it is doable, but you should not expect that if you go through the motions you will get a job there.

Not sure if this is what you are thinking but... if you are hoping to be in a big city because you like city life, I would think again. The people who are in the big city, work so hard they don't enjoy the big city. So either way, you aren't enjoying city life.  

I completely agree. Yea, the odds aren't great as you have to assume you can outwork other driven and capable residents. The other end of medicine is simply not as structured as the first part. Networking and luck can start to play a disproportionate role. You can be an amazing candidate on paper but there can often be another person that the hiring committee is fixated on because of intangibles, politics, etc.

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On 12/29/2020 at 6:50 PM, Edict said:

If you are among the best in your surgical cohort (i.e. you work harder than your other co-residents) and you get along well with people, this is possible. Otherwise its not. Just being willing to go through all the academics is not enough. Doing a PhD is not enough, you need to be very productive during it. 

I think the answer is that it is doable, but you should not expect that if you go through the motions you will get a job there.

Not sure if this is what you are thinking but... if you are hoping to be in a big city because you like city life, I would think again. The people who are in the big city, work so hard they don't enjoy the big city. So either way, you aren't enjoying city life.  

100% this. It is simply not enough to work longer hours than everyone else, be smart, be technically capable, etc. There are reasons why people say to only do surgery if you cannot imagine doing anything else. The road is long and you'll pretty much consider quitting on the daily. Just met a colleague the other day who is on his third ortho fellowship, after being on literal opposite ends of the country for his previous fellowships.

Also consider whether there is a certain idealization of these big cities/large centers. The cases may be higher volume, more difficult, more acute, etc. but the work environment can definitely be a shark tank

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