Time to panic?!

[nosuperman]

When I interviewed for Deakin (Australia) the guy said he'd recently met with Sandra Banner from CaRMS and he said the next couple years there would likely (unless some unpredicted infusion of funding for residencies from the government were to occur) be progressively tougher on IMGs as Canada is upping its med school acceptance numbers and won't have to worry about even looking at a comparable increase in residency spots until a couple of years.

 

Now Sandra also told me, in a separate correspondence, that doing a second undergrad as opposed to going to Australia would be "taking a step backward" (i.e. it sounded like she favoured the IMG route) because its taking a non-guaranteed route but from the looks of things matching in CaRMS and even in the US isn't guaranteed, especially outside of FM... so either way you're gambling.

 

Take from it what you will, ultimately nobody knows for sure what's going to happen.

[macballa]

If the Canadian government does increases the domestic med school seats, won't those who leave this year for instance, be alright as the students who are admitted into those increased seats will take some time to graduate depending on when the increase occurs no?

[leviathan]

If Canada is re-evaluating, couldn't that also mean more residency positions opening up for canadian IMGs? Or do you mean to say that they will increase the number of medical school spots here for canadian citizens.

 

I mean reevaluating as in, they are thinking that there isn't as much of a shortage as they thought, and all these IMG positions they were funding might go bye-bye.

[redshifteffect]

The idea that there is a "shortage" of doctors in Canada, especially provinces like Ontario is a bit of a misnomer. The truth is the shortage is only in a very few select fields, and if you're not in those fields you will have a hard time getting a job.

 

You have to pick which speciality you do very carefully, especially if you have a fixed idea where you want to live/work as it can be extremely competitive in some fields/areas to get employment.

[Mourning Cloak]

I mean reevaluating as in, they are thinking that there isn't as much of a shortage as they thought

 

See this report out of the CMA.

 

http://cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/Projections_paper.pdf

 

Summary:

The shortage projected in 1999 is not as severe as it was predicted to be, owing to several factors:

1) the number of first year med school places has increased by almost 900 positions since 1997 (a greater than 50% increase)

2) emigration has slowed down considerably from losing around 500-600 each year to around 200

3) fewer than expected number of physicians retiring; it appears that many wish to retire but for financial reasons cannot

 

These factors alone would have been enough to drastically improve the supply of physicians during the post 1999 period but in addition:

 

4) Statistics Canada's projections overestimated the population

 

In addition, Canada wishes to avoid the UK's mistake (faced with the same projected shortage, the UK increased physician production enormously, and now apparently there is quite the physician glut). All of this may lead to the country gradually easing back on the number of physicians produced per year. I would guess that the IMG residency spots would be the first target for reduction.

[Mashmetoo]

See this report out of the CMA.

 

http://cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/Projections_paper.pdf

 

"As a consequence of [the projected MD shortage], the number of first year places has increased by almost 900 positions since 1997(a greater than 50% increase), including the creation of the first new medical school (Northern Ontario School of Medicine) in almost 40 years.

 

Since the projections of 1999, emigration has slowed down considerably from losing around 500-600 each year to around 200. The number of physicians returning to Canada has remained steady around 300 meaning that for the last few years, Canada has benefited from a net gain of some 50 doctors.

 

Another phenomenon that has occurred since 1999 has been the fewer than expected number of physicians retiring. Based on comments attached to survey questionnaires, it appears that many wish to retire but for financial reasons cannot . . . .

 

These factors alone would have been enough to drastically improve the supply of physicians during the post 1999 period but in addition, Statistics Canada released revised population projections which were significantly lower than the previous iteration. This had a denominator affect, meaning the ratio would improve even if the number of physicians had remained static" . . . .

 

The UK has seen enormous increases in the production of physicians and some feel they may have “overshot the mark” . . . .

 

In summary, there are many forces that will seemingly reduce our effective supply of physicians in what appears to be a relatively bountiful future scenario. To what extent this will be felt and to what extent we are still in catch-up mode warrants constant further investigation and constant monitoring.

 

mmhmm, this is a very interesting piece of news. 200 Canadian physicians going South to practice each year is still equivalent to our losing an entire school of medical graduates the size of UofT each year... But things do seem to be much better than 1999.

[rmorelan]

Very intersting article actually - does this suggest that there will be less likely to be further increases in enrollment? All you generally hear about is the shortage constantly.

 

See this report out of the CMA.

 

http://cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/Projections_paper.pdf

 

Summary:

The shortage projected in 1999 is not as severe as it was predicted to be, owing to several factors:

1) the number of first year med school places has increased by almost 900 positions since 1997 (a greater than 50% increase)

2) emigration has slowed down considerably from losing around 500-600 each year to around 200

3) fewer than expected number of physicians retiring; it appears that many wish to retire but for financial reasons cannot

 

These factors alone would have been enough to drastically improve the supply of physicians during the post 1999 period but in addition:

 

4) Statistics Canada's projections overestimated the population

 

In addition, Canada wishes to avoid the UK's mistake (faced with the same projected shortage, the UK increased physician production enormously, and now apparently there is quite the physician glut). All of this may lead to the country gradually easing back on the number of physicians produced per year. I would guess that the IMG residency spots would be the first target for reduction.

[redshifteffect]

Very intersting article actually - does this suggest that there will be less likely to be further increases in enrollment? All you generally hear about is the shortage constantly.

 

That's the problem, most of the time it's the uninformed media or laymen spouting that information. Unfortunately it ends up encouraging people, when in reality there isn't as much of a shortage in many areas as people think.

 

Anyway trying to look for gainful employment in all but a few select areas will tell you, it's quite competitive, even for fellowships in the current environment (unless of course you're interested in family med).

[Mashmetoo]

That's the problem, most of the time it's the uninformed media or laymen spouting that information. Unfortunately it ends up encouraging people, when in reality there isn't as much of a shortage in many areas as people think.

 

Anyway trying to look for gainful employment in all but a few select areas will tell you, it's quite competitive, even for fellowships in the current environment (unless of course you're interested in family med).

 

There IS a shortage - of family doctors. No one ever said anything about having a shortage of plastic surgeons and Neurosurgeons. All that media hype was on how ordinary people can't even find a FAMILY doctor and can't even access the first gate of primary care. This is why ~50% of Canadian med grads end up matching in family medicine residencies.

[Mourning Cloak]

There IS a shortage - of family doctors

 

Currently, the country of Canada is short by 3,244 family physicians.

 

http://www.cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/10-FP_Shortage-E.pdf

 

Is that less or more than you thought?

[rmorelan]

Currently, the country of Canada is short by 3,244 family physicians.

 

http://www.cma.ca/multimedia/CMA/Content_Images/Policy_Advocacy/Policy_Research/10-FP_Shortage-E.pdf

 

Is that less or more than you thought?

 

I am still trying to digest that article What is interesting is the increase in FP of about 2000 in the last 5 years. If we really do have a shortage of only 3000 we will have meet the needs for that within the next 7ish years at this rate (enrollments at med schools continue to climb so that rate would in theory increase not decrease). So that would suggest we should actually stop even thinking about further expansion.

 

The article doesn't deal well with rural shortage though - increase the number of doctors and they will not all evenly spread out. Some will accept lower pay to live in the city. You have to have extra supply in the current system to drive down income enough in the big cities to push more outwards.

[leviathan]

You have to take into consideration that although we may only be short 3k now, the average of physicians in Canada is what..55? And the number of people getting into their age where they will need health care services the most (the baby boomers) are also rising quite high. I think part of the 'shortage' scare also encompasses predictions for future need. Whatever number of new physicians coming out to address that shortage are probably not going to maintain a narrow gap forever.

[rmorelan]

You have to take into consideration that although we may only be short 3k now, the average of physicians in Canada is what..55? And the number of people getting into their age where they will need health care services the most (the baby boomers) are also rising quite high. I think part of the 'shortage' scare also encompasses predictions for future need. Whatever number of new physicians coming out to address that shortage are probably not going to maintain a narrow gap forever.

 

That is the point of the article and why I am still trying to digest it - it DOES take most of those things in to consideration. It factors in the reduction of hours worked due to the new medical culture (we don't all want to work ourselves to the bone etc), the aging population and how that will increase load, the current work loads etc. Some aspects of the article I am not entire convinced about yet, but it is an interesting analysis for sure!

 

Also if I am reading this correctly the average age of a family doctor is less than 55 (probably fifty?) which is kind of in the middle of the 30-35 year career span.

 

Nothing in this article (even if it is completely correct) is going to make an immediate change on things but at the rates it is talking about by the time someone would get into medical school (say a year) and graduate in FM (6 years), the shortage will be considerably less. That would have big implications on career choices etc.

[leviathan]

Oh haha not gonna lie...didn't actually read the article since I shouldn't even be on pm101 right now when I have the pathology shelf in the AM. But, respect!

[Mourning Cloak]

The article doesn't deal well with rural shortage though - increase the number of doctors and they will not all evenly spread out. Some will accept lower pay to live in the city. You have to have extra supply in the current system to drive down income enough in the big cities to push more outwards.

 

That occurred to me, too.

 

Relative oversupply of FPs in city = fewer pts/FP = lower income = moving to periphery.

 

I wonder how far physician take-home would have to drop in the city to push enough people out into the country to eliminate the shortage there, or whether the system will merely accept that rural shortages are a fact of life. We'll have to wait and see.

[rmorelan]

That occurred to me, too.

 

Relative oversupply of FPs in city = fewer pts/FP = lower income = moving to periphery.

 

I wonder how far physician take-home would have to drop in the city to push enough people out into the country to eliminate the shortage there, or whether the system will merely accept that rural shortages are a fact of life. We'll have to wait and see.

 

Yeah it is going to be interesting - the fact that family doctors in general earn more than they used to is not going to make them want to move either - you are going to need more FP than ever to drive some of them out

 

Part of the problem is universal rates of pay regardless of location. In anything else with a drop in supply a rise in price would occur which would directly encourage people to in turn increase supply. This would be the equivalent of a rural FM doctor earning more than a city FM one which would tend to spread around the doctors more.

[Mourning Cloak]

This would be the equivalent of a rural FM doctor earning more than a city FM one which would tend to spread around the doctors more.

 

Why don't they do this, then? Sounds fair enough - you're willing to practice where most people won't (say Nunavut), you get better billing fees. If you want to practice in Vancouver, you take a hit.

 

It seems like a better option than mandating where FPs can settle (a la Quebec) which would also even things out.

[nosuperman]

So city docs take a pay cut of sorts... they're presumably going to be able to fill a waiting room more easily than rural docs... cue city docs chugging through more patients to compensate for the pay loss?

[rmorelan]

Why don't they do this, then? Sounds fair enough - you're willing to practice where most people won't (say Nunavut), you get better billing fees. If you want to practice in Vancouver, you take a hit.

 

It seems like a better option than mandating where FPs can settle (a la Quebec) which would also even things out.

 

Good question - I think in part it is because basically the OMA is basically a union and like all unions they work out income to be the same for the same activity for all members. It also reduces any form of in fighting, and prevents billing codes from becoming even more complex.

 

Also since the rules prevent doctors from getting funding from anyone except the province the local communities have restrictions on what they could do (otherwise some would find a way to supplement the income). There are a few programs though that do allow such things to occur though.