Specialty training out-of-sync with job market

[moo]

FYI, from CMAJ

 

 

Lauren Vogel

 

+ Author Affiliations

 

CMAJ

 

A national forum should be convened to align postgraduate training with the realities of the job market, as flatlining demand for once highly sought-after specialties is leaving an increasing number of new graduates without work to match their skills or pay down their debts, Canadian Medical Association delegates say.

 

Delegates to the CMA’s annual general meeting in St. John’s, Newfoundland, adopted a resolution on Aug. 23 that will compel the association to promote a national alignment of training positions with “current and future societal needs, evolving models of care delivery and available health systems resources.”

 

CMA should also assist physicians during all stages of their careers, with “special emphasis on helping medical students and residents make informed career choices by providing job-trend data and other career-planning resources,” delegates said.

 

New graduates specializing in orthopedic surgery, cardiac surgery, neurosurgery and nephrology are among those unable to find jobs — although, ironically, the glut of specialists comes at time when Canada is struggling with physician shortages and long wait times for specialist care, Dr. Shirley Sze says.

 

The crux of the problem, Sze earlier told delegates, is poor human resource planning on the part of the provinces, and a lack of career planning information and resources provided to medical students before they start specialist training.

 

“There needs to be a national review of the specialty training spots and jobs that are available because residents match across Canada for their training positions, not just provincially,” she explained.

 

About half of all resident physicians in Canada are concerned about finding employment, Dr. Roona Sinha told delegates. “As residents preparing to enter into practice, we want to be able to use all the skills and knowledge we have gained during our training to treat Canadian patients.”

 

“It’s not useful or fair for the system to train us if there are no positions for us in the end,” she added.

 

As it stands, there are few sources of job-trend data readily available to medical students, and attempts in Ontario and British Columbia to provide work-force information “is not coordinated,” Sze says.

Figure

 

Many graduates specializing in orthopedic surgery, cardiac surgery, neurosurgery and nephrology are unable to find jobs.

"Image courtesy of © 2011 Thinkstock"

 

Students are required to make career choices earlier in their schooling than ever before, she adds. “Before, you would graduate from medical school, do a year of rotating internships and then decide. Now that decision is being made in second or third year.”

 

With the average medical student facing some $158 000 in debt on graduation, many students gravitate to higher-earning specialties without a notion of the demand for such professionals, Sze says.

 

But Canada’s aging population and the increasing incidence of chronic disease is driving a need for generalists. “There’s changing medical practices and changing trends so you need to train the doctors that are able to cope with them,” Sze explains. “If we don’t inform our young people about these changes, and where the work is going to be, how can we possible meet future demands on the system?”

 

Other health human resources resolutions included ones that compel CMA to:

 

examine the effect of increasing population longevity on sustainability of health human resources;

 

examine practice location patterns of medical schools graduates to urban/rural distribution implications; and

 

develop a toolkit to promote adoption of practice redesign techniques to enhance access to care.

 

Such health human resource issues have surfaced annually at CMA annual general meetings since the collapse of a major push for the creation of a comprehensive “pan-Canadian” strategy for educating, recruiting, licensing and equipping doctors that was recommended by a blue-ribbon panel called Task Force Two in 2006.

 

The comprehensive plan, A Physician Human Resource Strategy for Canada: Final Report, urged wholesale reforms in five areas related to physician supply — education and training; interprofessionalism; recruitment and retention; licensure, regulatory issues and liability; and infrastructure and technology — while proposing that responsibility for overhauling the current system be vested with some manner of national agency (http://www.cmaj.ca/cgi/doi/10.1503/cmaj.060598).

 

The proposal was eventually consigned to gather dust on library shelves after it became mired in quintessential Canadian squabbles over jurisdiction. Various medical associations argued that they shouldn’t have to relinquish their licensing authority, while several provinces objected to a national approach to health human resources on the grounds that it would limit their ability to recruit doctors to underserviced areas.

[Renin]

Yikes. I certainly don't want to be an unemployed physician. Thanks, Moo.

[moo]

This is why I urge all medical students to consider future employment prospects when choosing a specialty. Many who train in ortho or other specialties need multiple fellowships, masters degrees, etc. before they can obtain a job. The safest specialties are the ones that allow you to set up a private practice. Relying on being employed at an academic center or OR time (uber-specialists or highly procedural-based specialties) is never a good thing as you're at the mercy of someone else.

[moo]

Haha, the CFPC will never back down from that. It's actually quite disgusting when you see the CFPC demanding money from you to keep using the CCFP designation (and if you've been a member for 10 years and paid them every year and got the required CME credits, you get the privilege of using the FCFP designation). Unfortunately we will never see the general internship ever again as (all?) provincial colleges now require new grads to either have the CCFP or FRCPC to get a license.

[Renin]

Perhaps someone should write a letter to the CMAJ and put the word out that the biggest reason for our so-called primary care shortage is the college of family physicians AKA the Napoleon-complex doctors.

 

They think it creates prestige when in fact it does the exact opposite. AND because of this it drives smart folks away from primary care, and unfortunately dumb ones into it (and yes there were people in my graduating class who went into FP that had no knowledge of anything, because they didn't need to! FP is open to anyone with a pulse!)

 

Before some holier-than-thou primary care zealot comes in and attacks me, I didn't say only stupid people go into FP. It's just that its more likely that stupid people can get into it because the bar is set so low.

 

There are only about 30-40 spots open for family this year; and only about half of them are for urban spots. I'd say that if you wanted "family medicine" it would be one of the not as competitive specialties, but the "urban" stream will be a lot more popular than the "rural" and "northern" streams.

 

Of the people I've spoken with that want family, everyone wants urban.

[Renin]

You make an excellent point. There is no incentive for medical graduates to pick rural medicine over urban, even in primary care.

 

This maldistribution problem could be easily solved by reverting to the general internship model, where newly minted licensed doctors could practice locums in rural areas to pay down debts and explore other options. I've said it before and will say it until they prove otherwise: The CCFP are stupid.

 

Nonetheless, FP anywhere is about as competitive as getting a job at Tim Hortons.

 

Well, I guess it's a busy Tim Hortons - I'm putting in an application this year for rural family med. Keep your fingers crossed for me

 

I think that there should be more support for rural family practitioners; I've heard some pretty terrible stories where new grads are just "tossed into the woods" (as a preceptor told me); and you have to set up everything yourself - your practice, clinic, billing, etc ... then find out that all the people in the area would rather drive the 2hrs to go into Winnipeg to get care anyway.

[Lactic Folly]

Might be province dependent. Some of our rural family med spots were quite competitive, for the perceived better training.

[NLengr]

I also agree that a return to the general practitioner system would improve.

 

As for being thrown into it with no education about setting up practice, billing, scheduling etc. That's pretty much the story for any residency. Family or specialist, rural or urban.

[Jochi1543]

There are only about 30-40 spots open for family this year; and only about half of them are for urban spots. I'd say that if you wanted "family medicine" it would be one of the not as competitive specialties, but the "urban" stream will be a lot more popular than the "rural" and "northern" streams.

 

Of the people I've spoken with that want family, everyone wants urban.

 

Not the case here. Our rural FM program is very competitive (>10 people/spot in some sites) and there are definitely many people in my class who are very keen on rural FM - especially for residency training.

[aaronjw]

This is actually, not true, believe it or not. At least in ontario, the rural spots are in fact more competitive than the urban spots. The main reason is because they are more hands-on and there are less spots in rural family compared to urban family. So chances are, the leftover spots (again, this is for ontario) are probably urban. The only exception was I think UofT that had 2 spots in barrie (which is not really rural).

 

To city slickers in TO, it sure seems rural.

[JB.]

I can't believe they counted Barrie as rural! LOL

[Corie]

Sorry for my lack of knowledge on this matter. Are FP residencies competitive in Ontario right now?

[NLengr]

In other related news, my training center is being pressured by the government to add IMG spots to all residency programs despite concerns about too many residents in the programs. PD's have the understanding that this is from the governmental level so they can win political points by telling the public more IMG's are being trained.

 

To make things worse, I have heard that if you say that you don't have room for an additional IMG spot, you are told that if you are too full a CMG spot has to be axed to make room.

 

I haven't seen any of this in writing, but I have no reason the believe various staff would lie to me.

[thehumanmacbook]

This is actually, not true, believe it or not. At least in ontario, the rural spots are in fact more competitive than the urban spots. The main reason is because they are more hands-on and there are less spots in rural family compared to urban family. So chances are, the leftover spots (again, this is for ontario) are probably urban. The only exception was I think UofT that had 2 spots in barrie (which is not really rural).

 

Really? I'm a bit confused though - last time I was in Northern Ontario (NOSM) people kept complaining about how their rural spots weren't being filled :S

 

Not doubting you or anything - just unsure of how the system works towards this.

[Renin]

In other related news, my training center is being pressured by the government to add IMG spots to all residency programs despite concerns about too many residents in the programs. PD's have the understanding that this is from the governmental level so they can win political points by telling the public more IMG's are being trained.

 

To make things worse, I have heard that if you say that you don't have room for an additional IMG spot, you are told that if you are too full a CMG spot has to be axed to make room.

 

I haven't seen any of this in writing, but I have no reason the believe various staff would lie to me.

 

I have a friend who is an IMG who asked me, quite earnestly, why CMG's hate IMG's.

 

Unfortunately, they're sort of being set out to be our "opposition" quite early in the game with policies like this. I am hoping to apply to a program which has traditionally been >50% IMG, so I think this will be quite interesting to see the dynamics.

[NLengr]

Well a from a tax payer perspective, it's stupid because the province has spent $500k to train CMG's, so axing CMG spots is the same as burning all that money in an oil barrell.

[Renin]

Well a from a tax payer perspective, it's stupid because the province has spent $500k to train CMG's, so axing CMG spots is the same as burning all that money in an oil barrell.

 

YAY! I'm worth 500k.

[rmorelan]

I take it that there's a spectrum of what's considered rural. NOSM rural may be too rural for anyone. The "rural spots" for say mac, UWO, UofT aren't nearly as rural as what you'd expect to find in northern ontario. They give you the advantage of more hands-on training, more autonomy as a physician, while still having a lot of social amenities and being relatively close to the bigger cities.

 

Take a look at the various FM site on the carms website for each FM program in ontario. You'll see places like grimsby, K/W, sarnia, chatham all considered rural, but those are still relatively populated areas.

 

yeah their definition of rural is kind of funny. I grew up in the the K/W area and we are anything but rural there

[rmorelan]

Sneaky moves. They're creating specialist gluts to entice more people into primary care.

 

Instead of this career-planning bull**** that's being spewed from these imbeciles, we should revert to the general internship once again. That'd fix all problems. The first step however is to knock the CCFP down from its "high" horse and make them realize that their demand for a 2-year FP residency before anyone can practice generally is what's creating this mess in the first place.

 

Creating a speciality glut is a pretty stupid way of getting people into primary care If the government wanted to more primary care workers it could quicker, cheaper, and less painfully just further restrict the number of residency positions.

 

Part of the problem is that overall the doctor shortage is ending in many areas I think, coupled with issues of residency positions being maladjusted. We are just going to have to get used to the idea that is a more competitive work environment and career planning is going to be very, very important as a result.

[Mourning Cloak]

Really, you're working on getting your specialty starting in clerkship. Does any third year med student really know anything about manpower planning in their specialty seven years hence (when they'll be looking for a job)?

 

I doubt it.

 

The specialties themselves need to be more proactive in regulating these booms and busts. If the number of jobs are dropping, they need to scale back the residency programs. If there are too many jobs are available, they need to expand the residency programs.

 

Leaving the market to regulate itself (e.g. the glut of grads scares off applicants, and the number of specialists gradually drops until there's a paucity, at which point students begin going back to it) is too crude a method.

[NLengr]

Planning was also thrown out of whack in 2008 with the market crash. Many of the boomer docs who planned to retire soon (say within 5 yrs) lost huge amounts of retirement money (30% seems like a common number). As a result, they didn't retire as planned, making things more difficult for new docs lately.

[Guest copacetic]

the recession is the biggest reason for the glut

[TheBoss]

I take it that there's a spectrum of what's considered rural. NOSM rural may be too rural for anyone. The "rural spots" for say mac, UWO, UofT aren't nearly as rural as what you'd expect to find in northern ontario. They give you the advantage of more hands-on training, more autonomy as a physician, while still having a lot of social amenities and being relatively close to the bigger cities.

 

Take a look at the various FM site on the carms website for each FM program in ontario. You'll see places like grimsby, K/W, sarnia, chatham all considered rural, but those are still relatively populated areas.

 

So by Ontario standards, would the entire province of Saskatchewan be considered rural? Kind of looks like it.

[TheBoss]

...and Manitoba, and most of Alberta and Quebec, and all of NFLD, and all of PEI, NS, and NB.

 

So, yes.

 

Well Manitoba, AB, and QC each have at least one urban center; there's an important difference between most and all. Also, pretty much everyone considers the territories and the east coast entirely rural anyways.

[mavrik13]

Well Manitoba, AB, and QC each have at least one urban center; there's an important difference between most and all. Also, pretty much everyone considers the territories and the east coast entirely rural anyways.

 

 

Pretty sure I'm living in a city of 400,000 people... not exactly 'rural'. Maybe for you Upper Canadians.