U of T rejects 2400+ people every year...

[apache]

science students also specialize in thinking that working more is the only way to make more money… primary care can be a cash cow from the rich in 25 percent of your practice... meaning you can average out a decent salary to provide awesome care during that other 75 percent of the time anyways.

 

doctors should stop whining about pay too… i only make 200 g, life sucks… either stop whining or whore your self out and make your half a mil… just stop *****ing, doctors get paid enough.

 

Because most premeds come from a science background, and in science the only way to succeed is to become more specialized?

 

aaronjw, you understand that its only the specialists who are facing a job market glut right now, right? The 'holistic' manner to address the problem is to stop people from becoming so specialized and to have them go into primary care.

 

Is this a problem, from your perspective? To me, its not. If people want better work from their primary care physician, perhaps they should pay for better training and CME for primary care.

[moo]

The problem is not the physician/population ratio. Canada's physician/population ratio is lower than the OECD average it seems.

 

In BC, for the first time in a long time, all MOH positions have been filled, even the undesirable and rural positions. Not a single opening. The one urban opening this year was filled by someone else from the feds with a ton of experience, as they are experiencing job cuts in that sector of government. So even in rural BC you can't get a traditional public health job anymore. And we all know that everyone is clamoring for these desirable urban locations that they won't hire a new grad. I'm sorry but I'm not uprooting my family to move to rural Canada for x number of years while waiting for a position to open up in Vancouver (even if there were positions available). As recently as four years ago there were openings in urban areas filled by new grads. Not only is that door shut, but so are the previously undesirable rural locations.

[10wattbulb]

So you'd rather train for 10 plus years only to realize that there are no jobs where you want to work or no jobs period? Or be stuck in a miserable specialty? Great. Why don't we open the floodgates and let everyone who wants to be a doctor in.

 

MD spots need to be cut by 50% at least.

 

We agree to disagree, moo . But don't twist around my argument by suggesting that we should open the floodgates. I never warranted such a thing.

 

Whoah, cutting MD spots by 50%; Ha ha... Very drastic! That's gonna do a lot of good to the disadvantaged populations in rural towns who already have a difficult time recruiting an MD in their regions even with the apparent "too large supply of MDs" (according to your arguments). Oh boy...

 

Too many people get into Med school these days thinking that life will be easy afterwards. Now they're realizing that manna doesn't fall from the sky; not even for the MDs. So harsh... :sarcasm:

[mm88]

 

Whoah, cutting MD spots by 50%; Ha ha... Very drastic! That's gonna do a lot of good to the disadvantaged populations in rural towns who already have a difficult time recruiting an MD in their regions even with the apparent "too large supply of MDs" (according to your arguments). Oh boy...

 

 

I don't think cutting spots at the vast majority of Canadian schools will make a difference to the "disadvantaged populations in rural towns", the people that usually end up practising there are usually graduates of schools like NOSM, Dal@UNB and MUN which account for only a very small fraction of the total med school seats in the country.

 

I believe Moo was referring to cutting seats at the big urban schools like UBC VFMP and UofT, where most of the students have 0 intention of rural practice upon graduation. And don't tell me that's not true. I KNOW it's true.

[Robin Hood]

I don't think cutting spots at the vast majority of Canadian schools will make a difference to the "disadvantaged populations in rural towns", the people that usually end up practising there are usually graduates of schools like NOSM, Dal@UNB and MUN which account for only a very small fraction of the total med school seats in the country.

 

I believe Moo was referring to cutting seats at the big urban schools like UBC VFMP and UofT, where most of the students have 0 intention of rural practice upon graduation. And don't tell me that's not true. I KNOW it's true.

 

Then he should have said it. Also, are we that in a surplus to suggest cutting seat by half? As for rural centers, maybe there should be more redistribution, like transfering some seats from a big city to a smaller one for schools that have a satellite campus, setting up a new satellite campus, and increasing spots at NOSM.

[mm88]

Moo doesn't really need to say anything, because he probably already knows service to rural region won't really be affected by 50% cuts across the board!

 

You don't mean to tell me that more than 50% of the aspiring grad of UdeS, UdeM, McGill wants to go to Lac St-Jean, or worse, Ungava bay to be a family doctor, do you? No? Well 50% cuts really don't make a difference to under serviced regions, because none of those 50% that aren't getting anymore were going to go to the middle of nowhere anyway. It's already a known fact that some people don't stick to their RoS and there is nearly no way to force them to, transferring seats might mean that people going to those rural places for school will leave afterwards.

 

Maybe the 50% cut will encourage people to actually MOVE up north/to rural areas for special resident statues there so they can go to places like NOSM and then maybe people will have sufficient vested interest to stay in those places.

 

Funny how the 2 camps for seat reduction in schools turned out like this:

 

-pre-meds are against the cuts

-med students/practising doctors for the cuts

 

People/MDs like Moo apparently have ulterior motives for keeping people from becoming doctors... Wouldn't you say that certain people also have motives for wanting more doctors?

[aaronjw]

We agree to disagree, moo . But don't twist around my argument by suggesting that we should open the floodgates. I never warranted such a thing.

 

Whoah, cutting MD spots by 50%; Ha ha... Very drastic! That's gonna do a lot of good to the disadvantaged populations in rural towns who already have a difficult time recruiting an MD in their regions even with the apparent "too large supply of MDs" (according to your arguments). Oh boy...

 

Too many people get into Med school these days thinking that life will be easy afterwards. Now they're realizing that manna doesn't fall from the sky; not even for the MDs. So harsh... :sarcasm:

 

The disadvantaged populations in rural areas won't be affected any more than they currently are and the influx of physicians over the past 10 years has done little to nothing to improve access to physicians for rural populations.

 

You're in drastic need of doing some research before floating fear mongering that have no merit.

 

"There's no sense in being precise when you don't even know what you're talking about"

[aaronjw]

I'm in the premed camp and I'm in favour of reductions.

 

 

Actually I'm more in favour of complete system overhaul instead of this piecemeal crap but reducing enrollment will help preserve those currently in the system from further being further diluted.

 

Moo doesn't really need to say anything, because he probably already knows service to rural region won't really be affected by 50% cuts across the board!

 

You don't mean to tell me that more than 50% of the aspiring grad of UdeS, UdeM, McGill wants to go to Lac St-Jean, or worse, Ungava bay to be a family doctor, do you? No? Well 50% cuts really don't make a difference to under serviced regions, because none of those 50% that aren't getting anymore were going to go to the middle of nowhere anyway. It's already a known fact that some people don't stick to their RoS and there is nearly no way to force them to, transferring seats might mean that people going to those rural places for school will leave afterwards.

 

Maybe the 50% cut will encourage people to actually MOVE up north/to rural areas for special resident statues there so they can go to places like NOSM and then maybe people will have sufficient vested interest to stay in those places.

 

Funny how the 2 camps for seat reduction in schools turned out like this:

 

-pre-meds are against the cuts

-med students/practising doctors for the cuts

 

People/MDs like Moo apparently have ulterior motives for keeping people from becoming doctors... Wouldn't you say that certain people also have motives for wanting more doctors?

[medigeek]

science students also specialize in thinking that working more is the only way to make more money… primary care can be a cash cow from the rich in 25 percent of your practice... meaning you can average out a decent salary to provide awesome care during that other 75 percent of the time anyways.

 

doctors should stop whining about pay too… i only make 200 g, life sucks… either stop whining or whore your self out and make your half a mil… just stop *****ing, doctors get paid enough.

 

I think it's also the amount of work it takes to get there. As well as the responsibility you have with being a doctor. When you go through a lot and have a high level of responsibility, you expect to be compensated very well. 200k is fine if the work week is 40 hrs and no more.

[10wattbulb]

Well actually, mm88, NOSM does a so-so job when it comes down to retaining MDs in the rural towns. The majority of NOSM graduates do their residency in the bigger cities and stay there. In 2012, only 17 of 54 graduates stayed in N.Ont. Many NOSM faculty members were disappointed with the results.

 

Anyways, I must point out that there are a lot of disadvantaged people in the big cities too who don't have access to adequate health care. One problem, as I stated in a previous post, is that the salaries of doctors have exploded in the last decade. Overall pay for doctors in Ont = $8 billion; overall # of doctors = 26,000. Hence, we pay nowadays ~$308,000 per MD. The average family MD makes $300,000/year, compared to $150,000 a decade ago (and the budget for MD salaries was $3.7 billion at that time).

 

By specialty, the radiologists and ophthalmologists have the highest pay, with an average salary of $600,000 (take note aaronjw). No wonder that training ophthalmologists have a hard time finding work; they're so expensive!!! They're almost unaffordable.

 

Those are stats from Toronto's Institute for Clinical Evaluative Sciences.

 

Bottom line: If MDs want to find work, they got to be a little bit more reasonable with how much $$$ they ask for (note that many MDs do work hard and fully deserve their very elevated salaries). Ergo, I have very little pity for MDs complaining that they can't find work. And I think that it's cheap to take it out on the "competition." There's competition in every field, the job prospects in Medicine are way way better than in most other fields.

[mm88]

I'm in the premed camp and I'm in favour of reductions.

 

 

Actually I'm more in favour of complete system overhaul instead of this piecemeal crap but reducing enrollment will help preserve those currently in the system from further being further diluted.

 

You sir, are a rare exception. Gold star for you!

 

Sadly, subtracting seats is a lot easier than complete overhaul. So guess what's going to happen, if indeed the governing bodies want to do something about this situation?

 

Well actually, mm88, NOSM does a so-so job when it comes down to retaining MDs in the rural towns. The majority of NOSM graduates do their residency in the bigger cities and stay there. In 2012, only 17 of 54 graduates stayed in N.Ont. Many NOSM faculty members were disappointed with the results.

 

Well then, perfect! We can cut 50% of the seats at NOSM too since <50% are staying in rural areas!

[medigeek]

Why cant we get rid of ALL of the IMG spots? Allow IMGs to match with CMGs.

[aaronjw]

Why cant we get rid of ALL of the IMG spots? Allow IMGs to match with CMGs.

 

How about best person for the job? IMG or CMG.

[10wattbulb]

The problem is not the physician/population ratio. Canada's physician/population ratio is lower than the OECD average it seems.

 

That's very true.

 

Some further stats:

 

Canada’s physician-to-population ratio in 2006 ranked 26th among the 28 developed nations. In 2007 ~5 million Canadians were without a family doctor.

 

In 2008, the Canadian physician-to-population ratio was 2.27/1000 people (OECD average is ~3/1000).

 

These facts, when combined with evidence that increased spending on physicians has been related to reduced wait times for treatment in Canada (Esmail, 2003; Barua and Esmail, 2010), clearly suggest that the supply of physician services in Canada is not meeting demand.

 

I can keep on going, but I'll let you read the report: http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/canadas-physician-supply.pdf

 

 

Come on guys! We're suppose to be in a developed country; we should be able to afford more MDs. There's no reason to cut down the number of spots in Med schools, and current MDs got to realize that finding a job is a problem for anyone in any profession (and much worst in other professions).

[Der Kaiser]

What this really is is a power struggle: the government vs physicians. The government is smarter, has planned ahead, and will win. Physicians will lose. The public will lose as well.

 

How do you figure the public will lose? More physicians means more competition for patients means better patient care. It also means that to make money physicians have to move to under-serviced areas. Finally, it means the government pays physicians less, which means less taxes for the public. It does suck for existing doctors though.

[rmorelan]

It's easy for moo to make this comment because he probably has friends who are now finishing their 5 year residencies and additional fellowships and still can't find a job. Seriously. Ask any chief resident in any surgical field what their job prospects are like...it's ugly.

 

yeah we also know residents in that spot now even as medical students. It is getting messy out there.

[moo]

We agree to disagree, moo . But don't twist around my argument by suggesting that we should open the floodgates. I never warranted such a thing.

 

Whoah, cutting MD spots by 50%; Ha ha... Very drastic! That's gonna do a lot of good to the disadvantaged populations in rural towns who already have a difficult time recruiting an MD in their regions even with the apparent "too large supply of MDs" (according to your arguments). Oh boy...

 

Too many people get into Med school these days thinking that life will be easy afterwards. Now they're realizing that manna doesn't fall from the sky; not even for the MDs. So harsh... :sarcasm:

 

In an ideal word, if I could force people to go up north to work I would. fact is, you can't mandate people work in a certain region. ROS contracts dont work. People would rather pay the penalty and get out than go up north, if they have to uproot their family. Even then, the trend is for med students to specialize, and there is not the population to support super specialists that a lot of med students aspire to be, especially in smaller centers.

 

Schools like NOSM and the NMP in BC are good. Its too soon to evaluate these progams to see if access has improved but early results suggest its working. I'm talking about cutting seats from the VFMP and schools whose focus is to produce super specialists like UT. Another way to do this is to cut specialty residency positions but then you'd have med students complaining they don't get to be an ophthal or orthopod.

 

Fact is, as a specialist, I'm paid lowly. I make more in my family practice working part time than I would in my full time specialty position, if I had one. I'm just looking for work, and you don't understand how frustrating it is to train so long to be told there are no jobs anywhere or to have unstable employment. Fact remains, if you want to increase recruitment to rural areas, then you have to restrict specialty residency positions. Many small communities cannot support cardiologists, GI, etc yet everyone wants to specialize.

[moo]

That's very true.

 

Some further stats:

 

Canada’s physician-to-population ratio in 2006 ranked 26th among the 28 developed nations. In 2007 ~5 million Canadians were without a family doctor.

 

In 2008, the Canadian physician-to-population ratio was 2.27/1000 people (OECD average is ~3/1000).

 

These facts, when combined with evidence that increased spending on physicians has been related to reduced wait times for treatment in Canada (Esmail, 2003; Barua and Esmail, 2010), clearly suggest that the supply of physician services in Canada is not meeting demand.

 

I can keep on going, but I'll let you read the report: http://www.fraserinstitute.org/uploadedFiles/fraser-ca/Content/research-news/research/articles/canadas-physician-supply.pdf

 

 

Come on guys! We're suppose to be in a developed country; we should be able to afford more MDs. There's no reason to cut down the number of spots in Med schools, and current MDs got to realize that finding a job is a problem for anyone in any profession (and much worst in other professions).

 

But it IS a problem because the taxpayer has invested a lot of money in training that MD. we can't let people jump ship to the US. Rather if we could save money from training all these specialists, and divert money to funding current unemployed grads to underemployed grads that would be ideal.

[lostintime]

Well instead of playing the guessing game of whether people REALLY will service rural areas and whether they are genuine or not, why not actually mandate they have to practice in rural areas or areas of need? I don't see anything really wrong with it. I mean, they still have the freedom of not applying for those spots (no one is forcing them to apply). It's just like applying for the military, the benefits are great, but you know what you are signing up for.

 

Are IMG's able to buy out of their ROS contract? I think their ROS contract is very stupid. For example, in Ontario, it only limits Ottawa and Toronto and SLIGHTLY GTA, but you can work in very very urban areas. That's not helping the doctor shortage at it. They should be forced to work in areas that are in need. Otherwise, why are we introducing all these IMG's where they are not needed? Doesn't make logical sense at all. By the way, I'm referring to IMG only spots. I'm all for letting the most competent person get the job and think they should just have one stream for "the best person for this residency" and then a separate stream for IMG's or even CMG's who WILL go to in-need areas.

[moo]

Well actually, mm88, NOSM does a so-so job when it comes down to retaining MDs in the rural towns. The majority of NOSM graduates do their residency in the bigger cities and stay there. In 2012, only 17 of 54 graduates stayed in N.Ont. Many NOSM faculty members were disappointed with the results.

 

Anyways, I must point out that there are a lot of disadvantaged people in the big cities too who don't have access to adequate health care. One problem, as I stated in a previous post, is that the salaries of doctors have exploded in the last decade. Overall pay for doctors in Ont = $8 billion; overall # of doctors = 26,000. Hence, we pay nowadays ~$308,000 per MD. The average family MD makes $300,000/year, compared to $150,000 a decade ago (and the budget for MD salaries was $3.7 billion at that time).

 

By specialty, the radiologists and ophthalmologists have the highest pay, with an average salary of $600,000 (take note aaronjw). No wonder that training ophthalmologists have a hard time finding work; they're so expensive!!! They're almost unaffordable.

 

Those are stats from Toronto's Institute for Clinical Evaluative Sciences.

 

Bottom line: If MDs want to find work, they got to be a little bit more reasonable with how much $$$ they ask for (note that many MDs do work hard and fully deserve their very elevated salaries). Ergo, I have very little pity for MDs complaining that they can't find work. And I think that it's cheap to take it out on the "competition." There's competition in every field, the job prospects in Medicine are way way better than in most other fields.

 

There's a difference between working and making a ton and the new grad struggling to make ends meet on a meager unaccredited fellowship salary which can be as low as 30k a year (yes, that's for unaccredited fellowships for those that can't find jobs). I don't think it's unreasonable for grads to just want to go out and begin making money when they're done.

 

Do I think we make too much? Yeah. Probably. All I want is A SPECIALTY JOB that pays a decent amount. Money isn't everything, otherwise I'd just continue with my family practice. I was grossing 400k a year prior to retraining. I was willing to take a salary cut to do what I loved, but apparently there are no positions, and I'm back at making a ton of money, doing something that, while it can be rewarding, is not exactly what I love. Don't feel pity for me, feel sorry for the govt that spent so much money training me the last three years, only for me to come back and be a glorified famly doc

[lostintime]

There's a difference between working and making a ton and the new grad struggling to make ends meet on a meager unaccredited fellowship salary which can be as low as 30k a year (yes, that's for unaccredited fellowships for those that can't find jobs). I don't think it's unreasonable for grads to just want to go out and begin making money when they're done.

 

Do I think we make too much? Yeah. Probably. All I want is A SPECIALTY JOB that pays a decent amount. Money isn't everything, otherwise I'd just continue with my family practice. I was grossing 400k a year prior to retraining. I was willing to take a salary cut to do what I loved, but apparently there are no positions, and I'm back at making a ton of money, doing something that, while it can be rewarding, is not exactly what I love. Don't feel pity for me, feel sorry for the govt that spent so much money training me the last three years, only for me to come back and be a glorified famly doc

 

Sorry to hear that, that's horrible and very discouraging. And sucks for the tax payers who also paid for your training and the patients who will be missing out on someone who could've made a difference in public health (although will still be making great contributions to family practice, but you know what I mean). Yeah honestly, I think this highlights that a lot of money AND time is wasted training specialists who are unable to make contributions doing what they love. Very unfortunate.

[10wattbulb]

Simple. There comes a point that diligent intelligent people won't think its worthwhile to go into medicine anymore.

 

I think Der Kaiser's claim is right (although a bit overly simplistic):

"How do you figure the public will lose? More physicians means more competition for patients means better patient care. It also means that to make money physicians have to move to under-serviced areas. Finally, it means the government pays physicians less, which means less taxes for the public. It does suck for existing doctors though."

 

Diligent intelligent people who have a true interest in Medicine (i.e. not just interested in making $$$ and prestige) will still apply to Medicine even if the salaries were 30% lower than they actually are. The bonus is that there would be less competition to get into Med school, and less competition further on in the residency programs (esp. if we bring down the salaries in certain specialties were it's harder to find work), and even less competition to look for jobs (since the gov would be able to pay for more physicians if the salaries were lower).

 

Example to prove my point: There are a lot of dilligent intelligent people who go on to do PhDs in Physics (or what not discipline). They are perfectly competent in their fields even though their salaries are not that high. As a matter of fact, the lower salaries, the difficulty of this field, and the low job prospects helps to keep the people who are not genuinely interested in the field out. And levels of intelligence wouldn't increase in the field even if the salaries were higher; the competition would, however.

 

moo, I know that when you're beginning in the field of Medicine, life is very tough. But I'm certainly not worried for you or any of your colleagues as life will get easier over time...

[moo]

I actually think Der Kaiser is right when he says:

"How do you figure the public will lose? More physicians means more competition for patients means better patient care. It also means that to make money physicians have to move to under-serviced areas. Finally, it means the government pays physicians less, which means less taxes for the public. It does suck for existing doctors though."

 

Diligent intelligent people who have a true interest in Medicine (i.e. not just interested in making $$$ and prestige) will still apply to Medicine even if the salaries were 30% lower than they actually are. The bonus is that there would be less competition to get into Med school, and less competition further on in the residency programs (esp. if we bring down the salaries in certain specialties were it's harder to find work), and even less competition to look for jobs (since the gov would be able to pay for more physicians if the salaries were lower).

 

moo, I know that when you're beginning in the field of Medicine, life is very tough. But I'm certainly not worried for you or any of your colleagues as life will get easier over time...

 

Don't cry for me. I am doing well financially. It just sucks to train to be a specialist, pay 4000 bucks to take the royal college exams (and not to mention the time went to studying for it) but have no true job at the end of it. I want to do public health, I want to advocate for the vulnerable, to contribute, but I can't. I am willing to take a HUGE pay cut to do it too

[moo]

Back to my refrain of reinstating general licensure and opening up specialist programs to anyone with an MD at anytime in their career.

 

You wanna fix the shortage? That's how you do it.

 

Yeah but we all agree that's not going to happen anytime soon. The CFPC has managed to convince all the colleges that you can no longer be a competent gp unless you go through their residency and pass that joke of an exam.

[10wattbulb]

Back to my refrain of reinstating general licensure and opening up specialist programs to anyone with an MD at anytime in their career.

 

You wanna fix the shortage? That's how you do it.

 

I do like your idea on that one. It would make life easier for so many MDs, and there would be no pressure to specialize right away. Hence, less people getting in the wrong field, etc.