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

[lostintime]

This is terrible. Why?

 

1. Rich upper class people tend to come from cities, and poor working class people come from rural areas.

 

2. Rich upper class people won't want to go rural, so they either won't apply for those positions or will take them and immediately pay out.

 

3. Poor working class people might not want to go rural after experiencing training, but will be expected to because of the contract which they will never be able to buy out of. Eventually med school will be two-tiered: rich elite specialists and poor working-class rural physicians.

 

Good point, but the average rural GP makes more than the average urban GP. And not all "rich kids" want to specialize, it is an extra 3+ years and arguably a tougher residency/life later on (though perhaps not the most politically correct thing to say).

[medigeek]

well, wouldn't the canadian students owe us, since we subsidized their education, while the Caribbean students payed it all on their own. what's so great about canada anyways, do you know how much cash you can make opening up a clinic of canadian trained docs near a resort in mexico… the taxes are lighter too, and i hear the weather is good.

 

except youre living in mexico still...

[A-Stark]

Many rural areas offer considerable signing bonuses and other incentives - I don't know that it amounts to twice the income, but the additional remuneration is considerable. However, that's not really enough - it's not as though physicians cannot make a good living in urban areas, and location and family/friend connections are often more important than money alone.

[PhoenixFlare500]

Nobody here is on the correct train of thought when it comes to fixing the rural doc shortage.

 

In order to solve the problem, physicians have to WANT to move to a rural place, not be FORCED to go because of negative consequences otherwise. There will always be a way to avoid the negative consequences. Physicians have to be DRAWN to rural areas for some reason. The only possible reason - money.

 

If rural physicians were paid 2x more, the rural physician shortage would be history.

 

It's easier to attract bees with honey than with bugspray.

 

Note that this discussion illustrates the importance of free market forces. If physician fees were subject to the free market influence, physicians would jack up their prices in rural areas, causing them to make more money, attracting more physicians to the area. Basically, the rural physician shortage is caused entirely by the communist/public healthcare system.

Out of the last 7 or 8 pages I just read in this thread, this one makes the most sense.

[aaronjw]

Out of the last 7 or 8 pages I just read in this thread, this one makes the most sense.

 

Why do you think so?

[PhoenixFlare500]

Because most of the other ones have been revolving around figuring out strategies to force people to work in areas where they don't want to. Even if you can keep a doctor in an area for 5 years, if he doesn't want to be there he's not going to be that passionate about his work and as a result patient care is going to suffer. Also, a lot of posts about these topics have revolved around treating IMGs like second-rate doctors/residents, now they seem to have moved on to treating rural docs like second-rate citizens.

[aaronjw]

Because most of the other ones have been revolving around figuring out strategies to force people to work in areas where they don't want to. Even if you can keep a doctor in an area for 5 years, if he doesn't want to be there he's not going to be that passionate about his work and as a result patient care is going to suffer. Also, a lot of posts about these topics have revolved around treating IMGs like second-rate doctors/residents, now they seem to have moved on to treating rural docs like second-rate citizens.

 

Except that financial incentives don't work as a long-term strategy.

[Kasiunut]

Because most of the other ones have been revolving around figuring out strategies to force people to work in areas where they don't want to. Even if you can keep a doctor in an area for 5 years, if he doesn't want to be there he's not going to be that passionate about his work and as a result patient care is going to suffer. Also, a lot of posts about these topics have revolved around treating IMGs like second-rate doctors/residents, now they seem to have moved on to treating rural docs like second-rate citizens.

 

The thing is that not everyone is motivated by money alone. People start to realize this once they get a bit older and things like being close to family, having your spouse be able to have a satisfying career, more opportunities for your kids, having friends close by etc will trump money.

 

And to be honest, I think just a lot of people who go into medicine period will end up not liking their jobs in general (obviously not everyone but you'll get a fair chunk that are disillusioned by what it really means to be a doctor). You can specialize and be in any area you choose and still be unhappy. Heck, I've met doctors in the past who honestly seemed bored stiff by their work and couldn't care less about giving me good care. I don't know why it seems that only being a rural doctor would make one unhappy.

 

The solution? I'm not sure. Its obviously a tough problem or otherwise we'd have figured it out.

[10wattbulb]

In order to solve the problem, physicians have to WANT to move to a rural place, not be FORCED to go because of negative consequences otherwise. There will always be a way to avoid the negative consequences. Physicians have to be DRAWN to rural areas for some reason. The only possible reason - money.

 

Yes, that's quite true (except $$$ is not the only thing). We should offer doctors who work in places where no other doctor want to work some nice incentives (eg. higher salary, transportation costs covered, the best working conditions possible, etc.). It's the only way to make sure that they 'anchor' themselves in the rural/disadvantaged community. A contract will work well in the short-term (i.e. for the # of years the doctor has to stay) but not in the long-term.

 

Summary of my thoughts on the issues presented in this thread:

 

-Many people want to go into Med school for $$$/prestige/social pressure (i.e. parents)/the challenge of getting in, etc. But most of these people aren’t even aware that their desire of going into Med school stems from their passion for these things as opposed to the passion for Medicine per se/helping others.

 

-ADCOMs do their best, but they can only really distinguish b/w ‘OK’ vs ‘not good enough’ applicants (and even then, they sometimes falter and reject applicants who would have made wonderful MDs). They can’t enter into candidate X’s head to see what (s)he really thinks about Med. And anyways, candidate X’s thoughts on Med before entering the field vs. afterwards can change drastically (initial ‘genuine’ passion can wear out).

 

- All MD graduates should be considered ‘general practitioners’ and should not have to specialize right away. That’s how things worked in the past, and it made life easier for so many graduates. Choosing your 'specialty' right after Med school might be a little too early and can result in people being stuck in the wrong speciality or in specialities where it's hard to find work.

 

- Some Med schools (like NOSM) could have their students sign a contract so that they spend X number of years working in a disadvantaged area, (i.e. rural and/or N.Ont). This way, Med students would know what they’re getting themselves into if they apply at NOSM, for instance, but they would still have some flexibility of practise location (any rural/N.Ont location would be OK). I believe that Quebec Med schools have their students sign a contract so that they spend at least 3? years working in Quebec.

 

P.S. It's true that rural docs are often treated like second-rate MDs. This is a big problem.

[PhoenixFlare500]

Sorry I didn't mean money is the solution to everything. The main point that I'm trying to make is that you need to find a way to get people to want to practice in rural areas. Financial incentives is one way but the best way that I can think of is to try to get people from those areas into med. And that doesn't mean that you then have the right to force them to work wherever you want them to, but it means that there's a much higher likelihood that they'll return.

[aaronjw]

Sorry I didn't mean money is the solution to everything. The main point that I'm trying to make is that you need to find a way to get people to want to practice in rural areas. Financial incentives is one way but the best way that I can think of is to try to get people from those areas into med. And that doesn't mean that you then have the right to force them to work wherever you want them to, but it means that there's a much higher likelihood that they'll return.

 

This is something I've said before on here somewhere because I believe that people who grow up in an area, generally, want to return to that area.

 

The issue is trying to increase enrolment for people from these areas which is no small feat either.

[rmorelan]

Out of the last 7 or 8 pages I just read in this thread, this one makes the most sense.

 

overall it probably does - a lot of the problem does stem from an income distribution problem - all things being equal if you have a high income most people prefer to live in larger cities.

 

Of course if done this won't be completed by doubling the rural docs salary - it would be done by redistributing the current amount total the government pays so city docs would lose income and rural (or probably better to stay under serviced) areas would get more (there is simply no room to increase expenses - actually big cuts to doctors fees are coming) The bulk of the doctors will still be in the cities though and that means the bulk of doctors will be quite opposed to that sort of change and do everything they can to pretty much prevent it.

 

Any such system would still be artificial as well so there will be still be areas of inefficiency (border issues between low/high service areas come to mind - i.e. more 2 feet to the left and increase you income. Also you could see doctors having people commute to their office in a rural area which would be an interesting flip)

[lostintime]

OF COURSE it's better to have people WANT to go practice in remote/rural areas than "forcing" them through negative reinforcement. However, if that's worked (not even including positive reinforcement and perks), why are we in this situation now? I don't see how it's that different from creating military specific med spots or the military specific PA program. Like I said, you're not doing this for EVERY med student in the country, just a select few who either actually want to practice in rural areas and will get an incentive through $$ for it, or other people who want to be a doctor more than anything and if they can't get through med school the normal way, will be willing to do this, and who knows, maybe in the process, fall in love with rural medicine.

 

I personally haven't met anyone who considers rural doctors "second class" so I don't really know what you guys are talking about. If anything, they deal with a lot more "s.hit hits the fan" stuff and use MORE clinical judgment without back-up. And the GP's in rural areas often play multiple roles and work harder and more efficiently than a lot of urban doctors.

 

I just don't see how doing all this promotion and having some people be non-genuine in their med interviews/apps saying how much they love rural medicine when they don't (personally know of many cases), why go through all that? If people apply to these spots, at least they are making a commitment to rural medicine. And the exposure to rural medicine in 5 years or however long is probably more reason for them to stay than all this "guesswork" that's being done.

 

There's tons of other examples where people don't have a choice where they work based on the market and jobs not opening up or government making decisions to make huge cuts. I don't really think it's an issue of the Charter.

[Med0123]

Yes, that's quite true (except $$$ is not the only thing). We should offer doctors who work in places where no other doctor want to work some nice incentives (eg. higher salary, transportation costs covered, the best working conditions possible, etc.). It's the only way to make sure that they 'anchor' themselves in the rural/disadvantaged community. A contract will work well in the short-term (i.e. for the # of years the doctor has to stay) but not in the long-term.

 

Summary of my thoughts on the issues presented in this thread:

 

-Many people want to go into Med school for $$$/prestige/social pressure (i.e. parents)/the challenge of getting in, etc. But most of these people aren’t even aware that their desire of going into Med school stems from their passion for these things as opposed to the passion for Medicine per se/helping others.

 

-ADCOMs do their best, but they can only really distinguish b/w ‘OK’ vs ‘not good enough’ applicants (and even then, they sometimes falter and reject applicants who would have made wonderful MDs). They can’t enter into candidate X’s head to see what (s)he really thinks about Med. And anyways, candidate X’s thoughts on Med before entering the field vs. afterwards can change drastically (initial ‘genuine’ passion can wear out).

 

- All MD graduates should be considered ‘general practitioners’ and should not have to specialize right away. That’s how things worked in the past, and it made life easier for so many graduates. Choosing your 'specialty' right after Med school might be a little too early and can result in people being stuck in the wrong speciality or in specialities where it's hard to find work.

 

- Some Med schools (like NOSM) could have their students sign a contract so that they spend X number of years working in a disadvantaged area, (i.e. rural and/or N.Ont). This way, Med students would know what they’re getting themselves into if they apply at NOSM, for instance, but they would still have some flexibility of practise location (any rural/N.Ont location would be OK). I believe that Quebec Med schools have their students sign a contract so that they spend at least 3? years working in Quebec.

 

P.S. It's true that rural docs are often treated like second-rate MDs. This is a big problem.

 

Not true. We don't have to spend at least 3 years working in Quebec, but people from Quebec tend to stay in the province because of cultural/linguistic concerns.

 

And in Quebec, the government strongly incitates MDs to practice in area with few doctors with monetary compensation (up to 45% increase of salary, cf this http://msssa4.msss.gouv.qc.ca/fr/sujets/medregion.nsf/05c106b5deec3b34852566de004c8580/d5b7230cc7f9dceb85256dd60061e799?OpenDocument&ExpandSection=-4). Don't you have similar plans to reduce shortage of MD in rural areas in Ontario?

[Robin Hood]

Yes, that's quite true (except $$$ is not the only thing). We should offer doctors who work in places where no other doctor want to work some nice incentives (eg. higher salary, transportation costs covered, the best working conditions possible, etc.). It's the only way to make sure that they 'anchor' themselves in the rural/disadvantaged community. A contract will work well in the short-term (i.e. for the # of years the doctor has to stay) but not in the long-term.

 

Summary of my thoughts on the issues presented in this thread:

 

-Many people want to go into Med school for $$$/prestige/social pressure (i.e. parents)/the challenge of getting in, etc. But most of these people aren’t even aware that their desire of going into Med school stems from their passion for these things as opposed to the passion for Medicine per se/helping others.

 

-ADCOMs do their best, but they can only really distinguish b/w ‘OK’ vs ‘not good enough’ applicants (and even then, they sometimes falter and reject applicants who would have made wonderful MDs). They can’t enter into candidate X’s head to see what (s)he really thinks about Med. And anyways, candidate X’s thoughts on Med before entering the field vs. afterwards can change drastically (initial ‘genuine’ passion can wear out).

 

- All MD graduates should be considered ‘general practitioners’ and should not have to specialize right away. That’s how things worked in the past, and it made life easier for so many graduates. Choosing your 'specialty' right after Med school might be a little too early and can result in people being stuck in the wrong speciality or in specialities where it's hard to find work.

 

- Some Med schools (like NOSM) could have their students sign a contract so that they spend X number of years working in a disadvantaged area, (i.e. rural and/or N.Ont). This way, Med students would know what they’re getting themselves into if they apply at NOSM, for instance, but they would still have some flexibility of practise location (any rural/N.Ont location would be OK). I believe that Quebec Med schools have their students sign a contract so that they spend at least 3? years working in Quebec.

 

P.S. It's true that rural docs are often treated like second-rate MDs. This is a big problem.

 

No, Quebec doesn't impose any RoS, not even for IMGs.

[Nucklehead]

I'm a med student at the end of my second year. I had assumed that medical school = job anywhere I want because there are no doctors. WRONG. Students have become very aware of the speciality physician glut. I'm actually pretty pissed about it...I had initially wanted to go into something surgical but from speaking to my friends in third year, a lot of their resident preceptors have warned them against specializing. I was in the OR for a morning and the resident was on his third fellowship. He was in his late 30's...and a still a complete slave to the hospital. Not cool.

 

Basically, I think doctors and the public all got screwed when the rotating internship year was scrapped. The real shortage is GPs. By forcing med students into residencies so soon in their training, most students decide pretty early on that they want to specialize because if you don't decide early enough, you're screwed for that residency. It's kind of this "shoot for the stars" mentality but it's assbackwards because there are no jobs! So tons of people end up specializing, will finish their residency, find no job, and be totally f'd cause they don't even have a general practice license to fall back on.

 

Of course, the solution is just to love primary care. I'm trying to.

[Robin Hood]

I'm a med student at the end of my second year. I had assumed that medical school = job anywhere I want because there are no doctors. WRONG. Students have become very aware of the speciality physician glut. I'm actually pretty pissed about it...I had initially wanted to go into something surgical but from speaking to my friends in third year, a lot of their resident preceptors have warned them against specializing. I was in the OR for a morning and the resident was on his third fellowship. He was in his late 30's...and a still a complete slave to the hospital. Not cool.

 

Basically, I think doctors and the public all got screwed when the rotating internship year was scrapped. The real shortage is GPs. By forcing med students into residencies so soon in their training, most students decide pretty early on that they want to specialize because if you don't decide early enough, you're screwed for that residency. It's kind of this "shoot for the stars" mentality but it's assbackwards because there are no jobs! So tons of people end up specializing, will finish their residency, find no job, and be totally f'd cause they don't even have a general practice license to fall back on.

 

Of course, the solution is just to love primary care. I'm trying to.

 

When was the internship abolished?

Also, one can't force himself to like something.

[Nucklehead]

When was the internship abolished?

Also, one can't force himself to like something.

 

Early 1990's. As well, it's not that I hate primary care. I could be happy doing it I think. For me though, it's more about this false sense of choice that the schools seem to propagate. But in reality they are really just trying to shunt you into family practice.

 

My main issue is if we still had the rotating internship we would have more time to experience the different specialties and even work for a couple years as a GP before making a more educated decision to enter into a specialty training program. And, if things don't work out, you could still practice as a GP.

[rmorelan]

Early 1990's. As well, it's not that I hate primary care. I could be happy doing it I think. For me though, it's more about this false sense of choice that the schools seem to propagate. But in reality they are really just trying to shunt you into family practice.

 

My main issue is if we still had the rotating internship we would have more time to experience the different specialties and even work for a couple years as a GP before making a more educated decision to enter into a specialty training program. And, if things don't work out, you could still practice as a GP.

 

or you could do both - some GP work in your clinic but also some speciality work as well in an area of interest to you. They not be enough work to fill your practise up completely but I think both you and patients would have some serious benefits under that scheme.

[megaMooMoo]

Originally Posted by Robin Hood View Post

 

Also, one can't force himself to like something.

 

Early 1990's. As well, it's not that I hate primary care. I could be happy doing it I think. For me though, it's more about this false sense of choice that the schools seem to propagate. But in reality they are really just trying to shunt you into family practice.

 

My main issue is if we still had the rotating internship we would have more time to experience the different specialties and even work for a couple years as a GP before making a more educated decision to enter into a specialty training program. And, if things don't work out, you could still practice as a GP.

 

dont you just love how pre-meds like to jump on any opportunity to give you advice despite what you've been through.

[Robin Hood]

Originally Posted by Robin Hood View Post

 

Also, one can't force himself to like something.

 

 

 

dont you just love how pre-meds like to jump on any opportunity to give you advice despite what you've been through.

 

You don't need to be in med school to realize that you can't force yourself to like something.

[megaMooMoo]

You don't need to be in med school to realize that you can't force yourself to like something.

 

correct, but you do need the experience to be able to figure out what compromises one must make broooo

[Robin Hood]

correct, but you do need the experience to be able to figure out what compromises one must make broooo

 

I wasn't talking about compromises, just about forcing yourself to like something.

[mm88]

I wasn't talking about compromises, just about forcing yourself to like something.

 

Awwww come on! Never heard of an arranged marriage? Isn't the motto for begrudging young people something like "don't worry, you'll grow into loving him/her?".

 

Maybe people will grow in to loving (rural) family med too! You never know!

[megaMooMoo]

I wasn't talking about compromises, just about forcing yourself to like something.

 

"Of course, the solution is just to love primary care. I'm trying to." = le compromis : D