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

[Nucklehead]

I think there is a a bit of a misunderstanding - I don't dislike family practice. I'm not trying to choke down some extremely bitter reality. I simply meant that for several reasons, including job opportunities, economics, lifestyle, and autonomy - family practice is probably the only foreseeable safe bet. Likely geriatrics and GIM, probably psychiatry too. I don't think this will strike many as breaking news. Primary care has always been the most flexible but now it's one of the only areas in medicine with future career opportunities.

 

The specialty overload is compounded every year by residencies churning out more grads than there are jobs...leading to oversupply. Somebody already mentioned this I think but the universities/hospitals/ministries are resistant to change anything though because reducing residency spots means reducing access to medical services. Residents are the slave labour of tertiary care. Bit of a conundrum eh?

[megaMooMoo]

I think there is a a bit of a misunderstanding - I don't dislike family practice. I'm not trying to choke down some extremely bitter reality. I simply meant that for several reasons, including job opportunities, economics, lifestyle, and autonomy - family practice is probably the only foreseeable safe bet. Likely geriatrics and GIM, probably psychiatry too. I don't think this will strike many as breaking news. Primary care has always been the most flexible but now it's one of the only areas in medicine with future career opportunities.

 

The specialty overload is compounded every year by residencies churning out more grads than there are jobs...leading to oversupply. Somebody already mentioned this I think but the universities/hospitals/ministries are resistant to change anything though because reducing residency spots means reducing access to medical services. Residents are the slave labour of tertiary care. Bit of a conundrum eh?

 

thanks for sharing, what you said was very enlightening

[10wattbulb]

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?

 

My bad for making a wrong statement, then. I'm not too familiar with the Quebec system, but I thought I read somewhere that they got out-of-province grads to sign some sort of a contract.

 

We do have some plans in Ont. to reduce shortage of MD in rural areas in Ontario, but they're not working too well. Even NOSM, the Med school created specially for those with an interest in rural medicine, is not doing a great job at recruiting the students who are genuinely interested in working in rural areas. Only 17 of 54 NOSM's 2012 graduates 'have chosen to continue to train in residency programs offered in Northern Ontario.'

 

BTW, is the students strike in Quebec affecting Med applicants/students?

[future_doc]

The strike may affect graduating Cegepien applicants next cycle if they lose this semester.

[Robin Hood]

The strike may affect graduating Cegepien applicants next cycle if they lose this semester.

 

Not only this, but most cegepiens and future cegepiens will get their admission delayed for one year. The 2010-2012 cohorte will have to wait till 2013, the 2011-2013 cohort will have to wail till 2014, because these guys, instead of graduating in Winter 2013, will graduate in Fall 2013, same for the 2012-2014 cohort, etc. The same will have to the university students applying to McGill and UdeM (unless they had outstanding grades and are not applying in their last semester-for UdeM).

[future_doc]

This is a far greater cost than any tuition that might be saved.

[A-Stark]

We do have some plans in Ont. to reduce shortage of MD in rural areas in Ontario, but they're not working too well. Even NOSM, the Med school created specially for those with an interest in rural medicine, is not doing a great job at recruiting the students who are genuinely interested in working in rural areas. Only 17 of 54 NOSM's 2012 graduates 'have chosen to continue to train in residency programs offered in Northern Ontario.'

 

NOSM does not offer training in all specialties, only in Family Med, Internal, Anesthesia, Gen Surg, Public Health, Obs/gyn, Ortho, Peds, and Psych.

 

No Path, Derm, Radiology, other lab specialties, Cardiac, Plastics, ENT, Neurosurg, Neurology, Emerg, Ophtho, PMR, Rad Onc, or Urology. Aside from the usual cohort of people who actually want to go elsewhere for residency, it's not surprising that fewer NOSM graduates continue on in residency there.

[10wattbulb]

NOSM does not offer training in all specialties, only in Family Med, Internal, Anesthesia, Gen Surg, Public Health, Obs/gyn, Ortho, Peds, and Psych.

 

No Path, Derm, Radiology, other lab specialties, Cardiac, Plastics, ENT, Neurosurg, Neurology, Emerg, Ophtho, PMR, Rad Onc, or Urology. Aside from the usual cohort of people who actually want to go elsewhere for residency, it's not surprising that fewer NOSM graduates continue on in residency there.

 

I am very aware of that, A-Stark, but let's face it: NOSM's main goal is to train students who will go on to become rural MDs, and most rural MDs are family doctors (not ophthalmologists/urologists/radiologists, etc.). If you're not interested in rural medicine, NOSM is really not the school you should apply to...

[Robin Hood]

This is a far greater cost than any tuition that might be saved.

 

Yes, but it seems students (and the government) are betting on time. A semester cancellation will be Hell for the government, and it will cost them more than the increase. Quebec will turn in Hell. University grads won't be able to get their jobs, some companies will lose a lot, universities won't get the cegepiens graduating this Winter, cegeps won't be able to receive the new HS grads because they will need to finish the actual semester, and on top of this, it's the government who pays for students' education.

[future_doc]

What a mess. It is a lose lose situation with ripple effects.

 

So much for timely dialogue way back, but the government believed they were in the driver's seat. But they don't care, they will still get their perks, their pensions. Politicians.

[rmorelan]

I am very aware of that, A-Stark, but let's face it: NOSM's main goal is to train students who will go on to become rural MDs, and most rural MDs are family doctors (not ophthalmologists/urologists/radiologists, etc.). If you're not interested in rural medicine, NOSM is really not the school you should apply to...

 

How many though return post training to a rural area? That is probably the more important question - I mean I probably want to practise in Ontario but will take residency anywhere in the country that serves my purpose. Perhaps some of the NOSM grads are taking the same approach - even FM spots at other places may have greater training perhaps (I really don't know - that is my point )

[10wattbulb]

How many though return post training to a rural area? That is probably the more important question - I mean I probably want to practise in Ontario but will take residency anywhere in the country that serves my purpose. Perhaps some of the NOSM grads are taking the same approach - even FM spots at other places may have greater training perhaps (I really don't know - that is my point )

 

My guess is that even less than 17 graduates end up working, post-training, in a rural area. And let's face it, if you're training in a specialty like ophthalmology or neurosurgery, you're probably not planning on returning to a rural area. They don't need these kinds of doctors in those places (or very exceptionally). And when someone comes from Montreal, does his/her MD at NOSM, but returns to Montreal to train as a family doctor, chances are that they'll stay there...

 

I personally encourage NOSM to get their students to sign a contract so that they spend X number of years (3 would be reasonable) post-training in a rural area. That way, those who are not serious about rural Med would think twice before applying to NOSM, and NOSM would be better able to fulfill its unique mandate. And, we'd be guaranteed that there would be MDs working in rural areas.

[Robin Hood]

Let's not forget something important about NOSM, which is that it's only 8 years old, so it's expected that they don't have all the residency programs. Sherbrooke has been around since 1969, and they don't have ER 5 years.

[A-Stark]

I am very aware of that, A-Stark, but let's face it: NOSM's main goal is to train students who will go on to become rural MDs, and most rural MDs are family doctors (not ophthalmologists/urologists/radiologists, etc.). If you're not interested in rural medicine, NOSM is really not the school you should apply to...

 

Most urban MDs are family doctors too, but while there aren't many rural cardiac or neurosurgeons, there are plenty of rural radiologists and even ophthalmologists. My first refraction was done by a rural ophthalmologist (unless you consider towns of 4,000 people too large to be "rural"); his OR was at the nearby regional hospital which has radiologists, anesthetists, cardiologists, and a variety of surgical specialists ranging from gen surg to vascular to ENT to ortho.

 

I didn't apply to NOSM, no, though I might in a few months to cover all my bases... (had to take some time off so I get finish next year... sigh... should change my sig I suppose).

[Wayward son]

We do have some plans in Ont. to reduce shortage of MD in rural areas in Ontario, but they're not working too well. Even NOSM, the Med school created specially for those with an interest in rural medicine, is not doing a great job at recruiting the students who are genuinely interested in working in rural areas. Only 17 of 54 NOSM's 2012 graduates 'have chosen to continue to train in residency programs offered in Northern Ontario.'

 

Interesting to see that most of the NOSM discussion of late has occured here in the UofT forum (edit: this is not the UofT forum...I guess that is what happens when I post at 6am because I can't sleep).

 

A couple comments:

 

1) I find that only 17 took NOSM residencies shocking. I would have expected 25 to 30 if not more. I have two friends who have finished NOSM. Both took NOSM FM residencies. The one who has finished residency is working in Northern Ontario.

 

2) It is still too early to tell how well NOSM's approach will work. I am assuming they will crunch the statistics and see what is working and what is not.

 

3) A current first year student stated that there were a lot of students in his class from the larger centers like Sudbury and Thunder Bay. I wonder if there is a difference between the urban/rural divide when it comes to residency? I remember reading in the Sault Ste Marie paper that the city was disappointed that all four of their students from the first graduating class took residencies in Southern Ontario. I also wonder if the older students are more or less likely to go for NOSM residencies as I would assume that a high percentage of the more mature students have spent most of their adult life working in Northern Ontario. I would imagine they are also more likely to choose FM.

 

4) A return of service agreement would work out great for me. If I am accepted at medical school I have every intention of going for a NOSM FM or FM+EM residency and continuing to work in rural Northern Ontario. It is where I like to be. But at the same time I am older (I would 40 by the time I would finish the two year residency), so the specialties hold no interest for me (If I was younger maybe GIM, but FM seems better to me anyways). However, just because something would benefit me does not necessarily mean it would be good policy. I am uncertain. Having worked in the north for years I have found that there are few things that people find more irritating than working with others who are just putting in their time to fulfill their agreement and get out.

 

5) To me the biggest problem keeping and attracting young professional people in rural Northern Ontario seems to be the lack of a dating scene. That is a major worry for most single people. I have known a fair number of young rural doctors and for the single ones this issue seemed to be the issue most likely to result in their departure. When they find "the one" many rural Northern Ontarians want to return. For this reason, I disagree with your position that fewer than 17 will end up working in the north after residency. Do I think that all 17 doing NOSM residencies will stay in the North? No. Do I think that several of the non NOSM residencies will return? Yes, within a couple years.

[apache]

i would reject any acceptance to any school that required me to do fm and work rural, because medicine isn't the same everywhere, and across disciplines. Like, I'm sorry I find Fm boring, not anything personally, but I'd spend more time zoning out my window than doing my referral letters, and being in a small town with no stimulation, I'd prob end up working 15 hours week.

 

i crave stimulation and people, huge cities, and the most complex abstract problems, and as far as I know we haven't figured out any brain sugeries to change our fundamental genetic make-up so it's so environmentally changed as to make me enjoy it.

 

I'd rahter work in public health as private consultant or something. Also, speaking plainly, i wouldn't feel competent having only two years of residency training.

[rmorelan]

Let's not forget something important about NOSM, which is that it's only 8 years old, so it's expected that they don't have all the residency programs. Sherbrooke has been around since 1969, and they don't have ER 5 years.

 

Western has been around for 130 and doesn't have dermatology - some places never acquire a particular specialty - they just don't ultimately see a particular need for it and the docs there don't want to convert to doing any training for residents

[NutritionRunner]

For those of us who can't find a family physician, it is hard to believe we have a surplus of doctors.

 

I'm not exactly in a remote rural area either (I'm in a decent-sized city only an hour from Toronto - Guelph).

 

I've called around to every doctor's office in the city. I've called the couple of walk-in clinics in the city. No one is accepting new patients. Absolutely no one!

 

So it's hard for me to believe we don't have a doctor shortage, at least in family medicine, when I can't even find a family physician! And I'm not the only one. The City of Guelph is actively trying to recruit more family physicians. (Anyone in family med want to come here when you finish residency? http://guelph.ca/employment-careers/careers-jobs/physician-recruitment/ )

 

I honestly don't know what I'm going to do when I graduate from university. I don't need to access a lot of medical care, but I do have hypothyroidism, so I need to have my blood levels of thyroid hormones monitored regularly and have my prescription renewed. It is truly going to be a real pain if I need to wait for 8 hours or more at a walk-in clinic just to have my thyroid hormone prescription renewed and to get my blood tested.

 

So while I understand that there may not be jobs for doctors in certain specialties in big cities like Toronto and Vancouver, there is certainly a need for family physicians even in non-rural locations.

[10wattbulb]

I also find it very,very hard to believe that we have a surplus of doctors. I also know quite a few people who are actively looking for a family physician and who can't find any!

 

Even in terms of the specialists, I know of a couple of people who should normally be followed by a cardiologist but who can't because no cardiologist can take them on (they're just too busy).

 

And when the problem's not about accessing the doctors, it's about accessing the resources. I know of one person who had to wait months and months on end before getting her surgery (and it was a necessary but uncomplicated one at that!) because no operating room was available. In the meantime, that person lived in misery.

 

I think that the 'surplus' is mainly from the province's perspective. Healthcare takes up ~40% of the provincial budget, so the gov is trying to lower the costs.

[schmitty]

For those of us who can't find a family physician, it is hard to believe we have a surplus of doctors.

 

I'm not exactly in a remote rural area either (I'm in a decent-sized city only an hour from Toronto - Guelph).

 

I've called around to every doctor's office in the city. I've called the couple of walk-in clinics in the city. No one is accepting new patients. Absolutely no one!

 

So it's hard for me to believe we don't have a doctor shortage, at least in family medicine, when I can't even find a family physician! And I'm not the only one. The City of Guelph is actively trying to recruit more family physicians. (Anyone in family med want to come here when you finish residency? http://guelph.ca/employment-careers/careers-jobs/physician-recruitment/ )

 

I honestly don't know what I'm going to do when I graduate from university. I don't need to access a lot of medical care, but I do have hypothyroidism, so I need to have my blood levels of thyroid hormones monitored regularly and have my prescription renewed. It is truly going to be a real pain if I need to wait for 8 hours or more at a walk-in clinic just to have my thyroid hormone prescription renewed and to get my blood tested.

 

So while I understand that there may not be jobs for doctors in certain specialties in big cities like Toronto and Vancouver, there is certainly a need for family physicians even in non-rural locations.

 

It's not really a doctor shortage problem, it's one of dispersion. I live in downtown Toronto and there are (no joke) 3 doctor offices within 5-10 minute walk with signs saying "accepting new patients."

[10wattbulb]

It's not really a doctor shortage problem, it's one of dispersion. I live in downtown Toronto and there are (no joke) 3 doctor offices within 5-10 minute walk with signs saying "accepting new patients."

 

OK, but everywhere else in Ont, that's not the case. Where I live, there's frequently 0 doctors accepting new patients, and I live in a quite urban area.

[aaronjw]

I also find it very,very hard to believe that we have a surplus of doctors. I also know quite a few people who are actively looking for a family physician and who can't find any!

 

Even in terms of the specialists, I know of a couple of people who should normally be followed by a cardiologist but who can't because no cardiologist can take them on (they're just too busy).

 

And when the problem's not about accessing the doctors, it's about accessing the resources. I know of one person who had to wait months and months on end before getting her surgery (and it was a necessary but uncomplicated one at that!) because no operating room was available. In the meantime, that person lived in misery.

 

I think that the 'surplus' is mainly from the province's perspective. Healthcare takes up ~40% of the provincial budget, so the gov is trying to lower the costs.

 

5 mins of research to locate physician per capita stats will show we have we gave more physicians than any point in the past 30 years.

[schmitty]

OK, but everywhere else in Ont, that's not the case. Where I live, there's frequently 0 doctors accepting new patients, and I live in a quite urban area.

 

That's what I said...it's dispersion. The metro Toronto area has 44% of the entire Ontario population and a lot more doctors than it needs. If they all spread out evening by capita, we would not have much of a shortage.

[10wattbulb]

5 mins of research to locate physician per capita stats will show we have we gave more physicians than any point in the past 30 years.

 

Which makes sense because we're one of the richest countries, so we should be able to train more physicians than most other countries. As a matter of fact, we should be exporting physicians to poorer countries who desperately need them and who can't train their own (just like we train more than enough teachers than what Ont requires, and many of these teachers end up teaching in Bangladesh, Thailand, India, China, etc). Unfortunately, instead of doing this, we're often taking doctors away from poorer countries (nowadays less than in the past, thankfully).

[10wattbulb]

That's what I said...it's dispersion. The metro Toronto area has 44% of the entire Ontario population and a lot more doctors than it needs. If they all spread out evening by capita, we would not have much of a shortage.

 

Hmm... I still feel that these doctors in Toronto who accept new patients are nevertheless quite busy and don't often run out of work!