Physician Shortage vs. Surplus

[studentforever]

Does anyone have any reliable sources regarding which area of medicine will have surplus vs. shortage in the next 5-10 years? I found a couple reports online for ontario but they are a few years old, and I didn't find anything for the other provinces (BC, Alberta etc...) and also read some contradictory articles where one sites proof that there's a need for this field but another site proof that it's actually over saturated and doctors can't find jobs. It's been kind of confusing. If anyone can offer any more info regarding the job markets of various specializes, please post!

[studentforever]

There's a weird form by the MOH in Ontario, which is this gaudy orange color, that has a relative need assessment for the next few decades. As far as I remember, radiology is going to be in the most demand by a long shot. Surprisingly, general internal medicine isn't. I wonder how they came to these conclusions.

 

are you referring to the 2010 needsbased study? do you have a link you can send?

 

that's suprising about radiology, I know a friend who just finished their residency here in canada but couldn't find jobs so decided to head down south...

[Lactic Folly]

Just goes to show you that no one has a crystal ball.

[mavrik13]

It's worth noting that all of those 'needs' based surveys/studies predict demand for the positions, but not necessarily the positions themselves. For example, there are no jobs in orthopaedic surgery, but many of the docs I work with regularly have 1-2 year waiting lists (if not longer) to see a new patient.

[Lactic Folly]

Exactly - my family is quite mystified how the job market for ortho can be so tight when the waiting lists for joint replacements are so long.

[medisforme]

Exactly - my family is quite mystified how the job market for ortho can be so tight when the waiting lists for joint replacements are so long.

 

OR time.

 

 

Nothing to do with the number of orthopaedic surgeons out there.

[jock2doc]

Unfortunately, health planning authorities seem to have a shortage of economics majors. It is known that adding labor without a corresponding increase in capital will lead to decreasing marginal returns. In this case, the increase in med school enrolments has not been accompanied by an increase in other resources essential for surgeons to practice (eg. OR's/non MD staffing). Now graduating surgeons are having a hard time finding work. On a positive note, I spoke with a staff neurosurgeon this summer and he believed there would be a mass exodus of senior surgeons in the next 10 years.

[rmorelan]

Unfortunately, health planning authorities seem to have a shortage of economics majors. It is known that adding labor without a corresponding increase in capital will lead to decreasing marginal returns. In this case, the increase in med school enrolments has not been accompanied by an increase in other resources essential for surgeons to practice (eg. OR's/non MD staffing). Now graduating surgeons are having a hard time finding work. On a positive note, I spoke with a staff neurosurgeon this summer and he believed there would be a mass exodus of senior surgeons in the next 10 years.

 

Oh there were a number of economists involved and they/the government know all of this of course - collectively we are dodging the ultimate truth which is the system cannot afford to have all those people people working at full capacity without significantly increasing costs and thus ultimately taxation.

[rmorelan]

are you referring to the 2010 needsbased study? do you have a link you can send?

 

that's suprising about radiology, I know a friend who just finished their residency here in canada but couldn't find jobs so decided to head down south...

 

really? with the recent US cuts to rads it isn't looking any prettier down there. In fact the reverse (depends on what type of radiology of course )

[rmorelan]

There's a weird form by the MOH in Ontario, which is this gaudy orange color, that has a relative need assessment for the next few decades. As far as I remember, radiology is going to be in the most demand by a long shot. Surprisingly, general internal medicine isn't. I wonder how they came to these conclusions.

 

The report itself actually almost surprising goes through how they came to all of these conclusions. There was quite a bit thrown in - population, demographics, illness patterns......

 

Of course that report was just for Ontario, and whenever you predict anything you also at the same time likely change it (if I told you there was going to be a ton of open jobs in one field likely a lot of people will change their plans and go into that field. Thus there would ultimately not be open jobs at all quite possibly when you manage to get there ).

[jock2doc]

Oh there were a number of economists involved and they/the government know all of this of course - collectively we are dodging the ultimate truth which is the system cannot afford to have all those people people working at full capacity without significantly increasing costs and thus ultimately taxation.

 

True enough. Our system is in need of (even the slightest) market pressures. A 15 year wait to see a foot surgeon would shorten quickly if a two tiered system was ever put in place.

[BoyInTheBubble]

A 15 year wait to see a foot surgeon would shorten quickly if a two tiered system was ever put in place.

 

This has been repeatedly shown to be wrong.

 

Two tiered systems LENGTHEN wait times.

 

The private health care system is designed to make money, not treat patients. It leads to cream skimming, adds costs and increases wait times. There is a large volume of literature about this. It only works out to be good for the surgeon's wallet. It increases the burden on the public system and everyone else loses.

[jock2doc]

I am a big supporter of public health care. The market for HC has too many failures for allocative efficiency to be reached, not to mention anything about equity. However, there has to be a way for the government to address the issues at hand, most notably, some outrageous wait times. If they don't want to increase revenues (via taxation) so they can invest in the capital required for these services, then the logical step would be to introduce market forces in select areas. I think we are seeing some of this now with elective surgeries and imaging. I agree with you that a two tiered system across the board may not be the answer, but I also feel that governments could do a better job than they currently are.

[NutritionRunner]

This has been repeatedly shown to be wrong.

 

Two tiered systems LENGTHEN wait times.

 

The private health care system is designed to make money, not treat patients. It leads to cream skimming, adds costs and increases wait times. There is a large volume of literature about this. It only works out to be good for the surgeon's wallet. It increases the burden on the public system and everyone else loses.

 

Germany has a 2 tier system, and has much shorter wait times than Canada. My friends living in Berlin can see their family doctor the same day as a walk-in, or within a week if they make an appointment. They've never waited more than a couple of days to see a specialist (as opposed to my waiting months to see one in Canada, when I was in enormous amounts of daily pain due to endometriosis). They've been able to have imaging (CT scans, MRIs) the same day or the next day, even when non-urgent.

 

Of course, there are major differences between Canada and Germany. But Germany certainly has a 2 tier system, with both public and private health care (and from what I understand from my friends, most doctors take both public and private patients) and have much, much shorter wait times. So I don't think it is true that a 2 tier system leads to longer wait times. In Germany, at least, the 2 tier system has much SHORTER wait times.

[aaronjw]

Germany has a 2 tier system, and has much shorter wait times than Canada. My friends living in Berlin can see their family doctor the same day as a walk-in, or within a week if they make an appointment. They've never waited more than a couple of days to see a specialist (as opposed to my waiting months to see one in Canada, when I was in enormous amounts of daily pain due to endometriosis). They've been able to have imaging (CT scans, MRIs) the same day or the next day, even when non-urgent.

 

Of course, there are major differences between Canada and Germany. But Germany certainly has a 2 tier system, with both public and private health care (and from what I understand from my friends, most doctors take both public and private patients) and have much, much shorter wait times. So I don't think it is true that a 2 tier system leads to longer wait times. In Germany, at least, the 2 tier system has much SHORTER wait times.

 

you don't say?

 

Figure 6.8.1 Waiting time of four weeks or more for a specialist appointment

 

http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/g6-08-01.html?contentType=&itemId=/content/chapter/health_glance-2011-59-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html

[NutritionRunner]

you don't say?

 

Figure 6.8.1 Waiting time of four weeks or more for a specialist appointment

 

http://www.oecd-ilibrary.org/sites/health_glance-2011-en/06/08/g6-08-01.html?contentType=&itemId=/content/chapter/health_glance-2011-59-en&containerItemId=/content/serial/19991312&accessItemIds=/content/book/health_glance-2011-en&mimeType=text/html

 

Well, my friends are obviously in the 83% that didn't have to wait long, not the 17% that had a longer wait. I also know that the plural of anecdote is not data, but their experiences with the medical system in Berlin have been nothing but positive (yes, we discuss these kinds of things quite a bit). Still, that graph shows the percentage of people having to wait more than 4 weeks to see a specialist is considerably higher in Canada. So it seems that the 2 tier system in Germany has resulted in fewer people having to wait over a month to see a specialist, when compared to Canada. Granted, there are significant differences between the two countries, but still, the data you presented does nothing to indicate that a 2 tier system, such as they have in Germany, increases wait times, which a previous poster stated.

 

Private health care doesn't mean a U.S.-style system. I certainly wouldn't want that. But I think there is merit in looking at some European systems to see what they do right and how we could improve access to medical services, and shorten wait times, in Canada.

[aaronjw]

Well, my friends are obviously in the 83% that didn't have to wait long, not the 17% that had a longer wait. I also know that the plural of anecdote is not data, but their experiences with the medical system in Berlin have been nothing but positive (yes, we discuss these kinds of things quite a bit). Still, that graph shows the percentage of people having to wait more than 4 weeks to see a specialist is considerably higher in Canada. So it seems that the 2 tier system in Germany has resulted in fewer people having to wait over a month to see a specialist, when compared to Canada. Granted, there are significant differences between the two countries, but still, the data you presented does nothing to indicate that a 2 tier system, such as they have in Germany, increases wait times, which a previous poster stated.

 

 

In Germany, 75.9% of health care expenditure is from public funds whereas in Canada its 70.4% yet in Canada, we spend about $800 (total spending) more per capita compared to Germany.

 

Based on this alone, it would seem as though there are other factors at play when simply looking at wait times as a gauge of whether a two-tiered system is better or not.

[Vidhya]

In Germany, 75.9% of health care expenditure is from public funds whereas in Canada its 70.4% yet in Canada, we spend about $800 (total spending) more per capita compared to Germany.

 

Based on this alone, it would seem as though there are other factors at play when simply looking at wait times as a gauge of whether a two-tiered system is better or not.

 

 

It's definitely a complex question. Why are we less efficient with our public health spending?

 

At the same time, as an older student with a husband who works in a different industry, we've had group insurance plans constantly available to us. "If" we were allowed to use these benefits to pay for private procedures and not add to the public burden, I would love to do so.

 

One of the largest problems seems to be: how do we avoid government cuts in public health spending should they allow us to use private insurance. In theory if the funding levels stayed the same and yet more individuals accessed private insurance (particularly for elective procedures), then the wait times should decrease.

 

But that would call for some well-reasoned and researched legislation and I certainly don't have much faith in my own provincial government to do so...(sigh). The last thing I want is a US style system.

[leviathan]

Oh there were a number of economists involved and they/the government know all of this of course - collectively we are dodging the ultimate truth which is the system cannot afford to have all those people people working at full capacity without significantly increasing costs and thus ultimately taxation.

 

This x 1000. The government does not want / cannot spend the money to open new hospitals and ORs and all the associated new billings that the unemployed orthopods / other specialists would accrue.

 

This is the only situation I am actually in favour of a two-tiered system. If you have a large number of surgeons itching to get into an OR and treat more patients, it would actually decrease wait times in the public system. When people leave the wait list to pay for their surgery privately, you decrease the number of people left waiting for their surgery in the public system. The counter to that is you would take away pressure from the government to improve the public system, and it eventually would harm it in the long run as more and more surgeons moved from the public to the private sector until the 'public' market was no longer saturated.

[leviathan]

One of the largest problems seems to be: how do we avoid government cuts in public health spending should they allow us to use private insurance. In theory if the funding levels stayed the same and yet more individuals accessed private insurance (particularly for elective procedures), then the wait times should decrease.

 

But that would call for some well-reasoned and researched legislation and I certainly don't have much faith in my own provincial government to do so...(sigh). The last thing I want is a US style system.

 

I think it would require some complex and very close monitoring of physician supply and demand. The problem would be deciding what constitutes an appropriate wait time for various operations, diagnostics, and so forth. The government should then be forced to offer adequate funding to ensure that wait times don't exceed some standard - especially if it affects morbidity and mortality.

 

Once it got to a point where private services were starting to make wait times longer in the public system, then they would maybe have to find a way to limit the ability to work in the private sector. Not sure if that would work in reality or how to implement that, though.

[BoyInTheBubble]

Once it got to a point where private services were starting to make wait times longer in the public system, then they would maybe have to find a way to limit the ability to work in the private sector. Not sure if that would work in reality or how to implement that, though.

 

There is no going backwards, unfortunately. You can't espouse the free market, and then take it away.

[BoyInTheBubble]

This x 1000. The government does not want / cannot spend the money to open new hospitals and ORs and all the associated new billings that the unemployed orthopods / other specialists would accrue.

 

This is the only situation I am actually in favour of a two-tiered system. If you have a large number of surgeons itching to get into an OR and treat more patients, it would actually decrease wait times in the public system. When people leave the wait list to pay for their surgery privately, you decrease the number of people left waiting for their surgery in the public system. The counter to that is you would take away pressure from the government to improve the public system, and it eventually would harm it in the long run as more and more surgeons moved from the public to the private sector until the 'public' market was no longer saturated.

 

The solution to the problem isn't patients leaving the public system.

 

The problem arises because doctors (and other staff) leave the public system. There is a finite amount of doctors. The only way that this actually works, is if you implanted new doctors into the private system, and left the public system untouched.

 

Experience shows us that this doesn't happen. Patients are able to leave the wait list, but so do the limited supply of doctors. In the end, rich people overpay to jump the queue while poor (aka uninsured) people wait even longer in the public system.

 

Germany has a very public system, and a huge amount more doctors per thousand. Canada's also significantly more rural.

 

(More med students and residents needed here!)

[Med0123]

The solution to the problem isn't patients leaving the public system.

 

The problem arises because doctors (and other staff) leave the public system. There is a finite amount of doctors. The only way that this actually works, is if you implanted new doctors into the private system, and left the public system untouched.

 

Experience shows us that this doesn't happen. Patients are able to leave the wait list, but so do the limited supply of doctors. In the end, rich people overpay to jump the queue while poor (aka uninsured) people wait even longer in the public system.

 

Germany has a very public system, and a huge amount more doctors per thousand. Canada's also significantly more rural.

 

(More med students and residents needed here!)

 

No. The problem arises because you have a finite amount of OR TIME and facilities causing surgeons to operate maximum once a week when most of the time they would want to operate more (2 or 2 1/2 days a week).

 

Hence, why would a surgeon not want to increase the availability of his skills to the population in a private environment if he can't do it in the public system? Of course its services have a price (a fixed material price: the cost of the facility, nurses, RT, etc. and a variable price: the value of his "talent") but in the end he will often be payed the equal amount or sometimes even less than he would in the public system.

 

The issue is that the PATIENT will have to pay a fee that would have been covered in a public hospital.

[NLengr]

At this point I think many residents, myself included, would be happy with any system, as long as it can give one a job.

[BoyInTheBubble]

At this point I think many residents, myself included, would be happy with any system, as long as it can give one a job.

 

I understand what you are saying, but that's not exactly the best way to make such an important policy