One in six newly graduated medical specialists can’t find work

[aaronjw]

http://www.theglobeandmail.com/news/national/one-in-six-newly-graduated-medical-specialists-cant-find-work-report/article14794764/

 

 

The findings are startling, given years of complaints about doctor shortages and long wait times for surgeries. But a new report suggests that nearly one in six recently minted medical specialists cannot find work in their field.‎

And one in five of the new specialists reported taking a series of short term fill-in posts — locums, in the lingo of medicine — to stay working.

 

Physicians who reported having trouble finding work included urologists, critical care specialists, gastroenterologists, ophthamologists, orthopedic surgeons and general surgeons, though doctors from other sub-specialties were also unemployed.

 

Steven Lewis, a health policy consultant based in Saskatchewan, suggested the report is proof reactive moves made over the last 15 years or so solved one problem by creating another. And he said the situation the report captures will only get worse, because medical schools will continue to graduate specialists at current levels for the next few years at least.

 

“I think we overshot the mark,” said Lewis, who was not involved in this study.

 

“I think that there is no question that ... almost doubling medical school enrolments since the late 1990s combined with easier paths to licensure for international medical grads was the wrong thing to do. We didn’t think it through as a country.”

 

The study was conducted for and released by the Royal College of Physicians and Surgeons. The principal investigator was Danielle Frechette, executive director for health systems innovation for the college.

 

Frechette said the organization, which sets standards for physician education in the country, had been hearing anecdotes about rising numbers of unemployed doctors, so decided to assess the situation.

 

The ensuing report, released Thursday, is based on a survey of over 4,000 newly graduated doctors and interviews with about 50 people knowledgeable about the situation — deans of medical schools, hospital CEOs and the like.

 

The report paints a grim picture but does not recommend ways to fix it; that was not the mandate. The Royal College of Physicians and Surgeons is convening a national summit in February to explore ideas for developing a co-ordinated approach to planning health system workforce needs, Frechette said.

 

She noted a fix will not be easy.

 

“We’re hoping that our research shows that this is not a simple issue. And that we shouldn’t have any knee-jerk reactions, otherwise we will perpetuate this boom-bust cycle that we’ve been in. It’s like Groundhog Day,” she said, referring to the popular Bill Murray movie.

 

Frechette suggested, however, that a national health systems workforce planning body would be an important start. Australia, Britain and the U.S. all have such an entity.

 

The report pointed to a number of factors that have contributed to the oversupply of specialists. Poor stock market returns in recent years have meant that some older doctors — most of whom must finance their own pension plans — have delayed retirement.

 

And there has been a realignment or rationalization of tasks in health care, with nurses and physician assistants taking on responsibilities that were once left to doctors, freeing them up to do some tasks that used to fall to specialists.

 

That effect, which Lewis called sensible, will only accelerate as less invasive treatments are brought on line. For instance, angioplasty — opening blocked cardiac arteries with balloons and stents — has replaced many open heart surgeries to bypass blocked arteries.

 

Lewis suggested the cycle of training specialists — which typically takes about nine years — is out of sync with the cycle of assessing future medical system requirements.

 

“Forecasting health human resource needs more than three or four or five years out is a fool’s game, because medical science changes, health needs can change, technology can change and so on.”

 

But Frechette said there are some low hanging fruit — problems that should be relatively easy to address. For instance, her study noted there are jobs going for the asking. And yet while it seems inconceivable in the era of Craigslist and LinkedIn, doctors are having a hard time finding these “help wanted” ads.

 

“Our research did discover that there are a lot of people who can’t find jobs, including orthopedic surgeons who would gladly go to where the jobs are, but they don’t know where they are,” she said.

 

Lewis said there are some other adjustments the system should consider. One is shortening the period of time it takes to train a specialist, which would allow planners to adjust the course more quickly if it appeared that a glut of doctors was forming.

 

“If your whole life is going to be doing hip and knee replacements, I think one can question whether it should take nine years of training,” he said.

 

Another suggestion involves sharing the wealth. He said it isn’t uncommon to hear of small communities where patients have to wait to see a specialist — but the three specialists in town aren’t keen to let a fourth hang a shingle.

 

“I think the one thing that’s clear is there won’t be a spontaneous solution that employs all of these new doctors effectively. Somebody has to make room for them,” Lewis said.

 

“And there have to be some policy and practice changes that will make sure that the vast majority of the new entrants find a useful home in the system without driving up system costs unreasonably.”‎

[shady]

Now ophthalmologists?? Holy ... . I don't know what to gun for anymore.

 

Edit: and general surgeons too... this is bad.

[Hockeynut]

They're not willing to go where the work is. My hometown has postings for general surgeons, orthopedic surgeons, etc for years! And can't find anyone. Heck they even have a tough time finding locuums

[shady]

Postings for ortho and no one applying? I find that hard to believe

[seeking1]

Here's the link to the report done by the Royal College: http://www.royalcollege.ca/portal/page/portal/rc/advocacy/policy/hrh/examining_specialist_physician_employment

[seeking1]

Man, I literally lol'ed (which usually doesn't happen) when I read the first few pages of the actual report. They slagged the crappy economy and interprofessional models of care for really dinging the job market for specialists.

[seeking1]

Wow, interprofessional practice models are just a big screw-you to young doctors. Right from the report:

 

““… we have advanced practice nurses in virtually every specialty now who can run a clinic, who can do a lot under the direction of a consultant. We have hospitalists, … physician assistants, ... and physiotherapists picking up what orthopedic surgeons used to do. … You can’t look at a profession that hasn’t increased its credentials and increased its training and has spread out. … Our hospital is paying for 16 anesthesia assistants. …and anesthesia specialists want more [anesthesia assistants]. … So even if I just put one anesthesiologist with two anesthesia assistants, I now need half as many anesthesiologists. That’s huge! ” [KII C58, emphasis added]"

[Hockeynut]

Postings for ortho and no one applying? I find that hard to believe

 

no one wants to come up to Northern Ontario to practice. We currently have a orthopedic surgeon commuting up from Toronto for 3 week stints once every two months to help ease the burden. (he used to practice here until he retired, couldn't find a replacement so they made him an offer he couldn't refuse to come out of retirement).

 

I'd post some recruitment ads they have, but I don't really want to give away where I'm from as it will give away my identity to anyone from McGill/my hometown. (If you want to see them shady pm me)

[rmorelan]

Now ophthalmologists?? Holy ... . I don't know what to gun for anymore.

 

Edit: and general surgeons too... this is bad.

 

We have known about this one for awhile - new grads often cannot access surgical time so may stuck in clinics etc, of course that fills up as well

[Intrepid86]

They're not willing to go where the work is.

 

Basically this.

[rmorelan]

Basically this.

 

This is part of it but on top of that some of these specialists cannot go there.

 

Look at that list:

 

urologists, critical care specialists, gastroenterologists, ophthamologists, orthopedic surgeons and general surgeons

 

some of them wouldn't be sustainable in low population areas. That just won't work, and the government cannot afford to put them there with respect to facilities.

 

but, and this is the key point, even if we did have the few we need migrate there permanently it wouldn't solve the problem. We have still many more doctors now being trained than we have spots ultimately for them. On top of that we are continuing to train people in the wrong specialties from a overall health care management point of view. In a sense all the prior analysis is coming to true as predicted. If we maintain the current enrollment levels then we are simple going squeeze out any remaining spots and then there would be no place to go.

 

One more thing I think have mentioned before - that stock market argument that keeps getting thrown around as delaying retirement etc. Well if that is true two points a) the stock market has exceeded the 2009 level now, and thus the losses are totally and completely erased and if those doctors worked 4 more years as a result then now have less retirement time to even worry about and even more savings - they are now very well off. Still don't seem any mass retiring happening though - so don't think that is going to adjust things much.

 

bottom line - we doubled enrollment to correct a shortage. We actually did in fact correct that shortage over 10 years and now we have shifted into a surplus. Yet we are still training people as if we had a shortage, which will lead to increasing underemployment as we continue.

[rmorelan]

Man, I literally lol'ed (which usually doesn't happen) when I read the first few pages of the actual report. They slagged the crappy economy and interprofessional models of care for really dinging the job market for specialists.

 

well valid points - what they are saying doesn't invalidate the inter professional model. It simply shows that we need even fewer doctors.

 

Of more concern or at least interest is the comment on training times being too long. That we should shorten the time required to create an orthopod for instance - which would be achievable only if they did a subset of what they do now. Personally I would not at all like that sort of limitation in my training and it would be a mess to administrate (as in say how do you do call when there isn't anyone that can do all the procedures? Do you have 15 sub training programs under orthopedics as an example? Is someone for each on call all the time?).

 

and of course established docs don't want to open things up for others - they know that times are good but won't be good forever (not the first time this has happened). You have to take what you can while you can. The government has a tendency to solve things like this with caps, restricting practice locations, and generally making it a mess for new grads first and older docs second. This is cycle we have seen before if you look back 20 years.

[RunningGuns]

I think the worst thing about those job shortages is the fact it's not due to a lack of demand. Have people seen the wait-lists for surgery in general? Unless you need life saving surgery you're going to be waiting weeks, months, or years. I understand that life-saving treatments have to come first, but it's still awful watching patients live with severe chronic pain in the mean time.

[medigeek]

Damn opthalmologists too now... sucks

[Med0123]

Damn opthalmologists too now... sucks

 

Not new.

see this http://www.premed101.com/forums/showthread.php?p=702924#post702924

[spontaneouscombustion]

I think the worst thing about those job shortages is the fact it's not due to a lack of demand. Have people seen the wait-lists for surgery in general? Unless you need life saving surgery - although I have had patients who have died waiting for surgical intervention, especially transplants [other factors here as well] or trauma - you're going to be waiting weeks, months, or years. I understand that life-saving treatments have to come first, but it's still awful watching patients live with severe chronic pain in the mean time. I wonder what the statistics are for those patients committing suicide?

 

Your post is unclear, but I find it hard to believe you had patients die waiting for transplant and/or trauma surgery for anything other than the "other factors". The "other factors" are the only factors.

[Laika]

that stock market argument that keeps getting thrown around as delaying retirement etc. Well if that is true two points a) the stock market has exceeded the 2009 level now, and thus the losses are totally and completely erased

 

In the US, the stock market has exceeded its pre-crash lows. Not so in Canada. In May, 2008, the S&P/TSX composite index closed at nearly 15,000. Today, the close was ~12,900. That's down around 13%. Also, your hypothetical example assumes that the investor held on to equities during the crash. If they sold near the bottom and waited to buy back in (as many people did), they would have missed out on the bounce back. Instead of having loses that "are totally and completely erased", they may have screwed themselves (and their retirement plans).

[Der Kaiser]

In the US, the stock market has exceeded its pre-crash lows. Not so in Canada. In May, 2008, the S&P/TSX composite index closed at nearly 15,000. Today, the close was ~12,900. That's down around 13%. Also, your hypothetical example assumes that the investor held on to equities during the crash. If they sold near the bottom and waited to buy back in (as many people did), they would have missed out on the bounce back. Instead of having loses that "are totally and completely erased", they may have screwed themselves (and their retirement plans).

 

Not to mention doctors are not usually good with their money;).

[RunningGuns]

Your post is unclear, but I find it hard to believe you had patients die waiting for transplant and/or trauma surgery for anything other than the "other factors". The "other factors" are the only factors.

 

You're right, I would need to include more information for clarification, and that would end up taking away from my underlying point. Therefore, I decided to edit that sentence out of my post.

[tooty]

The jobs situation is better than I thought. 1 in 6 don't have jobs, and 1 in 5 are locumming, meaning everyone can find work.

[lovestruck]

So what does this mean for current medical students interested in surgery?

 

Most of my classmates are willing to move anywhere in Canada but I know many rural places don't have the infrastructure to support surgical subspecialties!

[Hockeynut]

So what does this mean for current medical students interested in surgery?

 

Most of my classmates are willing to move anywhere in Canada but I know many rural places don't have the infrastructure to support surgical subspecialties!

 

we do in my hometown and are in dire need of surgeons,IMs,rads etc. just go look rural.

[uwodesperate]

Is there a central website that compiles all the vacant positions for every specialty?

[rmorelan]

In the US, the stock market has exceeded its pre-crash lows. Not so in Canada. In May, 2008, the S&P/TSX composite index closed at nearly 15,000. Today, the close was ~12,900. That's down around 13%. Also, your hypothetical example assumes that the investor held on to equities during the crash. If they sold near the bottom and waited to buy back in (as many people did), they would have missed out on the bounce back. Instead of having loses that "are totally and completely erased", they may have screwed themselves (and their retirement plans).

 

if they bought high and sold low as you suggest well then they clearly haven't exactly being getting the best advise. Bluntly that approach is idiotic unless you need the cash - which since they were able to continue to work they didn't.

 

Of course some may have done it but really I hope that is far and few between

[rmorelan]

Is there a central website that compiles all the vacant positions for every specialty?

 

no, such an animal would require centralization which is absent - which is exactly why we keep getting into trouble like this