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

[rmorelan]

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!

 

it means there is a bit of trouble. not much point beating around the bush about that.

[uwodesperate]

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

 

Meh I will just be fellow for life when the time comes

[lovestruck]

it means there is a bit of trouble. not much point beating around the bush about that.

 

So what's the best gameplan these days? Stay away from surg or if your open about location, keep gunning?

[Hockeynut]

So what's the best gameplan these days? Stay away from surg or if your open about location, keep gunning?

 

I find this very funny. people start medschool saying they'd go anywhere to practice, come the end of their residency they're all super choosy (Montreal,Toronto,Calgary or Vancouver).

[aaronjw]

Urban vs rural health care: Canada's real two tier health care

[lovestruck]

I find this very funny. people start medschool saying they'd go anywhere to practice, come the end of their residency they're all super choosy (Montreal,Toronto,Calgary or Vancouver).

 

In my experience I'd say most people are open minded! Most want to be close to family so rural but at least 2-3 hours from home is ideal.

 

Some specialties just don't condone themselves to rural practice. Neurosurg for example is never going to be accessible rurally.

 

Also, after almost a decade of education, people want the freedoms to do what they love and where they love and honestly I can't blame them!

[hamham]

I find this very funny. people start medschool saying they'd go anywhere to practice, come the end of their residency they're all super choosy (Montreal,Toronto,Calgary or Vancouver).

 

I'm with you on this one, Hockeynut.

 

It just goes to show that going rural is never an easy decision. Many med schools now are promoting rural medicine, and encouraging students to consider rural, but it's never an easy decision, esp when you have spent your entire life in an urban setting. Take UBC for instance. We set up regional sites at Prince George, Kelowna etc (cities more rural than Vancouver of course) in hope that the graduates from these sites will consider practicing med in these cities. Yet, time over time, we see new graduates moving out of these cities (once they are done) to return to urban centers. The need for rural doc is why IMGs still stand a shot if they want to return. Some IMGs that I know would rather wait for an opening in urban cities than consider rural med. In short, going rural is easier said than done.

[Hockeynut]

Urban vs rural health care: Canada's real two tier health care

 

You are right BUT there are many regional health centers, one may consider them urban Rural. Say towns of 20-40 thousand which have virtually all the amenities yet seem to still be under staffed.

[Hockeynut]

In my experience I'd say most people are open minded! Most want to be close to family so rural but at least 2-3 hours from home is ideal.

 

Some specialties just don't condone themselves to rural practice. Neurosurg for example is never going to be accessible rurally.

 

Also, after almost a decade of education, people want the freedoms to do what they love and where they love and honestly I can't blame them!

 

i don't blame them yet at the same time I don't exactly want to hear them complain about how there aren't any jobs. ( the reasons you mentioned are the main factors of why we can't keep any physicians)

[aaronjw]

In my experience I'd say most people are open minded! Most want to be close to family so rural but at least 2-3 hours from home is ideal.

 

Some specialties just don't condone themselves to rural practice. Neurosurg for example is never going to be accessible rurally.

 

Also, after almost a decade of education, people want the freedoms to do what they love and where they love and honestly I can't blame them!

 

3-4 years of education by my count.

 

Undergrad doesn't count nor does paid training of residency

[aristarchus]

From a similarly-themed article:

"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."

 

http://www.huffingtonpost.ca/2013/10/10/unemployed-doctors-canada_n_4074976.html

[aaronjw]

You are right BUT there are many regional health centers, one may consider them urban Rural. Say towns of 20-40 thousand which have virtually all the amenities yet seem to still be under staffed.

 

Health care extends as much to practitioners as it does facilities.

 

20% of Canadian population is rural/small town that accounts for <10% of family physician and <2 specialist supply.

[RunningGuns]

it means there is a bit of trouble. not much point beating around the bush about that.

 

rmorelan, do you know why Canada doesn't, or can't, have mobile surgical centres that are extensions of the hospital, perhaps similar to MMIC?

[spontaneouscombustion]

Urban vs rural is the two tier of everything in this country. Its a fact of life that no one wants to live in these towns unfortunately, and anyone that has a shot will try to get out.

[seeking1]

Urban vs rural is the two tier of everything in this country. Its a fact of life that no one wants to live in these towns unfortunately, and anyone that has a shot will try to get out.

 

Yeah, its pretty much global at this point. The US has the same divide, India, China, Japan, Ukraine, Russia, France, etc. Administrators and economy managers in major cities don't really want to devote more resources to rural areas these days. Its unfortunate because here in Canada, rural areas don't have as much power in self-governance as they do in the US.

[rmorelan]

Health care extends as much to practitioners as it does facilities.

 

20% of Canadian population is rural/small town that accounts for <10% of family physician and <2 specialist supply.

 

True - although those sorts of statistics get me worried for another reason. At best the rural areas can absorb then 20% of the supply ideally based on that (although of course it is a lot less as there are in fact some doctors already there). That isn't really a lot of "reserve"

 

My point is rural areas are not some bottomless pit that can take every single extra grad coming out of the system even IF they wanted to go there - and of course they don't want to all go there. I would be cautious in thinking permanently "oh they can just go rural". That is the same sort of talking like there is this endless shortage of family doctors Well, no there isn't and you cannot continue to run at these enrollment numbers forever and expect anything to be free.

 

Basically we need a stable comprehensive long term plan to training doctors with centralized access to information, or we are going to continue to move in boom bust cycles and/or have a lot of our grads having to go to the US if they can.

[ralk]

True - although those sorts of statistics get me worried for another reason. At best the rural areas can absorb then 20% of the supply ideally based on that (although of course it is a lot less as there are in fact some doctors already there). That isn't really a lot of "reserve"

 

My point is rural areas are not some bottomless pit that can take every single extra grad coming out of the system even IF they wanted to go there - and of course they don't want to all go there. I would be cautious in thinking permanently "oh they can just go rural". That is the same sort of talking like there is this endless shortage of family doctors Well, no there isn't and you cannot continue to run at these enrollment numbers forever and expect anything to be free.

 

Basically we need a stable comprehensive long term plan to training doctors with centralized access to information, or we are going to continue to move in boom bust cycles and/or have a lot of our grads having to go to the US if they can.

 

Finding ways to get more specialists to underserved rural areas may not solve the problem on its own, but it still needs to be part of the solution. For one, no plan will be able to solve specialist un/underemployment with a single policy prescription, so multiple avenues will be necessary. If increased rural specialists only provide jobs for 20% of the unemployed specialists, that's still 20% fewer unemployed specialists.

 

Besides, in fixing specialist unemployment, if it gets done WITHOUT fixing the problem of rural undersupply, that problem will only be exacerbated. Imagine what the situation in underserved communities will be if specialists didn't have to risk unemployment to avoid working in those communities!

 

Finding the proper rural/urban balance in physician distribution needs to be the first priority. Adjusting overall levels of physicians without doing so is like baking cookies by focusing on the amount of total ingredients to use before looking at what the ratio of ingredients should be. You might end up with the right number of cookies, but they're going to taste like $#(&

[rmorelan]

Finding ways to get more specialists to underserved rural areas may not solve the problem on its own, but it still needs to be part of the solution. For one, no plan will be able to solve specialist un/underemployment with a single policy prescription, so multiple avenues will be necessary. If increased rural specialists only provide jobs for 20% of the unemployed specialists, that's still 20% fewer unemployed specialists.

 

Besides, in fixing specialist unemployment, if it gets done WITHOUT fixing the problem of rural undersupply, that problem will only be exacerbated. Imagine what the situation in underserved communities will be if specialists didn't have to risk unemployment to avoid working in those communities!

 

Finding the proper rural/urban balance in physician distribution needs to be the first priority. Adjusting overall levels of physicians without doing so is like baking cookies by focusing on the amount of total ingredients to use before looking at what the ratio of ingredients should be. You might end up with the right number of cookies, but they're going to taste like $#(&

 

oh absolutely - we have too issues, rural shortages that have to be fixed to some degree and total surplus comprised of too many doctors and on top of that too many doctors in the wrong specialty.

 

I don't have to imagine - hehehe - we exactly know because it was in large part the cries from rural areas that this entire process started over 10 years ago.

 

The problem is we never really addressed the rural doc shortage that well directly. We just churned out more and more doctors in the vague hope that the trickle down effect would have some of them end up there. The current strategy is rather silly for dealing with rural issues. You have the wrong types of doctors being trained, no actual focus on getting doctors there, not training the sort of person that would want to be here in many cases - even by simply making sure everyone knows, hey look there is pretty good chance you are not going to be able to work in TO post grad.

 

I think we have to view this as very related but different problems - we actually need a rural doc strategy that works but we don't have one AND we need to ensure we are not swarmed with a generalized doctor surplus. Historically if the later occurs the costs shoot up as everyone tries to get what they can out of the system. Generalized rising health care costs won't help get any rural efforts off the ground.

 

Trouble is there are only a few ways to get people to go rural. What do we have here (maybe we can think up some more):

1) Pay or otherwise reward them differently - we do already pay people more for after hour work as it is not popular, you could in theory do the same with rural positions

2) Force people - give them no choice at all - with return on service or as it has been done in the past simply not letting new docs bill from saturated areas (historically the field "eats its own" in cases like this - since new docs don't already have patients or practices) or starve them out somehow.

3) Get the right people who simply want to be there.

 

With a generalized surplus in docs without planning you already missed the boat on 3). The government won't do 1) to a large open degree as it is actively trying to reduce doctor salary. Leaves us with 2) which is never popular with new grads etc and is probably the least stable of all the approaches.

[NLengr]

Finding ways to get more specialists to underserved rural areas may not solve the problem on its own, but it still needs to be part of the solution. For one, no plan will be able to solve specialist un/underemployment with a single policy prescription, so multiple avenues will be necessary. If increased rural specialists only provide jobs for 20% of the unemployed specialists, that's still 20% fewer unemployed specialists.

 

Besides, in fixing specialist unemployment, if it gets done WITHOUT fixing the problem of rural undersupply, that problem will only be exacerbated. Imagine what the situation in underserved communities will be if specialists didn't have to risk unemployment to avoid working in those communities!

 

Finding the proper rural/urban balance in physician distribution needs to be the first priority. Adjusting overall levels of physicians without doing so is like baking cookies by focusing on the amount of total ingredients to use before looking at what the ratio of ingredients should be. You might end up with the right number of cookies, but they're going to taste like $#(&

 

As was said before, even if we filled every rural opening in the country, we still would have more people than jobs. There are very few surgical jobs for urologists, opthomologists, cardiac surgeons, ortho in rural areas. The fact that these are open has more to do with the job being undesirable rather than there not being any candidates. It's part of the solution, but it's not going to be much more than a small part.

 

One thing we need to talk about as a country if attaching funds to PATIENTS as opposed to the SYSTEM. For example, if that was done, hospitals would make money when they operated or saw patients. Then there would be a major drive to get timely care completed by hospitals. We'd see OR and clinic time magically open up across the country. Right now, institutions have no reason to provide more/faster care, because doing so causes them to lose money from there limited supply of funding.

 

More OR/clinic would mean more jobs for new surgeons/physicians.

[spontaneouscombustion]

I dont see that ever working in a system where the person setting policy is also paying the bills. The government is never going to promote policy that encourages more people to visit the hospital.

 

This just seems a problem the medical profession bought upon itself and its really not in anyone elses interest to fix.

[medigeek]

I find this very funny. people start medschool saying they'd go anywhere to practice, come the end of their residency they're all super choosy (Montreal,Toronto,Calgary or Vancouver).

 

Cause those places are more desirable, or at least the suburban areas. Not everyone wants to live in hicktown.

[rmorelan]

I dont see that ever working in a system where the person setting policy is also paying the bills. The government is never going to promote policy that encourages more people to visit the hospital.

 

This just seems a problem the medical profession bought upon itself and its really not in anyone elses interest to fix.

 

only trouble is the medical profession doesn't set the enrollment levels at the medical schools directly - and although they certainly should have gotten their act together on the ratio of various specialty training positions there are some pretty annoying hospital level structures to manage as well (residents run things of course directly for over 50% of the week when you consider call and weekends, and holidays etc at the major learning centres. The system kind of depends on that, which is why no one was exactly in a big hurry to remove positions. You could in theory get staff to cover that time but as you can imagine that isn't exactly a) cost effect feasible for some fields under our current models)

 

We had a very good model for Ontario at least for various positions for 3 years now (the Population Needs based Model) - which has been chugging along pretty much predicting things correctly since it came out. Not unexpectedly no one acted on it in any fashion really yet. It suggests by 2017 we will no longer have a doctor shortage in family medicine even - which I guess would mean most people not in at least clerkship in medical school will become already full doctors in a surplus world (although of course some regional bias will remain ) No model is perfect of course but so far things are lining up pretty closely.

[rmorelan]

Cause those places are more desirable, or at least the suburban areas. Not everyone wants to live in hicktown.

 

Plus it is a lot easier to say you will move anywhere when you likely aren't already married and potentially have children - medical school and residency + fellowships is a LONG time - say 10 years in a lot of cases, and is often the time things like that happen. Things change - and a doctor's partner and family often have jobs/commitments that restrict where they can go. I think people underestimate that effect sometimes

 

Plus the shear "I will do anything to get to go to medical school and be a doctor!!!" wears off a bit when you actually are going to be doctor for sure Then you look up and go, well gezz I want to be a doctor AND have access to a particular location of choice.

[Hockeynut]

Cause those places are more desirable, or at least the suburban areas. Not everyone wants to live in hicktown.

 

Then I would appreciate not hearing these people complain about how they can't find jobs. The feeling of entitlement is through the roof with many med students/recent grads when it comes to situations such as this. At some point you need to go out and find the jobs.

[Jamone]

I used to consider going to a rural area to practice, until I lived in a city for years to go to university and got used to city life.