Medical school enrollment is too high

[obi]

 

Someone want to explain how there are no jobs for doctors yet lots of listing? Can only imagine what it's like in other provinces.

 

It's not a numbers issue, it's a distribution issue. We have tonnes of small communities that NEED doctors (thus job availability) but we have tonnes of doctors that have NO desire to live in a small community. Once the doctors filter out the small communities from their job search they are left with few or no job availabilities.

 

Honestly IMO it's perfectly fair for a doctor to not want to work in a small community. But if that's the case then they must be willing to deal with the consequences and go through the fellowship game / consider moving pretty far.

[Hanmari]

Would it help at all to go out initially to a less urban setting, practice for few years to build experience, then look for a job in the big cities? Might be a nice way to pay off debts quickly, if work experience could compensate for lack of fellowship. Might also just be wishful thinking.

[aaronjw]

Would it help at all to go out initially to a less urban setting, practice for few years to build experience, then look for a job in the big cities? Might be a nice way to pay off debts quickly, if work experience could compensate for lack of fellowship. Might also just be wishful thinking.

 

I have a problem with people who do this. If going to an underserved area and then realizing that environment is not for you then I'm ok but if the goal is simply experience and debt repayment then those people should just stay away.

 

The relationship between a physician and patient, Esp for family physicians, is built on trust and rapport. It must suck to be a community act as a revolving door for some snotty doctor who is just using the people as a stepping stone to the bigger city and debt repayment.

 

This is also the problem with ROS crap.

[Leon]

I have a problem with people who do this. If going to an underserved area and then realizing that environment is not for you then I'm ok but if the goal is simply experience and debt repayment then those people should just stay away.

 

The relationship between a physician and patient, Esp for family physicians, is built on trust and rapport. It must suck to be a community act as a revolving door for some snotty doctor who is just using the people as a stepping stone to the bigger city and debt repayment.

 

This is also the problem with ROS crap.

 

When the vast majority of physicians desire living in cities, compromises are going to have to be made to get physicians into rural areas. That's just the way it is. It's not possible to change the mindset of the physicians and make them want to suddenly enjoy living in a small community so alternate solutions must be sought. Naturally, these alternate solutions will come with their own issues.

[PhoenixFlare500]

When the vast majority of physicians desire living in cities, compromises are going to have to be made to get physicians into rural areas. That's just the way it is. It's not possible to change the mindset of the physicians and make them want to suddenly enjoy living in a small community so alternate solutions must be sought. Naturally, these alternate solutions will come with their own issues.

 

That's where rural recruitment comes in.

[Birdy]

I have a problem with people who do this. If going to an underserved area and then realizing that environment is not for you then I'm ok but if the goal is simply experience and debt repayment then those people should just stay away.

 

The relationship between a physician and patient, Esp for family physicians, is built on trust and rapport. It must suck to be a community act as a revolving door for some snotty doctor who is just using the people as a stepping stone to the bigger city and debt repayment.

 

This is also the problem with ROS crap.

 

Yes, it does suck. My mother is on her fourth family doctor since moving home five and a half years ago. As a patient with a complex history and considerable ongoing issues in need of follow up, changing doctors is a huge problem.

 

Lacking the long term follow up is very frustrating. However, poor long term follow up is preferable to the constant clinic shuffle of being a doctorless patient.

 

Most of us are aware we can't expect to have downtown Toronto care levels in a province of 140,000 people, but we do think it can be better than it is.

[Leon]

That's where rural recruitment comes in.

 

Yup. I feel like it's the only long term solution for solving this issue. But then comes the problem of people complaining that it's "unfair" to preferentially reserve seats for individuals from rural backgrounds. There are always going to be problems no matter what model you choose. That said, I think rural recruitment will become a reality at some point.

[aaronjw]

When the vast majority of physicians desire living in cities, compromises are going to have to be made to get physicians into rural areas. That's just the way it is. It's not possible to change the mindset of the physicians and make them want to suddenly enjoy living in a small community so alternate solutions must be sought. Naturally, these alternate solutions will come with their own issues.

 

Right so maybe we can start applying a weighting criteria to select more rural location applicants and/or other creative options above and beyond the incentive options that people go up there to get then leave once the time is up. Like say, you are required to pay back, in full, the subsidized portion of your UG medical education if you leave before your contract is up and make the contract 10 years, not 5. Bet that cuts down on the phonies.

 

That, combined with a selection pool from underserved areas just may help keep physicians in these areas over being a continuous revolving door.

 

Cue the whining...

[aaronjw]

Yup. I feel like it's the only long term solution for solving this issue. But then comes the problem of people complaining that it's "unfair" to preferentially reserve seats for individuals from rural backgrounds. There are always going to be problems no matter what model you choose. That said, I think rural recruitment will become a reality at some point.

 

The needs of the community out match the whines of entitlement. Life isn't fair and it's not fair that these people either move to where there is care, suffer with inadequate care, or go without care.

[PhoenixFlare500]

Yup. I feel like it's the only long term solution for solving this issue. But then comes the problem of people complaining that it's "unfair" to preferentially reserve seats for individuals from rural backgrounds. There are always going to be problems no matter what model you choose. That said, I think rural recruitment will become a reality at some point.

 

That's not really a good point. Getting a high school education is a right. Getting into medical school is not. The country's not paying for our medical education so we can live it up and feel awesome. They're paying so that people can have access to medical care. If others are complaining, they can sign a long-term ROS, then feel entitled.

[Leon]

That's not really a good point. Getting a high school education is a right. Getting into medical school is not. The country's not paying for our medical education so we can live it up and feel awesome. They're paying so that people can have access to medical care. If others are complaining, they can sign a long-term ROS, then feel entitled.

 

I agree that it isn't a strong counterargument, but this is what comes up the most when I debate this topic with anyone. There is an inherent assumption that all forms of education are supposed to be "equal opportunity" and that preference to people from specific geographic regions is discriminatory.

 

I don't agree- I'm in favor of most OOP schools favoring applicants from their province, for example, but I wanted to bring up this point since it's the common counter to rural recruitment.

[rmorelan]

sid note on educational rights, because it gets messy with things like this:

 

the Supreme Court of Canada found that “once the state does provide a benefit, it is obliged to do so in a non-discriminatory manner...."

 

so once the province offers anyone for instance a high school education then suddenly under canadian law (as I understand it in my layperson way) then everyone does actually have a right to it. This is how people with disabilities have argued they absolutely must have access to schools and the province must provide that access.

 

so at present everyone does have the right to a high school education - at least as long as we are providing it to anyone In that matter the government actually has no choice.

[Leon]

sid note on educational rights, because it gets messy with things like this:

 

the Supreme Court of Canada found that “once the state does provide a benefit, it is obliged to do so in a non-discriminatory manner...."

 

so once the province offers anyone for instance a high school education then suddenly under canadian law (as I understand it in my layperson way) then everyone does actually have a right to it. This is how people with disabilities have argued they absolutely must have access to schools and the province must provide that access.

 

so at present everyone does have the right to a high school education - at least as long as we are providing it to anyone In that matter the government actually has no choice.

 

How would this apply to schools in most provinces favoring applicants from in province? Or even Western's SWOMEN system? I thought schools had the right to determine how they want to select medical students. I'm curious since this seems to directly prohibit rural recruitment and I always thought it was the choice of the school to not employ geographical preference.

[rmorelan]

How would this apply to schools in most provinces favoring applicants from in province? Or even Western's SWOMEN system? I thought schools had the right to determine how they want to select medical students. I'm curious since this seems to directly prohibit rural recruitment and I always thought it was the choice of the school to not employ geographical preference.

 

universities are not direct extensions of the government. They are only funded by about 1/3 with tax dollars - another 1/3 or so is tuition and the rest is donation/grants/investments etc, etc. Varies of course by school.

 

I have heard them described as private charitable corporations that receive significant public funding.

[rmorelan]

In rewinding this thread a bit back to the basics there were two main points the OP was making

 

a) That current enrollment to medical school is too high for the future employment demand for physicians.

 

I don't think that is a particular radical thought on the forum right now. We have job shortages, and a lot of students worried about this. We have a lot of residents worried about it as well

 

if we accept that a) is true for a moment it leads to the conclusion that we need to thus reduce the intake of students in some fashion. We cannot have the numbers of students (which are at historical highs of course) continue indefinitely.

 

that leads us the big question - how exactly should be cut the enrollment numbers - by what means of selection should we use - to say cut a very significant number of students from admittance beyond what we are currently doing. This means that students perfectly acceptable this year would not be accepted in a following year - we would be looking for "more". There would be a chance under such rules that if I personally be applying again that I would not be admitted as an example.

 

So hypothetically how should be do it? If you are in medical school looking at your classmates how would you removed say 25% or more more them from the class? ie make it a tangible exercise as if you had to do it. If you are not in medical school yet what of our criteria would you increase?

1) raise academics, i.e. GPA

2) raise cut offs, i.e. MCAT

3) demand more ECs

4) enforce more regional biases or some other bias

5) other?

 

and importantly how would that adjustment produce the best doctors afterwards that you could possible accept? Why is that the best way of doing it?

[doctorme]

Reduce the number of seats and each individual school keeps their policies? Schools who weight academics heavily continue to do so and schools who bias on ECs and such continue to weigh that.

[rmorelan]

Reduce the number of seats and each individual school keeps their policies? Schools who weight academics heavily continue to do so and schools who bias on ECs and such continue to weigh that.

 

why would that necessarily produce the best doctors? that just off loads the question to the schools in a sense - ha, side stepping the debate.

 

It would also have TO basically doing exactly what the OP suggested as the average of 3.90 would jump to potentially the 3.95 range. It would just that much harder to have any ECs to compensate. Similarly Ottawa, another GPA heavy school would also be pushed well into the 3.9+ range (as it is already almost there). Is that what we think is best?

[Leon]

So hypothetically how should be do it? If you are in medical school looking at your classmates how would you removed say 25% or more more them from the class? ie make it a tangible exercise as if you had to do it. If you are not in medical school yet what of our criteria would you increase?

1) raise academics, i.e. GPA

2) raise cut offs, i.e. MCAT

3) demand more ECs

4) enforce more regional biases or some other bias

5) other?

 

 

I feel like 4 would accomplish the most. It would reduce seats and also select for candidates that may, in the future, contribute to solving the rural shortage problem.

 

The academic cut offs are so high right now that I don't think increasing them any further is going to necessarily help in any way other than to narrow down the pool. Thoughts?

[rmorelan]

I feel like 4 would accomplish the most. It would reduce seats and also select for candidates that may, in the future, contribute to solving the rural shortage problem.

 

The academic cut offs are so high right now that I don't think increasing them any further is going to necessarily help in any way other than to narrow down the pool. Thoughts?

 

There likely then under that system be the systematic exclusion of people from particular areas under the somewhat arbitrary regional zones (it would be like NOSM except everywhere - in theory someone from TO could get into that school but realistically that is extremely unlikely to occur. Western, Ottawa etc would basically collapse down to their regions. Western for instance would accept the same number of SWOMEN applicants but only say 1/2 of non swomen. Where you go to high school becomes a very big deal then ).

 

I think I am playing devils advocate a bit here - mostly because while I think the OP statements lacked a certainly measure of tact I think we overly focused on that to the exclusion of the core problems we are about to face. This is not really a theoretical debate.

[Leon]

 

I think I am playing devils advocate a bit here - mostly because while I think the OP statements lacked a certainly measure of tact I think we overly focused on that to the exclusion of the core problems we are about to face. This is not really a theoretical debate.

 

I agree. I usually do the same thing to promote debate. Someone has to say the more radical viewpoints to properly explore all the options.

 

Regional preference in Ontario would not really help with the problem of rural physician shortages. But rural recruitment would help, at the cost of reducing seats for people from urban regions which would forcibly raise admission criteria for urban applicants and bring about a deviation in the cut offs for the two different pools of applicants.

 

Argh, my brain hurts. I'll come back to this once I'm done my exam tomorrow

[rmorelan]

Hmmm my take from the above was that we have a residency/infrastructure limitations (ie a poor job market) and we should select only the best of the best (as defined by academic performance primarily) as students for those positions (all from original post). Suboptimal phrasing but regardless of the form of the argument, there is in fact an argument there worth exploring - because we have to really As the OP's very thread title was - "medical school enrollment is too high" - if you believe that then changes should come.

 

Of course that is my take on it - but I think not exploring things related to it is a bit of a waste.

[rmorelan]

I agree. I usually do the same thing to promote debate. Someone has to say the more radical viewpoints to properly explore all the options.

 

Regional preference in Ontario would not really help with the problem of rural physician shortages. But rural recruitment would help, at the cost of reducing seats for people from urban regions which would forcibly raise admission criteria for urban applicants and bring about a deviation in the cut offs for the two different pools of applicants.

 

Argh, my brain hurts. I'll come back to this once I'm done my exam tomorrow

 

ha - you know my brain hurts a bit on this as well - THAT'S my point. This isn't easy, and it is going to very likely happen and very likely needs to (at least at some point). It would be nice to swing around and look at what that means a bit I think

 

and you know a Western cut for SWOMEN being unchanged at 3.7 and 8/8/8 and NON-SWOMEN going to 3.8 and 11/11/10 (just as an example - throwing out possible cut offs etc) would be a very interesting thing

[doctorme]

why would that necessarily produce the best doctors? that just off loads the question to the schools in a sense - ha, side stepping the debate.

 

It would also have TO basically doing exactly what the OP suggested as the average of 3.90 would jump to potentially the 3.95 range. It would just that much harder to have any ECs to compensate. Similarly Ottawa, another GPA heavy school would also be pushed well into the 3.9+ range (as it is already almost there). Is that what we think is best?

 

Very true. But if we agree that all the Canadian schools produce well-trained, equivalent doctors, then perhaps increasing standards in all those 4 domains across different schools will allow us to have a diverse pool of exceptional doctors.

[HycrestJIT]

It is not opinion, it's pretty much fact that the current rates of enrollment are not sustainable. Unless there is a corresponding increase in residency funding a larger and larger proportion of new med students will be pushed into fields they don't want. Namely, family med in undesirable locations. This is not desirable nor is it a sign of a well functioning system. You are not attracting people who are going to be happy or inspired doing their job or living in these locations. You are basically forcing them down a path after 10-13 years of education...

 

Why is this at all a bad thing? Other fields operate in this manner as a daily reality. Becoming a teacher? There are hard to find jobs as a teacher in desirable areas; looks like you'd have to look elsewhere. Same thing for plumbers, electricians, carpenters, tailors, engineers, lawyers, etc.

 

Really, if you want to set-up shop somewhere, you end up dealing with the (potential) competition of others who also live in that same area who provide a similar service. It's true for all these other professionals. So why not the fee-for-service, self-regulating physicians?

 

Why should medicine be special? Why do medical professionals feel so entitled that simply because they went to school for so much longer that they are owed jobs that they want without compromise? I'm sorry, but life doesn't work that way.

 

There are many jobs in life where people look outside the country for gainful employment. Again, why should medicine be exempt? Furthermore, why should a heavily subsidized system seek to cater to the whims of its entitled products rather than seek to serve the very people who fund it (ie. placing physicians in places where they're needed).

 

Rogerroger, I'm not targeting you (or asking you to answer the above questions). Please don't take this that way. I also understand that my post may come out stronger than I mean it to, mostly because I think that there is a bias for young medical professionals to feel entitled about jobs where most other professions/trades don't operate in that manner. I don't understand why we think we should be special just because we're medical practitioners. Or why we blame the system for the lack of our own foresight in picking jobs that have employment (and this is where I think medicine could do so much better - educating its trainees on where jobs are available).

 

Roger, I'm also not saying that I think you have that bias; it's just that your post touched on a pet-peeve of mine, intentional or not, and I'm at a point where I feel like ranting (not because of you).

 

Final rant: there are lots of specialist jobs, they just happen to be in rural/regional centres. Again, why people feel so entitled to not go where the work is baffles me. 10+ years of school doesn't make a person special; it makes them highly trained (and highly trained people still eat, sh*t and die like everyone else).

 

I often think that we, as a profession, forget that we exist in service for others.

 

./endrant

 

(And apologies for those to whom this came across strongly).

[NLengr]

Why is this at all a bad thing? Other fields operate in this manner as a daily reality. Becoming a teacher? There are hard to find jobs as a teacher in desirable areas; looks like you'd have to look elsewhere. Same thing for plumbers, electricians, carpenters, tailors, engineers, lawyers, etc.

 

Really, if you want to set-up shop somewhere, you end up dealing with the (potential) competition of others who also live in that same area who provide a similar service. It's true for all these other professionals. So why not the fee-for-service, self-regulating physicians?

 

Why should medicine be special? Why do medical professionals feel so entitled that simply because they went to school for so much longer that they are owed jobs that they want without compromise? I'm sorry, but life doesn't work that way.

 

There are many jobs in life where people look outside the country for gainful employment. Again, why should medicine be exempt?

 

Final rant: there are lots of specialist jobs, they just happen to be in rural/regional centres. Again, why people feel so entitled to not go where the work is baffles me. 10+ years of school doesn't make a person special; it makes them highly trained.

 

I often think that we, as a profession, forget that we exist in service for others.

 

./endrant

 

(And apologies for those to whom this came across strongly).

 

Medicine is special because according to the ON govt yesterday it costs them 780k to train a specialist to the end of residency. That's lots and lots of tax dollars. Every person who is unemployed or heads down south means a wasted 780k. That's wasted taxpayer dollars. You might like paying taxes but I certainly don't.

 

Second, you're wrong that there is plenty of jobs for all in rural areas areas. For some specialties, there may be some unfilled spots. It's not enough to employ everyone in every specialty. There is a reason the CMA, royal college and specialty associations are all looking at employment numbers. Its not a simple "everyone go rural" issue like you are making it out to be.