Untrained And Unemployed: Medical Schools Churning Out Doctors Who Can't Find Residencies And Full Time Positions

[武田信玄]

But the public nature of our healthcare system, coupled with a lack of HR planning and appropriate infrastructural investments from government, leaves those physicians unable to fill a niche.

If the Liberals hadn't burned that one billion dollars in that Oakville plant, maybe we would've had enough funding to offer poor Lurie a residency spot. What amazes me is that the Liberals got re-elected again this year. Wow!

 

So no, I don't think our current predicament is a result of just "a lack of HR planning". I will die a happy man if I can see a law gets passed that says if a ruling party f@#@ks up to a certain extent, that this party is banned from any election for an x amount of years.

[武田信玄]

The blaming foreigners and blah blah. 

I have two problems with introducing foreign doctors in our current situation.

 

1. A very common argument FOR introducing foreign doctors based on practicality is that it takes a lot of Canadian taxpayers' money to train doctor. Better to have some other countries to train doctors for us and then we pick the top of their cream. This way we save money. But I'm not sure if my logic is tight here, but if we follow this argument, then we might as well replace all our doctors with foreign doctors. This way we don't even need to spend a single cent on medical school. Or at the very least, I would buy this argument more if I actually saw a decrease in our Canadian medical school spots. But I see the opposite. Instead, we are pumping more money into our medical school to pump out more graduates, and yet introducing more IMGs to compete with the unchaning residency spots. This to me just doesn't make any sense. How is doing this going to save our tax money? Please point out the flaw of my logics here.

 

2. Another very common argument, also based on practicality, is that our CMGs don't have enough passion to go to rural areas and to serve under-served populations. Therefore, we can introduce IMGs and force them to work in those areas for an x amount of years before they can return to other parts of the country to practice. Again I would buy this argument more if this were actually the case. However, I am just going to quote something from the reading materials in this thread:

 

http://forums.premed101.com/index.php?/topic/78064-how-i-improved-my-mmi/

 

One of the documents (I think it's some federal government report or something) specifically says "IMGs are expected to work in rural areas but unfortunately they rarely do". So if we don't enforce the rule, this second argument is useless.

 

People may argue that we cannnot treat IMGs like slaves and force them to live in certain areas and this is against human rights and blah blah blah. You have to remember by coming to Canada, these IMGs are getting paid way better than in their home countries (usually). So I see it as a fair trade-off. Nobody is forcing them to come to Canada. Besides, the supposed rule only requires them to stay in rural areas for a few year, not forever.

[oshaku]

A problem for foreign doctors is that they may face more discrimination in rural areas compared to the city, where people are more progressive. Foreign docs will most likely experience increased loneliness because there're be less people from their cultural background in rural areas. None of these factors promote foreign docs staying in the rural area after their contract. That's the feedback from at least one foreign doc I know (who eventually went back to his home country)

[sleeping_sickness]

Your solution is just going to saturate the US market eventually.

 

Taking into consideration the fact that the US population is roughly 10x that of Canada, I doubt that our unemployed docs will ever  saturate the US market. It's not at all a bad idea to write the USMLE during med school to keep doors open. Who knows what will happen during your training and what your priorities will be when you finish. Maybe you'll end up with a competitive american fellowship and they'll offer you a job afterward? This definitely does happen. Oftentimes I've seen staff physicians who move around quite a bit once they finish their training. They'll work for a few years in a less desirable city while keeping their eyes and ears open for the position they want. 

[GrouchoMarx]

we should be questioning the insanity of our bureaucratic match system, not the fact that a guy who has reasons to stay in the gta didnt apply to far away programs.

[JohnGrisham]

we should be questioning the insanity of our bureaucratic match system, not the fact that a guy who has reasons to stay in the gta didnt apply to far away programs.

I disagree, its fine to want to stay in a region - but you go where the work is(in this case where you get in for residency). Basic supply and demand, its not the systems fault on that.

[Organomegaly]

If the Liberals hadn't burned that one billion dollars in that Oakville plant, maybe we would've had enough funding to offer poor Lurie a residency spot. What amazes me is that the Liberals got re-elected again this year. Wow!

 

So no, I don't think our current predicament is a result of just "a lack of HR planning". I will die a happy man if I can see a law gets passed that says if a ruling party f@#@ks up to a certain extent, that this party is banned from any election for an x amount of years.

 

Poor HR planning is what you alluded to when you talked about distribution issues in rural verse urban areas, and it is a huge part of the problem. Next, the rural reservoir of available jobs is not infinite. What will happen when these full-time positions are also claimed?

 

I don't care much for the political slant on this issue. No party will have a magical fix; having liberals ousted won't change physician unemployment. And for your information, $1 billion is almost NOTHING when it comes to largescale healthcare investments. The Ontario budget last year was $115 billion dollars. $13 billion was in deficit, and $45 billion was spent on healthcare. Do you still think the Oakville powerplant is the mother of all our problems? 

[NLengr]

 

"When Brandt graduated in 2010 from Western University as an otolaryngologist, he says, he and his wife were willing to go anywhere in the country for work.

But he couldn’t find a position, and instead did a year of sub-specialty training in the U.S. Despite learning reconstructive facial plastic surgery from the physician who literally wrote the textbook, as well as having published 30 medical-research papers himself and won various awards, the 37-year-old returned to face six months of unemployment."

 

Ouch...if this guy can't find a job lol, I can't imagine who does. 

 

I know of at least one ENT job in the country that's sitting open waiting to be filled. However, it's not in a super desirable area, so they're having trouble filling it.

 

One of the problems is some newly minted specialists are fairly inflexible with moving to where the jobs are. In many specialties there are some opportunities available, if you are willing to move out of the few hundred km ring around the major cities, or away from Southern Ontario. But many people aren't willing to do that and make a choice to stay in an area and do locums/more fellowships etc. waiting for something to open up.

[GrouchoMarx]

I know of at least one ENT job in the country that's sitting open waiting to be filled. However, it's not in a super desirable area, so they're having trouble filling it.

 

One of the problems is some newly minted specialists are fairly inflexible with moving to where the jobs are. In many specialties there are some opportunities available, if you are willing to move out of the few hundred km ring around the major cities, or away from Southern Ontario. But many people aren't willing to do that and make a choice to stay in an area and do locums/more fellowships etc. waiting for something to open up.

the only way taht spot will fill is whne all the good spots in the us and canada fill first

[武田信玄]

Taking into consideration the fact that the US population is roughly 10x that of Canada.

US also has 10x more med schools no? And they admit even more IMGs than Canada.

 

They have also increased med school admission spots without increasing too many residency spots in recent years.

[武田信玄]

None of these factors promote foreign docs staying in the rural area after their contract.

It's totally fine with me if IMGs don't stay in the rural areas after their contracts are over. The problem is that many of them leave the rural areas long before their contracts are over, and the government does very little to stop them from leaving. Again I'm just quoting information from this post:

 

http://forums.premed...mproved-my-mmi/

 

The PDF documents from this post seem pretty official and legit to me.

 

I mean, you sign a contract, but then you breach the contract, and there is no legal repercussion??? That's just not right.

[NLengr]

the only way taht spot will fill is whne all the good spots in the us and canada fill first

Ha ha ha.

[武田信玄]

Poor HR planning is what you alluded to when you talked about distribution issues in rural verse urban areas, and it is a huge part of the problem. Next, the rural reservoir of available jobs is not infinite. What will happen when these full-time positions are also claimed?

 

I don't care much for the political slant on this issue. No party will have a magical fix; having liberals ousted won't change physician unemployment. And for your information, $1 billion is almost NOTHING when it comes to largescale healthcare investments. The Ontario budget last year was $115 billion dollars. $13 billion was in deficit, and $45 billion was spent on healthcare. Do you still think the Oakville powerplant is the mother of all our problems? 

Well my rant about the liberals is just me venting some personal frustration with my province.

 

But back to my original point. What I was trying to say is that we don't necessarily have a doctor shortage. Rather, the problem lies within our geographic distribution of doctors, which is a result of our population distribution. Therefore, keep increasing the number of medical graduates, or even keep increasing the number of residency spots, is not going to solve the problem.

[indefatigable]

I know of at least one ENT job in the country that's sitting open waiting to be filled. However, it's not in a super desirable area, so they're having trouble filling it.

 

One of the problems is some newly minted specialists are fairly inflexible with moving to where the jobs are. In many specialties there are some opportunities available, if you are willing to move out of the few hundred km ring around the major cities, or away from Southern Ontario. But many people aren't willing to do that and make a choice to stay in an area and do locums/more fellowships etc. waiting for something to open up.

I think it's a question of context. After residency with a spouse that works in a given location (and possibly family in the area), it may be difficult to drastically change. Conversely, if opportunities are mainly available in "undesirable" locations then education and training should promote that from day one. I think if jobs are mainly in northern ontario say, then more education/training should occur in remote northern ontario to avoid subsequent disruptions in people's lives. I think the default should be less change rather than having to "hop" around the country as much as possible.

[oshaku]

It's totally fine with me if IMGs don't stay in the rural areas after their contracts are over. The problem is that many of them leave the rural areas long before their contracts are over, and the government does very little to stop them from leaving. Again I'm just quoting information from this post:

 

http://forums.premed...mproved-my-mmi/

 

The PDF documents from this post seem pretty official and legit to me.

 

I mean, you sign a contract, but then you breach the contract, and there is no legal repercussion??? That's just not right.

 

what can the government do? put them at gun point and force them to keep on practicing till the end of their contract?  Moving to a foreign country is hard, even harder when there aren't many social support system to help you adjust.  unhappy doctors don't make good doctors and if they leave their rural post before the end of their contract, at least it opens up a spot for someone who might be better for it.

 

So long as the contract was signed in good faith, I'm not really in favor of punishing someone for breaking it simply because a lot of things can change between signing the contract and the end of the contractual period.  

 

BTW, can you be a bit more specific about what you're quoting?  I checked out the post and could not figure it out.  Some of the links point to reports over 500 pages long.  It'd be more helpful if you can point to specific passages (or at least readable chunks)

[JohnGrisham]

I think it's a question of context. After residency with a spouse that works in a given location (and possibly family in the area), it may be difficult to drastically change. Conversely, if opportunities are mainly available in "undesirable" locations then education and training should promote that from day one. I think if jobs are mainly in northern ontario say, then more education/training should occur in remote northern ontario to avoid subsequent disruptions in people's lives. I think the default should be less change rather than having to "hop" around the country as much as possible.

But none of that is new. It is always a possibility from day 1, knowing that you may have to move around to where the work is. To think otherwise is naive and uninformed on the part of the student/doctor.  While yes, in a perfect scenario you can stay put where you want - life is not perfect, and the medical profession is not immune to supply/demand constraints. 

 

As an entering M1, i know very well that i could be anywhere across the country come residency and after that for the first few years of work. Lengthy conversations with my partner have resolved that it is a possibility, while we hope we can stay put, it is apart of the "package" of pursuing medical school and a medical career.

[JohnGrisham]

what can the government do? put them at gun point and force them to keep on practicing till the end of their contract?  Moving to a foreign country is hard, even harder when there aren't many social support system to help you adjust.  unhappy doctors don't make good doctors and if they leave their rural post before the end of their contract, at least it opens up a spot for someone who might be better for it.

 

So long as the contract was signed in good faith, I'm not really in favor of punishing someone for breaking it simply because a lot of things can change between signing the contract and the end of the contractual period.  

 

BTW, can you be a bit more specific about what you're quoting?  I checked out the post and could not figure it out.  Some of the links point to reports over 500 pages long.  It'd be more helpful if you can point to specific passages (or at least readable chunks)

AFAIK, if you sign a ROS agreement, and you break it - you pay back the difference in what you were subsidized for your training. This was back in 2010, when a friends sister broke her contract and had to pay a pretty penny. It worked out for her, in that the physician money she was making made it possible to do it - and it was worth it for her to be near family.

[indefatigable]

But none of that is new. It is always a possibility from day 1, knowing that you may have to move around to where the work is. To think otherwise is naive and uninformed on the part of the student/doctor.  While yes, in a perfect scenario you can stay put where you want - life is not perfect, and the medical profession is not immune to supply/demand constraints. 

As an entering M1, i know very well that i could be anywhere across the country come residency and after that for the first few years of work. Lengthy conversations with my partner have resolved that it is a possibility, while we hope we can stay put, it is apart of the "package" of pursuing medical school and a medical career.

I understand what you are saying and it seems to be the reality. I don't dispute that. I just hope that adjustments can be made to minimize these disruptions. In my case, at the moment I have no partner, but feel it would be easier to have a chance at that in a more stable situation. Also, living in unfamiliar remote areas can be tough if not from the area, foreign, or as a bachelor. In any case, I think you will have a good shot at choosing your path Gohan - it sounds like you will have the possibilities covered.

[武田信玄]

what can the government do? put them at gun point and force them to keep on practicing till the end of their contract?  Moving to a foreign country is hard, even harder when there aren't many social support system to help you adjust.  unhappy doctors don't make good doctors and if they leave their rural post before the end of their contract, at least it opens up a spot for someone who might be better for it.

You don't need to tell me how hard it is to adjust to a new culture...

 

What happens when you breach a contract? As Gohan mentioned, according to Canadian law, you pay a fine, and/or your lose some of your credits. Better yet, I would love to see a system in which if these foreign doctors refuse to stay in the rural areas for five years according to the contract just because they don't like that place, then they lose their licence to practice (not forever, but for an x amount of years).

 

BTW this is not me being xenophobia. This is called you make a promise and you keep it. The original intention of introducing foreign doctors is to serve these under-served rural areas because we have a shortage of doctors specifically in those areas, but, and I want to re-emphasize this point, not because we have a shortage of doctors in other non-rural areas. By not enforcing this contract, we are not only defeating the original purpose of introducing foreign doctors and not helping our rural population, we are also saturating the non-rural areas where we don't need more doctors.

 

Also please remember that these doctors know about what's in the contract before they agreed to come to Canada. Again, nobody is forcing them to sign the contract. So they are fully aware of their commitment. So let me ask you this, what do you call someone who promises he/she will do something for sure but later on refuses to keep the promise?

 

Maybe you want to argue that the contract is not fair, is evil, is against human rights. I disagree. I said before that Canadian doctors are paid and treated much better than those in a lot of other countries. I grew up in China. In China, doctors are paid like slaves. In China, doctors get stabbed if they can't cure the patients (not always obviously). People don't respect doctors in China. Therefore, for a Chinese doctor to come here and practice, I personally think it's a step up. Just look at how many Chinese-trained doctors write USMLE each year. So for them to spend 3-5 years in a rural area to practice, what's wrong with that? They still get a significant pay raise in the end. They can move to wherever they want after the contract period. What's so evil about that? You can't even commit 3-5 years to serve some under-served population but you want another country to accept you and offer you a pay raise right away? What kind of free lunch is that?

[武田信玄]

BTW, can you be a bit more specific about what you're quoting?  I checked out the post and could not figure it out.  Some of the links point to reports over 500 pages long.  It'd be more helpful if you can point to specific passages (or at least readable chunks)

I will find it for you. And don't worry, I assure you I read it in one of the PDF documents. I've read every single document in that post when I was preparing for MMI last year.

[武田信玄]

I mean, the issue can be simplied as following:

 

we have a shortage of CMGs in rural areas but not in urban areas

the reason is that few CMGs want to go rural

so we introduce IMGs to serve rural areas

but IMGs don't want to go either and we are not enforcing it

so my question is, what's the point of introducing IMG?

[_ _]

I mean, the issue can be simplied as following:

 

we have a shortage of CMGs in rural areas but not in urban areas

the reason is that few CMGs want to go rural

so we introduce IMGs to serve rural areas

but IMGs don't want to go either and we are not enforcing it

so my question is, what's the point of introducing IMG?

The government didn't have to pay for their education

[plane]

The government didn't have to pay for their education

 

I could be wrong but I think a more significant reason is more in principle--CSAs and naturalized IMGs have been pushing for equal access to residency spots. 

[evans]

I could be wrong but I think a more significant reason is more in principle--CSAs and naturalized IMGs have been pushing for equal access to residency spots. 

 

I don't get it. Why should we reserve spots for IMGs solely based on principle?

 

 

Also, it makes no sense that we have a system where Canadian physicians who are flexible in location or specialty are going unmatched. 

It makes sense to prioritize these Canadians first, before IMGs. We have already spent the thousands of dollars in that student's undergraduate, medical, (and likely) research training, so we are just losing that investment if we insert an IMG instead.

 

I certainly don't think spots should be reserved for IMGs, so long as there is an abundance of Canadian medical students who don't match.

 

I do agree that IMGs may bring diversity, and some may be very qualified applicants (like ones that came from Ivy-league American schools) but if we do that, I think that we should lower the number of spots for Canadian medical schools first...so we're not left with MDs without residencies. We don't save money by picking an IMG for residency if we already paid some unmatched Canadian med student's tuition.

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