Ontario to fund new residency spots with return of service requirements

[rmorelan]

20 minutes ago, ellorie said:

Going to be honest here, I'm a little confused why people feel like the government is inappropriately "taking advantage of medical students" by attaching a ROS.

They are literally paying for extra spots that otherwise would not exist.  Why would they pay for spots that result in more physicians where they aren't needed?  It would be very altruistic of them to do so, but not really in their best interests.

It sucks if you end up having to move to the ass end of nowhere for two years, it really does.  I would be really pissed off if I had to do that.  But when you go to medical school, nobody guarantees that you can practice the specialty of your choice in downtown Toronto.  If the ROS is really not acceptable, the option still exists of going into the first round again next year.  It's not like they waited for people to accept the positions and then sprung an ROS on them out of nowhere.

I think maybe it stems from the issue that the government likely has taken away so many spots in the past few years, only to return them now specifically with the strings and lower than the original cost. Basically the created the problem they now attempt to solve, but did so in a way that specifically serves their interests and are trying to score political points in the process. There simply wouldn't be so many unmatched positions if they didn't create them. They are both arsonist and firefighter here. 

On the other hand we have add long term staffing issues in many areas of the province and this always ultimately was a solution - no one is guaranteed a particular spot in a particular location and everything else they tried has basically failed. While they would never be so open as to say "look like it or not I am sticking you for a long time in a place you may not want to go, because it serves the public good" part of would at least ha be happier if they did. They created a lot of grief this way - and there are too many coincidences here to suggest there wasn't a plan. The government usually moves pretty slowly - and yet here with in a week of the match we have a brand new provincial plan in place, and a organized recruitment effort by the armed forces exactly lined up. Could be an over call I admit but it does look suspicious 

[ralk]

8 hours ago, jfdes said:

To be fair to the medical schools and OMSA, it makes sense politically to provide these statements. If you yell at someone for doing something you've been advocating for, they are less likely to do something for you in the future. Need to acknowledge the one step forward (even with the two steps back), because it gives you a better position to lobby privately for more steps forward.

Positive is one thing, but there's a difference between being merely supportive and cheerleading. I'm not arguing schools or the OMSA should be negative, just not offering a full-throated support of such a plan. Especially in my time in medical school, the OMSA has seemed to be satisfied with getting table scraps whenever an issue that affect medical students pops up - the recent Ontario contract dispute with the OMA is the prime example I point to, where the OMSA pushed its members to vote for a plan that provided little benefit for soon-to-be physicians aside from a few half-reversals of already-proposed cutbacks. They're proving that they'll throw their full weight behind government plans as long as the immediate move is positive - and, as I said, creating new residency spots is a good thing - nevermind that the sum of the government's actions are decidedly destructive.

The OMSA seems to confirm that the current spots will be available to start on July 1st of this year, which would make this a decided short-term win for unmatched students. That makes this more of a crisis intervention move, and there is a crisis. However, this is a slow crisis, one that rolled out over the past decade, especially the past two years, and requires more long-term solutions. This sets a bit of a dangerous precedent - that the provincial governments can purposefully break aspects of medical training, offer to fix it in ways favourable to them that no group would have accepted under the previous, unbroken system, and receive praise for it from physician and medical student groups. We need better from our representatives than to be complicit in these sorts of arrangements.

[shady]

9 hours ago, ellorie said:

Going to be honest here, I'm a little confused why people feel like the government is inappropriately "taking advantage of medical students" by attaching a ROS.

They are literally paying for extra spots that otherwise would not exist.  Why would they pay for spots that result in more physicians where they aren't needed?  It would be very altruistic of them to do so, but not really in their best interests.

It sucks if you end up having to move to the ass end of nowhere for two years, it really does.  I would be really pissed off if I had to do that.  But when you go to medical school, nobody guarantees that you can practice the specialty of your choice in downtown Toronto.  If the ROS is really not acceptable, the option still exists of going into the first round again next year.  It's not like they waited for people to accept the positions and then sprung an ROS on them out of nowhere.

Actually, they otherwise would have existed if it weren't for the Liberals removing those spots. They created the problem and are now using it to start a precedent of ROS contracts for CMG's

[Hanmari]

9 hours ago, ellorie said:

Going to be honest here, I'm a little confused why people feel like the government is inappropriately "taking advantage of medical students" by attaching a ROS.

They are literally paying for extra spots that otherwise would not exist.  Why would they pay for spots that result in more physicians where they aren't needed?  It would be very altruistic of them to do so, but not really in their best interests.

It sucks if you end up having to move to the ass end of nowhere for two years, it really does.  I would be really pissed off if I had to do that.  But when you go to medical school, nobody guarantees that you can practice the specialty of your choice in downtown Toronto.  If the ROS is really not acceptable, the option still exists of going into the first round again next year.  It's not like they waited for people to accept the positions and then sprung an ROS on them out of nowhere.

Because they are actually paying for spots that otherwise would have existed; all they're doing is just returning spots that were previously taken away, which were of course without ROS. The whole process is more or less a farce in which the med students and the public are led to believe they are being given a solution when really it's still below baseline. Residency spot allocations shouldn't feel like a Black Friday sale where they hike the price then cut it.

 

[indefatigable]

5 hours ago, ralk said:

Positive is one thing, but there's a difference between being merely supportive and cheerleading. I'm not arguing schools or the OMSA should be negative, just not offering a full-throated support of such a plan. Especially in my time in medical school, the OMSA has seemed to be satisfied with getting table scraps whenever an issue that affect medical students pops up - the recent Ontario contract dispute with the OMA is the prime example I point to, where the OMSA pushed its members to vote for a plan that provided little benefit for soon-to-be physicians aside from a few half-reversals of already-proposed cutbacks. They're proving that they'll throw their full weight behind government plans as long as the immediate move is positive - and, as I said, creating new residency spots is a good thing - nevermind that the sum of the government's actions are decidedly destructive.

The OMSA seems to confirm that the current spots will be available to start on July 1st of this year, which would make this a decided short-term win for unmatched students. That makes this more of a crisis intervention move, and there is a crisis. However, this is a slow crisis, one that rolled out over the past decade, especially the past two years, and requires more long-term solutions. This sets a bit of a dangerous precedent - that the provincial governments can purposefully break aspects of medical training, offer to fix it in ways favourable to them that no group would have accepted under the previous, unbroken system, and receive praise for it from physician and medical student groups. We need better from our representatives than to be complicit in these sorts of arrangements.

Agree.  By not providing a more tempered response, the OMSA is allowing the government to present itself as a good faith actor, when there's been no acknowledgment of responsibility (i.e. that their cuts could have led to the crisis in the first place),  an unprecedented attached ROS, and all done haphazardly at the last minute.  Personally, I think it was the bad press the government was getting rather than OMSA's negotiating ability itself that led to the move.  Now the social/contextual capital has all been used up to get a deal which seems to be essentially unilateral on the government's terms.  Moreover, it seems as if the residency positions have a temporary rather than permanent character, which means that once the boost in funding is spent, the residency position shortfall could return.     

[shikimate]

12 hours ago, ellorie said:

Going to be honest here, I'm a little confused why people feel like the government is inappropriately "taking advantage of medical students" by attaching a ROS.

They are literally paying for extra spots that otherwise would not exist.  Why would they pay for spots that result in more physicians where they aren't needed?  It would be very altruistic of them to do so, but not really in their best interests.

It sucks if you end up having to move to the ass end of nowhere for two years, it really does.  I would be really pissed off if I had to do that.  But when you go to medical school, nobody guarantees that you can practice the specialty of your choice in downtown Toronto.  If the ROS is really not acceptable, the option still exists of going into the first round again next year.  It's not like they waited for people to accept the positions and then sprung an ROS on them out of nowhere.

This is an artificially created "crisis". They consciously cut CMG residency spots few years ago, in full knowledge of the fact that around this year there'll be a crisis since more students are graduating. 

If you purposely botch a surgery just so you can go back and "save" the patient or bill for a second surgery later I don't call that good care. A firefighter who sets the fire then try to save the fire to appear like a hero is called a criminal.

I blame both the government and the school administrators. If more people write Step 1, match to the US, even for FM and IM, we wouldn't have this problem.

[polarbear89]

Does anyone know if this new program will be affecting the quantity of positions next year? 

[A-Stark]

6 hours ago, shikimate said:

This is an artificially created "crisis". They consciously cut CMG residency spots few years ago, in full knowledge of the fact that around this year there'll be a crisis since more students are graduating. 

If you purposely botch a surgery just so you can go back and "save" the patient or bill for a second surgery later I don't call that good care. A firefighter who sets the fire then try to save the fire to appear like a hero is called a criminal.

I blame both the government and the school administrators. If more people write Step 1, match to the US, even for FM and IM, we wouldn't have this problem.

They did indeed intentionally cut spots, but I think you're giving them far too much credit in saying that they'd know what would happen. I think over the last 10-20 years we've seen a steady erosion in the quality of decision-making in government departments, where political hacks have gotten ever more influential and the short-term is paramount. In NL, the government has cut any and all discretionary education funding and has occasionally "forgotten" to budget properly for residency salaries. They've otherwise cut any money for residency transfers (well mostly) but still fund ROS-related fellowships of fairly questionable need. 

[NeuroD]

3 hours ago, A-Stark said:

They did indeed intentionally cut spots, but I think you're giving them far too much credit in saying that they'd know what would happen. I think over the last 10-20 years we've seen a steady erosion in the quality of decision-making in government departments, where political hacks have gotten ever more influential and the short-term is paramount. In NL, the government has cut any and all discretionary education funding and has occasionally "forgotten" to budget properly for residency salaries. They've otherwise cut any money for residency transfers (well mostly) but still fund ROS-related fellowships of fairly questionable need. 

Very well might be true. But boy is it sad when the best-case explanation for the crisis the government caused is that they were stupid, and the worst-case is that it was malicious for personal gain. 

[GrouchoMarx]

I'm not impressed.

 

ROS are ineffective.

For one, they're temporary so you get a revolving door. If the government was truly concerned about remote, terrible places having medical care, they'd pay the care providers a huge premium to stay. 

Another problem is as mentioned above the government slashed these spots recently. Bringing them back with an ROS attached is a shitty bait-and-switch tactic to help get some votes during election time.

evidence dictates that ROS programs dont work. People leave early, buy out, just ignore the buy out, or find other ways of not staying there for too long. 

finally i wonder if anyone has challenged the ROS in court. i wonder if youd actually have to pay back an ROS since the money is tied to a salary you get as a resident, and employers cannot recover salaries theyve already paid to employees. so in essence, much of the ROS$ is untouchable once paid to the resident. But IANAL...

 

[Crash Bandit]

On 4/17/2018 at 10:15 PM, rmorelan said:

Plus it is an election year - you don't know who is going to win this thing. There already have been a number of upsets. If you come down publicly hard on the Liberals and they win where does that leave you? If they lose it doesn't matter what you said about them - they are gone and the winning party isn't going to really get mad at you for praising something that obviously is something you would praise. So you have a no win, may lose situation.  

 

Good point. They are in a difficult balancing spot.

[1D7]

On 4/18/2018 at 10:52 PM, GrouchoMarx said:

ROS are ineffective.

For one, they're temporary so you get a revolving door. If the government was truly concerned about remote, terrible places having medical care, they'd pay the care providers a huge premium to stay. 

Another problem is as mentioned above the government slashed these spots recently. Bringing them back with an ROS attached is a shitty bait-and-switch tactic to help get some votes during election time.

evidence dictates that ROS programs dont work. People leave early, buy out, just ignore the buy out, or find other ways of not staying there for too long. 

finally i wonder if anyone has challenged the ROS in court. i wonder if youd actually have to pay back an ROS since the money is tied to a salary you get as a resident, and employers cannot recover salaries theyve already paid to employees. so in essence, much of the ROS$ is untouchable once paid to the resident. But IANAL...

 

Would healthcare providers actually stay though? I imagine people would just do locums occasionally or leave after working a year or two and building up some money.

The only ways for these communities to receive more care is if the ROS was simply extended longer and more stringently enforced. Only other option is to have more 'SWOMEN' or 'indigenous' type admission bonuses for medical school admissions, but that takes years to have any effect.

[Edict]

I think stringently enforced RoS can actually work, however Ontario RoS conditions don't seem to be as stringently enforced. I wonder if a multiplier for (physicians who work in areas that are deemed underserviced) or a retention bonus that is market based might work (the current ones do not provide enough financial incentive (I believe I have seen numbers ranging from 20,000 to 80,000 one time)).

I personally do not believe in quotas based on where you do high school like SWOMEN. If you look at the US, doctors practicing in NYC (not the ones who work in top academic institutions who draw in patients from across the country mind you) make up to 200-300,000 less than those working in middle America. 

Yes, if you look at statistics, people are more likely to return to practice where they grew up. However, I feel like this discriminates unnecessarily against those from urban areas who do want to practice rurally and unfairly benefits those who are from rural areas and are able to get into medical school with lower requirements who then go onto practice in urban areas with no consequences. 

[medigeek]

Moral of the story - vote early for Doug Ford

We're seriously overdue for cuts to all these overpaid public sector guys who do nothing all day but collect 6 figure checks while doctors face steep cuts. To add insult to injury, our lovely premier has already planned big raises for them. Then there's the federal attacks trying to take away well justified tax benefits. I mean I know most docs do vote conservative, especially now. But those who didn't before.. what were you thinking? And those who still don't want to? Well every party has blind voters.

[crysally]

31 minutes ago, medigeek said:

Moral of the story - vote early for Doug Ford

We're seriously overdue for cuts to all these overpaid public sector guys who do nothing all day but collect 6 figure checks while doctors face steep cuts. To add insult to injury, our lovely premier has already planned big raises for them. Then there's the federal attacks trying to take away well justified tax benefits. I mean I know most docs do vote conservative, especially now. But those who didn't before.. what were you thinking? And those who still don't want to? Well every party has blind voters.

http://www.cbc.ca/news/canada/windsor/doug-ford-says-he-s-dead-against-supervised-injection-sites-1.4628547

This is what I am thinking lol. Very conflicted.

[medigeek]

11 minutes ago, crysally said:

http://www.cbc.ca/news/canada/windsor/doug-ford-says-he-s-dead-against-supervised-injection-sites-1.4628547

This is what I am thinking lol. Very conflicted.

Minor issues in the grand scheme of things. Debating little things doesn't matter a lot when you have the most sovereign state debt in the 1st world. 

[goleafsgochris]

On ‎4‎/‎20‎/‎2018 at 5:32 PM, 1D7 said:

Would healthcare providers actually stay though? I imagine people would just do locums occasionally or leave after working a year or two and building up some money.

The only ways for these communities to receive more care is if the ROS was simply extended longer and more stringently enforced. Only other option is to have more 'SWOMEN' or 'indigenous' type admission bonuses for medical school admissions, but that takes years to have any effect.

The problem is that even the indigenous admissions don't work that well.

I cant find the source, but I remember reading that indigenous students from rural communities are fairly unlikely to go back to those communities after residency.  You can see why...maybe when you start med school you intend to, but say you are now used to the amenities of a city (or even medium sized town) for the last 6-10 years.  You have friends here.  Maybe you have a romantic partner.  Maybe you want kids and want to give them the advantages that a city can bring over a remote community.  Its a lot easier in theory to say "ill go back after" than in practice.  Life is just a lot different at age ~27-33 after you've spent your 20s away from home.

[NLengr]

12 minutes ago, goleafsgochris said:

The problem is that even the indigenous admissions don't work that well.

I cant find the source, but I remember reading that indigenous students from rural communities are fairly unlikely to go back to those communities after residency.  You can see why...maybe when you start med school you intend to, but say you are now used to the amenities of a city (or even medium sized town) for the last 6-10 years.  You have friends here.  Maybe you have a romantic partner.  Maybe you want kids and want to give them the advantages that a city can bring over a remote community.  Its a lot easier in theory to say "ill go back after" than in practice.  Life is just a lot different at age ~27-33 after you've spent your 20s away from home.

I agree here. I work in a rural practice. It is hell. Too busy, nothing to do here except skidoo and fish, little for my kids here. 

I am actively looking for a job elsewhere even though it means leaving the province I love. 

[JohnGrisham]

57 minutes ago, goleafsgochris said:

The problem is that even the indigenous admissions don't work that well.

I cant find the source, but I remember reading that indigenous students from rural communities are fairly unlikely to go back to those communities after residency.  You can see why...maybe when you start med school you intend to, but say you are now used to the amenities of a city (or even medium sized town) for the last 6-10 years.  You have friends here.  Maybe you have a romantic partner.  Maybe you want kids and want to give them the advantages that a city can bring over a remote community.  Its a lot easier in theory to say "ill go back after" than in practice.  Life is just a lot different at age ~27-33 after you've spent your 20s away from home.

I spent many of my formative years quite rural, and then in a big city.  There's a reason people move away from rural spots.  I honestly wonder sometimes if it just makes more sense from an infrastructure perspective to just pay those who want to anwyays, to move closer to big cities. If you want to stay 1000km away by personal choice sure, but you need to understand you can't necessarily expect the same resources. Just not practical.  Obviously industry and first nations are a different story, more complicated ones.

[F508]

A solution that seems to work well is satellite sites during medical school. A rural site affiliated with my University used to have a huge shortage of doctors. Ever since there's been a medical school there, they have filled all their physician needs. I think there might be a certain natural selection among the students accepted at the rural site. I'd imagine the die hard urban students won't even rank that site pre-admission. 

[rmorelan]

50 minutes ago, NLengr said:

I agree here. I work in a rural practice. It is hell. Too busy, nothing to do here except skidoo and fish, little for my kids here. 

I am actively looking for a job elsewhere even though it means leaving the province I love. 

Sorry to hear that!

I do think in large part that is one of major issues with rural medicine - there is a relative limit to how useful earning a high income and living in a rural place is for MOST people - there are a ton of exceptions of course but overall most medical student don't want to live there and don't have to. And yeah our training is so long - upwards of 15 years when you include the undergrad all in a major city- that it is completely normal that people would have found relationships/activities that are hard to give up.

[NLengr]

7 minutes ago, rmorelan said:

Sorry to hear that!

I do think in large part that is one of major issues with rural medicine - there is a relative limit to how useful earning a high income and living in a rural place is for MOST people - there are a ton of exceptions of course but overall most medical student don't want to live there and don't have to. And yeah our training is so long - upwards of 15 years when you include the undergrad all in a major city- that it is completely normal that people would have found relationships/activities that are hard to give up.

The thing is I want to be able to stay but honestly everything is just too crappy here. 

[rmorelan]

14 minutes ago, NLengr said:

The thing is I want to be able to stay but honestly everything is just too crappy here. 

this is the sort of stuff the government needs to pay attention to if they want to actually solve the issues involved

[heydere]

1 hour ago, NLengr said:

The thing is I want to be able to stay but honestly everything is just too crappy here. 

Yea sorry to hear that. What are some things that are crappy? Is it the work environment? or the living conditions?

[GrouchoMarx]

1 hour ago, rmorelan said:

this is the sort of stuff the government needs to pay attention to if they want to actually solve the issues involved

i dont think anything can be done.

rural living is a vestige of the pre-industrial era.

the sprawling distance between our small towns is the result of historically cheap gas and expensive airfare.

now that its become vice versa there are few reasons for anyone to want to move to a rural location but plenty to make them want to leave.

cities are expensive. rural life does not provide the opportunities for people to gain the capital to make the move. rural skills are not transferable to city life. nobody cares if youre a farmer on bay street. nobody cares if youre a logging roughneck in the arts district. these people are stuck there. 

canadian small towns are torture. isolation, xenophobia, cold weather. i lived in a few and counted the days until i could leave each time.

the way our parliamentary system is set up, these rural outposts have a disproportionate amount of voting power. hence they want doctors, so the government tries to figure out ways to entice/strongarm doctors there.

id much rather see the money go towards subsidizing these people to move to the city, and the companies can just fly out the workers when theyre needed like they do out in the oil sands.

otherwise i dread that the future of our political system will become feudalist, with wealthy city-states and sprawling fiefdoms.