Dear colleagues,

The Royal College is deeply concerned about ineffective workforce planning that has resulted in the inability of some highly trained medical and surgical specialists to find jobs following certification. I want to bring you up to date on our work advocating on behalf of Fellows and all Canadians about this challenging situation.

Let me provide a bit of context. To the best of our knowledge, specialist unemployment was first reported in the research literature for cardiac surgery, neurosurgery and orthopedic surgery in 2010. Since then, physicians in many other specialties have told us that they are unable to practice to the full extent of their training after having completed long and grueling medical education programs.

Meanwhile, discussion and debate about specialist unemployment has created an erroneous impression that the health system is somehow burdened with ‘excess’ physicians. There is an obvious disconnect between such a notion on one hand, and the reality of long wait times for surgeries and appointments on the other. How can both be true? To answer this and many other questions, the Royal College has taken on a leadership role to better understand the complex issue of specialist unemployment, looking for answers and carrying out human resources for health research and advocacy on several fronts.

Royal College Employability Study
Most significantly, we began in April 2011 to collect data for a comprehensive study that seeks to identify the causes of specialist unemployment and clarify a number of misunderstandings related to the issue. The study examines the impact of specialist unemployment on patients, the health system and physicians. It delves into complex variables such as economic changes, hospital infrastructure, changing demographics and scopes of practice, and their effects specialist employment. Underpinning the study are 50 in-depth interviews that we carried out with key experts, including national specialty society leaders, program directors, specialty committee chairs, physicians in practice, hospital executives, unemployed physicians, residents, health system experts and other stakeholders. After a year and a half of consultation, the study is nearing completion. We will release a full report in early 2013.

Following the report’s release, the Royal College will follow up in a final discussion with roughly 80 physicians from the national specialty societies. We are keenly aware of the relevance of this work for Fellows and all Canadians. Our discussions with the specialty societies will ensure that we have adequately considered all relevant issues and that we have identified practical recommendations about how best to move forward.

Engaged in public debate
In the meantime, we continue to participate in public debate on this issue. Recently, we joined an online discussion hosted by the Toronto Star in which some participants asked why specialists should receive ‘special consideration’ when so many other professions face underemployment.

I don’t accept the premise of that question. Health care system stakeholders owe it to all Canadians to identify the root causes of specialist unemployment and underemployment. Canada puts vast resources into training these individuals; a health care system that cannot utilize them appropriately is serving neither the population it purports to represent nor the hard-working, rigorously trained physicians in whom it has invested so heavily.

A national forum on specialist unemployment
As an important next step, we will work with stakeholders across the health care system by convening a national forum of residents, medical education and health care leaders—many of whom are also looking into the issue of specialist unemployment.

What do we expect as an outcome of our research and advocacy? From our findings so far, it seems clear that the absence of a pan-Canadian approach to the collection of health workforce data and analysis—and the resulting absence of a cross-jurisdictional approach to health workforce planning—has resulted in squandered human and financial resources. That much we know. It would appear, therefore, that we need to encourage jurisdictions to work together to ensure that physicians are properly employed. We are confident that our report and national forum in 2013 will yield more ideas and more answers.

Contribute to our researching by sharing your stories
Our employability study revealed that more than 14 percent of 2011 Royal College Certificants did not find staff appointments or employment within 4 to 12 weeks of writing their exams. It is my hope that Fellows and Certificants can add to our knowledge by contributing their own stories of specialist unemployment or underemployment.

Please use the comment functionality below to tell us your experience with this issue. What particular obstacles have you faced or observed in your professional journey or workplace? How is this reality affecting you, as a specialist? Your participation will help identify new issues and contribute to this important debate.


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer


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