Dear Colleagues,

Last November I sent you a message to express my concern about the growing problem of physician unemployment and underemployment. I also described the Royal College’s efforts over several years to pinpoint the root causes of this failure in workforce planning. Today, I am pleased to announce that the Royal College is sharing the results of a workforce study into why some highly trained physicians and surgical specialists have trouble finding work in their specialties following certification.

This report presents a careful analysis of data we have collected since April 2011 on physicians, hospital infrastructure, health systems, changing demographics and government policies as they relate to specialist unemployment. The report also reflects 50 interviews on the subject with national specialty societies, physicians in practice, physician educators, hospital leaders, unemployed physicians, residents, health system experts and others. While the knowledge we have gained through our employment study does not suggest solutions to the problem of physician unemployment and underemployment, it provides us with enough analysis about causes to begin to map constructive ways forward. It is our hope that this study will spark additional research and data collection, as well as bring together representatives from across the Canadian health care system, to work together in identifying and implementing solutions.

A strong impetus for in-depth research

Allow me to provide a bit of background about how the Royal College came to study this issue. Since 2008, we have hosted an annual conference with Canada’s national specialty societies on the subject of human resources for health. Three years ago, some societies made it clear in a pre-conference questionnaire that unemployment and underemployment were serious issues within their disciplines. They asked us to look into the problem. In response, we developed a research question that enabled us to study the high-level, national factors that contribute to physician unemployment and underemployment.

The results of our study tell a troubling story. We learned that 16 per cent of specialists and subspecialist physicians cannot find work, compared to 7.1 per cent of all Canadians, as of August 2013. Also of note is the number of specialists and subspecialists (31.2 per cent) who chose not to enter the job market, but instead pursued further subspecialty or fellowship training because they believed such training would make them more employable. We also learned that employment challenges are trending upward, suggesting that the problem will worsen.

What is behind this worsening trend?

Our study showed us that there are three often intertwined factors contributing to physician unemployment and underemployment:

  1. The main factor is the economy, where a weakened stock market has forced many physicians to delay their retirement. Hospital resources that physicians need to practice, such as operating rooms and hospital beds, have been reduced to control costs. This has directly impacted physician employment.
  2. The evolution of the health care system was identified as a second factor, with issues such as the emergence of interprofessional models of care that rely less on physicians, and a misalignment between health workforce planning, health care delivery models and residency intake quotas.
  3. The third factor being personal and context-specific issues, such as a lack of adequate career and job search counselling, and the fact that new medical specialists are older today than in the past and have families, often making it difficult for them to relocate.

As Canada’s leader in the education and certification of medical specialists, the Royal College has a responsibility to its members and to all Canadians to work toward finding answers to a problem that appears to be growing, in particular across resource-intensive disciplines such as Hematology, Cardiac Surgery, Neurosurgery and Nuclear Medicine. But our research indicates a problem that is system-based, making it virtually impossible for any one organization working in isolation to pinpoint solutions, let alone implement them.

A pan-Canadian process for solving the employment challenge

In February, the Royal College will host a national forum that brings together stakeholders across the health care system, including residents, medical education and government and health care leaders. Many of these parties have engaged in their own research and approaches and we are eager to hear their perspectives and ideas as well as their results. We expect this forum to serve as the foundation for building a pan-Canadian, cross-jurisdictional workforce collaboration to address physician employment issues. Ultimately, we would like to see the emergence of a national agency or think tank for human resources for health planning to foster research and inform planning. We believe February’s forum is a promising next step.

I encourage you to use the comment functionality at the end of this message to share your insights or experiences about the problem of specialist unemployment and underemployment. What are the best ways to nurture a lasting collaboration among health care leaders? What do you think are the key elements for a successful pan-Canadian health human resources agency? Your participation will contribute to our ongoing debate, analysis and solutions.

Warm wishes and kind regards,

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