Dear Colleagues,
Earlier this month, I announced the release by the Royal College’s first-ever comprehensive workforce study into the issue of specialist employment. I reported that after two years of study we had uncovered an egregious failure in workforce planning that has left many specialist physicians unable to find work in their fields. As our report acknowledged, this reality is particularly troubling and confusing given that Canadians can spend months and even years waiting to see a specialist. How can long wait lists be the norm when our colleagues are short on work?
We cannot conclude from our findings that Canada has too many specialist physicians.
The report generated considerable interest and response not only from Royal College members, but also the media. More than 55 articles, television spots and radio interviews probed and analyzed our findings. Some commentators focused on a particular aspect of the report — such as the key message that six per cent of specialist physicians cannot find appropriate work — and others used the report as an opportunity to share their perspectives about a health care system badly in need of repair.
Some in the media reached the erroneous conclusion that Canada has too many specialist physicians. We worked hard to make clear at the report’s release that we can derive no such conclusion from our findings. The issue of specialist unemployment is far too complex to be interpreted as a simple case of supply versus demand.
A systemic problem requires systemic solutions. In February, the Royal College will delve into the issues more deeply by convening a national summit of residents, health care and government leaders, and medical education experts. We expect the forum will serve as the foundation for a pan-Canadian, cross-jurisdictional workforce-planning collaboration that can begin to tackle this pervasive challenge.
Spirited dialogue on a key human resources issue.
I was encouraged by the number of Fellows who used this blog to express their views and to share diverse experiences with one another — over 130 comments. Many were lengthy, thoughtful assessments of the report’s findings. Some were from despondent specialists frustrated by a health human resources approach that is serving neither them nor their prospective patients. I was heartened by the compassion and encouragement in some of your comments to younger physicians who are having trouble finding work.
Your thoughts and ideas on discussion items for our February 2014 National Summit on Physician Employment are also welcome. I will keep you informed of our progress on this issue and welcome any further comments you have on the subject.
Warm wishes and kind regards,
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer
December 3, 2013 at 12:09 am
I am surprised to learn that physicians are not getting jobs and wait list for patients. Canada spends > 11% of the budget on health, which is better than many developed counteries. We are only 31-32 million people in this country. It means there is total mismanagement some where and it happening in cycles every 10-15 yrs so system needs to be fixed properly and spending needs to be controlled. It is totally failure of health planners, administrators and politicians. High time to change slogan “Free health in Canada”
November 8, 2013 at 4:52 pm
Whether physicians are salaried or contract doesn’t matter with respect to wait times or full employment of recent graduates. Government pays the cost and can control the costs by either reducing the number of salaried positions or by reducing the payouts for contractor’s services (e.g. by closing ORs).
The system is perfectly designed to deliver the outcomes observed! it won’t get better by nibbling around the edges.
We should be talking about patient-based funding instead of service based funding! My own experience: my orthopod said he needed MRIs both knees. I went to the MRI unit and they did one knee. I said, ‘what about the other knee?’ They said ‘oh. we don’t do both knees at one sitting because we won’t get paid as much as when we do two separate MRIs’ Now, that’s just plain stupid. It gets worse. My orthopod has never received the results of the MRI. I went back to the hospital to ask for the results to be sent and further, asked them to give me the results on a DVD (I brought one with me). I was refused and we’ve made the decision about surgery without the MRI results. It is wrong at so many levels I wouldn’t know where to begin. But you can be sure that they were paid for the MRIs even though the patient got less than nothing out of the whole mess.
November 2, 2013 at 7:20 pm
Whether or not Canada has too many specialist physicians depends on what constitutes “too many”. If we define it by patient need, then no, you are correct that Canada does not have an oversupply of specialists. But if we persist in our single-payer, ration-by-wait-list system, then the number of specialists will continue to exceed the number of jobs. In most other industries, when applicants exceed jobs, this constitutes an oversupply.
I propose we cut entry positions in all oversupplied residencies immediately. Subsequently, we seriously focus on shortening total training time through competency-based resident education and improving clerkship-level education. Shorter residencies means it’ll be easier to titrate the volume of specialists over a shorter period of time. We must advocate to universities, hospitals, and specialists to self-police selfish hiring practices. Over the long-term, we must advocate implementing some form of private system to absorb periodic specialist excesses that naturally result from cyclic variations in supply and demand.
Just some thoughts.
January 28, 2014 at 5:39 pm
Competency-based education is a trojan horse.
It will not shorten residency time, but expand it!
It comes at about the same time as concerns over resident overwork are arising.
Since residents will soon be prohibited from pulling the marathon call shifts like we all once had done before, they will instead have their residencies extended in years to make up for lost time.
This solution maintains the supply of cheap resident labor so that hospitals do not have to pay for attending-level physicians after hours.
April 29, 2014 at 9:22 pm
You got the initials wrong.
It’s C.G.B. Spender.
November 2, 2013 at 11:33 am
I really didn’t want to hijack this forum, but I’m getting desperate. I’ve practiced for 10 years and I just can’t do it anymore. I have no thoughts of self-harm but I need out of medicine. Honestly I need out of medicine. I just can’t stand it anymore. I don’t want to get into it but there is no passion anymore, no interest, no get-up-and-go. I wouldn’t even say I’m depressed but I’m feeling kinda low. I have daily feelings that I want to quit!!!!! I dread going to my office/hospital/meetings, etc. I’m faking it right now and people would have no idea. Like many a typical doctor, I never complain out loud about things I can’t change.
Only my wife knows that medicine makes me feel helpless. Could this be compassion fatigue as they call it? I’ve tried taking a vacation, I’ve tried cutting back hours, I’ve tried switching to different clinical and admin type work. I feel worthless inside medicine. Does this resonate with anybody? I’ve got 6 kids and I live in Alberta. It’s not the patients I can’t tolerate but I can’t put my finger on it–I won’t actually complain about my pay–it’s good, but perhaps it’s how hard I work for that pay.
Can anybody post any resources where I can get help? I’m NOT suicidal but I’m feeling like I can’t do this anymore. I don’t want this to be a fatal career move on the other hand however.
Please, fellow MD’s. I’m serious, doctor-to-doctor, Can anyone give me some advice? I didn’t think the RCPSC itself would be a useful resource but this rolling blog I have really found to see others open up.
Eternally grateful.
Doctor out west.
November 2, 2013 at 4:32 pm
AMA has a Physician and Family Support Program. Visit the website for details. Call 1-877-SOS-4MDS.
November 9, 2013 at 9:28 pm
There’s a CMA physician health initiative which you can Google. They have some helpful online information, from my recollection. A few years back, I attended a physician health conference which was close by, and I found it extremely thought-provoking, and reassuring, in that I found out how many people shared the same types of feelings and experiences as I had. The meeting this year is in a week, in Calgary, so it would probably be a really worthwhile investment of time and money for you to attend that, if you can manage to go. It could assist you in setting up some contacts for further discussion and advice, and just make you feel less desperate and alone.
You have a large family and must feel pretty tapped out, I’d guess. Good thing that your wife is aware. In the short term, I’d try to restrict hours in a way that gives you some actual free days, and then use those days to explore other possible interests, that might allow you to continue for the time being to earn an income, until you’ve figured out a new plan.
November 1, 2013 at 6:24 pm
Having physicians work as independent, fee-for-service contractors within a publicly-funded system is counter-productive, especially for those specialties that are dependent on facilities that only hospitals can provide. Further, the institutions themselves operate at arm’s length from the Ministries that pay doctors. How can such a system be nimbly responsive to changing medical human resource needs?
Given that many, if not all, practitioners entering medicine today will finish their careers in practices unimaginable when they started, how about giving up some autonomy for some certainty? Salaried physicians, able to upgrade or add to their training during their careers as “part of their work”, who retire with public service pensions, could form part of a larger human resource plan. If that is unpalatable, then the other extreme (though it makes less sense to me) would at least be as fair – have all health authority appointments expire after three years, after which ALL doctors must re-apply. Stagger reappointments to allow for continuity. If there must be “competition” for resources, there is no reason to favour “incumbents”.
James is correct that people go where the money is; medicine might be better off if, to a degree greater than occurs now, that would be in some other field entirely (hyperbole intended, but there is, I believe, a grain of truth in the statement).
November 2, 2013 at 11:55 pm
While fee for service practice may not fit well within a fixed budget single payor health care system, neither does the public’s seemingly unlimited demand for certain types of health care delivery. Where there is physician recruitment in attempt to meet such demand, without commensurate increase in access to hospital based facilities, the systems breaks down. For example, earlier this year, all gastroenterologists in Victoria, BC had to close their practices because there were collectively 3000 or so patients on the colonoscopy waiting list there. Victoria is one of the few communities in BC that had recruited increased GI manpower in recent years, in an effort to do “the right thing”. The result, however, is that with increased public demand for colorectal screening, waiting times for colonoscopy exceeded the published professionals standards of the Canadian Association of Gastroenterology. To avoid the legal jeopardy of having patients go undiagnosed with colorectal cancer “under their watch” as a result of such delay, due to funding limitations beyond their control, the gastroenterologists were forced to take the measure of closing their practices to new referrals. Patients were therefore being referred from Victoria in to Vancouver. In some metropolitan Vancouver hospitals, other gastroenterologists had to follow suit by closing or restricting their practices. The result is that instead of acting as gatekeepers by restricting the number of new practitioners entering practice within their community, these physicians were forced to act as gatekeepers in another way altogether. Obviously, without the necessary funding for colonoscopy access to increase, the end result was that the public was no better off. One way or another, it seems, even though the funding restriction is not of their doing, physicians are the ones who have to make the extraordinarily tough decision of where along the line the restriction to access is going to be made.
A salary model would not address this. However, it certainly would address another issue, namely whether physician remuneration is to be viewed as compensation for work done or as incentive to do yet more work. Certainly, entrepreneurial medicine purely for financial gain is not the ideal of our profession. This indeed could be seen as “greed”. Dr. Vuksic’s suggestion that financially-motivated individuals should consider non-medical careers is based on such principle. However, I suspect that very few individuals practice medicine for primarily such purposes. Most, I would think, see remuneration as compensation, not incentive. However, if a salary model is to be used, its inherent limitation on financial compensation must be balanced with offsetting limitation of work hours. If the work to be done by salaried physicians exceeds the number of hours “paid for”, then new physicians should be hired to do it. Nobody should be expected to do more work without compensation. But then who would ensure that enough work is being “paid for” to meet published professional standards regarding wait times? If the number of referred patients exceeds the specialist work being paid for, will the payor step in to limit the number of patients entered into the referral pool? Is this desirable? Moreover, would primary care physicians no longer be able to freely refer their patients at all, let alone to the consultant of their choice? Somewhere along the way, this would break down. I suspect that once again, the tough choices would be on the backs of physicians.
For certain types of physicians, who may not have to directly reconcile an enormous referral pressure on the one hand (with the legal liabilities that long wait lists carry) and limited access to facilities on the other, such as purely hospital based practitioners, a salaried structure would be easier to implement. ER physicians, hospitalists and anesthesiologists would come to mind. Shifts, and compensation, would be predetermined. For others, however, unless our entire profession collectively adopts an HMO type model from primary care down, there would still be an incompatibility somewhere along the line between unlimited demand by patients, conveyed through primary care, and specialists dealing with restricted access for procedures.
November 4, 2013 at 2:12 pm
Excellent points, that highlight the lack of a simple solution. As a hospital-based specialist I have no idea what it feels like to have overwhelming referral pressures such as Dr Fishman describes. I do know what it’s like to do “just a little bit more, please” every day until one just can’t anymore – after which the guilt that accompanies saying “no” kicks in.
I also concur with the suggestion that a small minority of doctors are primarily financially motivated. If anything, dollars have been used to keep us “quiet”, and outside of some crucial decision-making. The majority of my departmental colleagues would, I suspect, trade away income in favour of more control over their practices and the associated pressures.
October 31, 2013 at 4:14 pm
Well I’m probably in the small minority with my opinions but here goes nothing. As an academic physician, I have talked to many such unemployed or underemployed grads, and the stories they tell me are pretty much the same. I agree we need to get our own house in order. Many of them tell of stories where physicians making insane amounts of money, and are not willing to hire more people and split the pie.
I may be the only one here that thinks that Canada does spend enough money on healthcare. When it takes up 50% of your provincial budget, and the province is already in debt, how much more do we want? My hospital like so many others are in huge deficit, and it’s just not possible to open up more OR units or increase the number of clinics.
If there is a fix amount of money available that can’t be increased, then one possible solution is some people to make less, so that more workers can be hired. To be more specific, though facilities may not increase, but more workers have the potential of increasing efficiency. As an individual, I may be able to scope 10 patients a day but If I have 4 scoping days I may be only doing 4 or 5 a day because of fatigue. However, with a few more worker perhaps we could increase those numbers. There is a diminishing returns of course but I do not feel we have reached it.
The problem of facilities is also one of mal-distribution. There are procedure suites in outlying areas that sit empty while those in bigger centers are too full. In some jurisdictions those are starting to become utilized but it does require specialists to travel. Again more pain for us, but perhaps better for the system.
Of course, you might argue that some of new grads may consider moving to those out lying areas for jobs and that is also an valid thing to debate. Perceived lifestyle however is a major determinant of career choice nowadays, eeven above the perceived availability of jobs. A maldistribution of the billing ocodes makes certain careers much more desirable than others. As usual. people will go where the money is.
October 31, 2013 at 2:21 pm
Canada is in a curious situation: very long wait time in certain specialist areas and many of these being ones that physicians can’t find work in. Seems odd… surely there should be a possible fix that gives physicians jobs and reduces waiting times.
Looking in from the outside it seems as if one of the factors mentioned in the report warrants further investigation. When I’ve spoken to hospitals it’s apparent that existing specialists have much influence in the hiring of new specialists. Surely a conflict of interest here, as with fee for service (FFS) payments an existing physician may have a reduced patient load, therefore salary, if a new physician is hired. I’m sure that in a lot of cases this is not a factor in wait time as many facilities are run to 100% capacity so patient care does not suffer as a result of a physician wishing to keep their income high. After all its understandable they want a good income as the training costs and commitment they make is very high.
I believe looking at the percentage of time operating theatres and other specialist equipment is utilised would be interesting, to gain an understanding of how frequently a physicians influence to preserve their salary actually occurs. I’m sure in some cases it would show that there is room in existing facilities for new physicians, and not hiring them is negatively impacting patient care, but that existing specialists do not wish to share the FFS pot regardless of the impact this has on wait times and patient care in general. If this is the case surely it needs to be addressed.
In highly cost effective healthcare systems such as Germany they try to utilise facilities 24/7 to ensure wait times are minimal and facilities used cost effectively, it works well. If there is a situation in Canada where individuals greed can negatively affect patient care surely this should be examined? I’m sure the graduates who can’t find work currently would welcome working nights to ensure they can remain in Canada and not loose their hard earned skills.
October 31, 2013 at 2:36 pm
Greed, or hoarding of work, is often suggested as a contributing factor to non-recruitment, as noted in this post. However, for specialties that depend on hospital resources, groups that expand their specialist numbers inevitably find that wait lists for patient access to hospital facilities increase further unless the capacity for accommodating patients in the facility expands. I described this situation in an earlier post regarding facility based specialties. The issue of balancing “sharing the fruits” (ie being non-greedy) therefore actually has a negative impact on patient access. In other words, what may be seen as some as greed, is in fact usually an effort to keep wait lists for one’s patients at a medically and legally safe level as defined by published professional standards. True, it is rationing by the practitioners themselves, and hence open to “interpretation” as greed, regardless of the true motive. In an ideal world, access would increase, to the benefit not only of patients, but also practitioners. Meanwhile, unless facility capacity increases, training more specialists seems senseless, and places existing practitioners in the position of having to choose between the principle of timely access for their patients on the one hand, and the principle of being fair to other qualified trainees on the other.
October 31, 2013 at 10:34 am
The study is very good at demonstrating the lack of career planning for the residents and programs that produce specialists. It also demonstrates the archaic deficiencies in the allocation of resources. It speaks of the tenacities of the elder specialists in the face of stock market instability. It is a good start in the development of a more rational approach to physician underemployment.
The document does not address the international medical graduate fluctuations we have seen in the past decade. The document does not address the corporate profits and patent profits that eat away resource allocations that patients in Canada have been given the right to expect. The document does not address the political interests of the CMA, Royal College, College of Family Medicine, and CMPA and the powers these groups have in times of underemployment.
October 31, 2013 at 10:14 am
For hospital/facility-based specialists, such as GI or interventional cardiology, the factor limiting recruitment is the hospital/facility’s budget for increasing throughput capacity for procedures. In our region, there is no increase in sight for such budgets, and as a result, we have long wait lists. Recruiting recent trainees would simply redistribute resources and not meet the public’s need for increased access. In other words, the pie would be sliced thinner, with each specialist having reduced access for their patients. While the wait may shorten to see the interventional specialist in their office or clinic, the subsequent wait for the procedure will increase to at least an equal degree. In fact, the wait would probably increase, because we have learned that when new specialists are recruited, the pent up demand actually increases the total collective number of referrals to that specialist group. In other words, the demand would increase, while the supply (of procedures) remains fixed, and hence a tighter bottleneck and longer overall waits. Those already in practice have to wrestle with their own workload demands, as well as their ability to access facilities for their own patients. Such access for their own patients is essential, for legal and ethical reasons. CMPA tells us that we are obligated to provide care within time frames established by our profession as being safe. This is extremely stressful and frustrating, as this is a “lose – lose” scenario: we either work too hard while new recruits sit without work; or patients under our professional watch wait dangerously long. The governments/health regions must increase budgets to increase facility access if we are to address the public’s needs. Otherwise, there is no point to training more specialists whose practices would be so entirely dependent on such facility funding.
October 31, 2013 at 9:41 am
As a pathologist for years I faced that same problem. In 1994 at the era of cutting finances to hospitals, Rae days…etc. I lost the contract job I had for two and half years. During my employment period I was
obliged to pay unemployment insurance monthly payment. When my job ended I tried to collect unemoyment but was refused…answer was “no such thing as physicians collecting unemloyment…if you are not on maternity leave, go work in a walk in clinic..or go house to house doing house calls (not realizing that this was not what I was trained in Canada for). Many pathologists at that time became General practitioners and this is not allowed anymore because family practice is a speciality. It seems to be an ongoing problem that fluctuates and surfaces every now and then. We need a steady solution.
October 30, 2013 at 9:13 pm
After over 20 years of operations, the Hospital Authority in Hong Kong has ballooned with admin staff, and the salary of the several top administrators have gone up to C$500,000 (or 4 million HK$) annually, compared that with the highest salaried doctor in the system which is around C$250,000 or so.
Of the 40,000 plus employees of the Hospital Authority, about one-third is never involved with active treatment of the patient (active treatment was defined as having patient contact in clinical settings). Now after many years of fanfare and self-congratulations, the waiting time to see an ophthalmologist is 180 weeks, to see an orthopaedic surgeon is over a year, to get a knee arthroplasty is beyond 3 years. In the private sector(those who have private health insurance or can pay themselves0 can see an ophthalmologist within a week or less, get a knee arthroplasty within a week, pending on OR time availability in the private hospitals. Now the HK government is planning to incorporate a “public-private sector co-operation” to ease the burden on the public hospital sector. HK tried the UK and Canadian models but it is not working. Patients in HK who can afford private medicine are lucky to have private medicine available but not in Canada. When I came to practise in HK in 1992, I get an announcement of “opening of practice” in my mailbox maybe 2 to 3 such notices a month at most, now I am getting 2 week at least. These are from doctors leaving the Hospital Authorities and most are the frontline specialists who saw no chance of further promotion nor increase in pa scale as the ones higher up the ladder are staying in the system longer.
Is there any value for a relaxation of the no-private medicine policy in Canada?
October 30, 2013 at 8:40 pm
Older physicians need not retire but hospital privileges in areas where there is limited time/space such as in the OR, cath lab, or endoscopy suite should be linked to hospital service i.e. on call for Emergency referrals and care of in-patients. As physicians age and take less and less call, their other privileges need to be reduced to allow younger specialists to fill that gap. The younger physicians often work faster, bring new expertise and ideas to the hospital and improve throughput and outcomes.
As an older physician but part of a group with a diverse age spectrum, I am happy to learn from the ‘new guys’; our group welcomes our new additions. We try to regularly take new people on to fill the gap but are limited by administrative restraints. It is unreasonable to allow physicians to ‘protect their turf’ without giving back to the hospital and the resources should be shared equitably.
It is also unreasonable for hospitals to be closing beds and reducing OR and endoscopy time when there is such a long waiting list while hospital administrators are increasing in number with higher salaries and big fat bonuses. It is the administration budget that should be the shoestring, not the patient care budget.
October 30, 2013 at 9:03 pm
Agreed. In my institution a surgeon takes FULL call equally shared, or he/she looses their designated OR and endoscopy time.
October 30, 2013 at 7:25 pm
This is a difficult situation without a short term fix. In my opinion, one of the major problems is that of older hospital based specialists working full time many years passed what would be considered a reasonable retirement age. Many will state that they cannot afford to retire any younger.
This situation, I feel, is the result of the complete failure of all our medical associations to negotiate a pension scheme. Whether we like it or not, we are government employees, and after a lifetime of service we should have the opportunity to enjoy the benefits of a properly organized government pension.
October 31, 2013 at 12:40 am
That’s an interesting point. Nurses, physiotherapists, etc. all get pensions and are healthcare workers….why don’t physicians?
October 30, 2013 at 7:09 pm
One may conclude that by simply accommodating longer waiting times and fewer specialists in the system the government creates an artificial impression of physician overproduction by not funding enough the specialist positions in healthcare. In my speciality – pathology we are always short of medical staff, and asked to do process and interpret more biopsies and do it faster, and more accurate, limitless. The staff turn-over rate and revolving door is high even in apparently attractive geographic locations, as a result as more and more MD pathologists wish to work part-time or retire early.
January 28, 2014 at 5:32 pm
Pathology is strange in that it is paid for out of the hospital purse rather than out of the public plan. This makes pathology departments in hospitals chronically short-staffed because hospitals don’t want to hire/pay for more pathologists, yet expect the existing ones to do more work without a fair increase in remuneration. Current pathologists do not resist because they are collectively weak and individually afraid of being replaced by the next scab that will do what’s demanded without putting up a fuss to the administrators. Recent pathology graduates are having a very hard time finding work because of this, despite all the caterwaul of a “shortage”.
The best solution would be for pathology to adopt a fee-for-service model that bills the public plan and stays out of hospital budgets completely.
This is one instance where fee-for-service would be the fairest method of compensation since pathologists cannot make more work for themselves – they can only do the work provided to them by surgeons and other such doctors that send them tissue. The danger of “milking the system” in such an arrangement is quite low to non-existent.
October 30, 2013 at 6:25 pm
There are limited positions for specialists who depend on hospital resources such as OR’s and Cath Labs due to limited funding provided for these services.
The current deficiency in hospital funding and the fact that specialists currently working in hospitals are retiring at an ever increasing age means less opportunity for new specialists in Ontario.
I personally know a recently qualified Orthopedic surgeon who took a job in Vermont because of no openings in Ontario.Yet there is a long waiting list of patients waiting for orthopedic procedures.
Love it or hate it….this is government controlled medicine
October 30, 2013 at 5:59 pm
Whether there is a surplus or not depends on who is asked.
According to the payer (government), there may well be a surplus of physicians, as they have allocated a certain amount of money and are intent on limiting growth of expenditures. Since it’s politically difficult to cut physician remuneration, they are taking the path of least resistance and reducing hiring. This has nothing to do with real or perceived needs on the part of the public, and everything to do with the amount of money the payer is willing to put forward.
Of course, if you ask someone who has been waiting for six months for an operation, it’s preposterous to suggest that there is a surplus.
What is clear is that without money to pay them, and facilities in which to work, many specialists are going to either have to accept under/un-employment, or move abroad. The central planners have decided they cannot afford to employ everyone, so this is the way it is.
In a few years, once the budget is tidy, they may well change course and we will once again have “shortages.”
Central planning has its advantages and disadvantages. This is one of the disadvantages.
October 30, 2013 at 5:42 pm
There is an excess of specialist in certain areas and we need to decrease training in those areas and force medical schools to train family physicans not specialists. The push in trying to increase the number of training programs and number of trainees is for the cheap labor that comes with residents and fellows.
October 30, 2013 at 4:57 pm
If Gastroenterology specialist, Dr. Elderly, retires tomorrow and his/her eager young replacement, Dr. Spritely, takes over the practice and receives active hospital privileges, will the length of the waitlist for endoscopies change? Of course not. The problem is the failure of the hospitals to address the needs of patients, only the needs of administration. Administrators mushroom in numbers but there is certainly no evidence-based research to show that this has resulted in better patient care, only in fewer dollars to pay for treatment staff and facilities.
Barry Koehler, Rheumatology (thankfully, not a hospital-dependent specialty)
October 30, 2013 at 2:41 pm
Are the unemployed physicians not able to open their own offices and help take care or those who are waiting to be seen for three months?
October 30, 2013 at 3:23 pm
Not all medical issues can be solved by “opening [our] own offices”. Surgeons require operating rooms, support staff etc. Radiation oncologists require cancer centres with specialised equipment. These are just a couple of examples. If only the solution were so simple… I would have a job!
October 30, 2013 at 6:38 pm
Not all physicians who are having trouble finding work can open offices to work, pathologist cannot. They need to be in a laboratory to work. I know a hematopathologist who spent 4 years looking for work!
October 30, 2013 at 1:20 pm
We need to look to our own house first.
Programs continue to train residents for jobs that do not exist now and will not exist in the near future.
The Royal College must take a leadership role in this matter and decrease training positions in those specialities where there is not a perceived need for manpower.
Sent from my iPad
November 1, 2013 at 1:05 pm
It’s difficult to say that we have too many cardiac surgeons, as an example, when the line up for cardiac surgery is so long. Yet there are no jobs. Cardiac surgeons need OR’s to do their work. Yet we can’t create ORs with no money, as the provinces are bankrupt. So here is a radical idea. You cap the surgeon’s incomes, and you force hospitals to hire more people to fill the gap. Previously, caps on incomes did not work, because surgeons just stopped working when they met their caps, thereby increasing wait times. What’s missing is somebody to take up that slack. Of course, cutting anyone’s income is bound to be raise a revolt, but if we want to give jobs to our young doctors, without increasing funding, that is the only way. It may not decrease the wait times, but it won’t increase it. I would argue it’s not the Royal College who has to take a leadership role, but the Provincial Medical associations that must take a lead role.
The idea that we can predict the number of physicians in each specialty 4 to 5 years in advance is probably not sound. The last time we tried to limit medical school enrollment, based on prediction models, created the doctor shortage of the 90’s. What Is definitely true, however, is that over the last 20 years, the income disparity between specialities has increased to ridiculous levels. People are people and they will always be attracted to extremely lucrative specialties, creating imbalances in the system. More income parity would help our people make better choices as to their careers.