Info for IMGon Return Of Service Agreement

[TheTruthIs]

be aware...
if you are applying for a specialty in Ontario after your residency you must do a return of Service and they only have Northern locations that you must serve for 5 years ... by NORTHERN I mean anything Sudbury and higher latitude:

http://www.health.gov.on.ca/english/providers/program/uap/desiglist_mn.html

This is like blackmail because IMGs are doing work in residency. Without IMGs those spots would go unfilled anyways because the schools do not train enough of their own doctors for the country. Why should IMGs be forced to work where no one else wants to with no added perks on top of that ? After training where one chooses to work should be their own choice ... I think that this is a major problem that needs to be looked at, there is no justification for this ROS, as IMGs have families too and do not want to pack their bags and move up north. At least in the US docs have the choice to move to smaller towns and get paid more .. any opinions?

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[Giemsa]

This is like blackmail because IMGs are doing work in residency. . . . . Why should IMGs be forced to work where no one else wants to with no added perks on top of that ? . . . . there is no justification for this ROS . . . . any opinions?

If there were no ROS, there'd be no IMG spots. The ROS pays for the residency. That's the justification.

Back in ?2006 it was decided to add some residency spots through CaRMS that were exclusively dedicated to IMGs. Predictably, the question arose who was going to pay for these. The federal government didn't want to shell out the hundreds of millions of dollars (literally) to fund these spots (each specialty resident costs about $500,000 to train, and each family med resident between $200,000-300,000). So the individual health regions - the communities - banded together to scrape up the money and fund a residency position, usually in family medicine. So, for example, Eskasoni in rural Cape Breton needs two family docs in their community in the worst way, and they just can't recruit one for anything. So they spend $400,000 and sponsor two 2-year family medicine residency spots for IMGs at Dal. But what does Eskasoni get in return?

Enter the ROS. The IMG who takes the spot is required to enter a contract to practice in a designated in-need community. For example, in the case of Eskasoni, the IMGs who took the two seats would both agree to practice family medicine in the community for two years after graduating. After this period, they would be free to go wherever they liked.

the schools do not train enough of their own doctors for the country

Actually, with the incredible enrollment increases, the decrease in retirement, the reversal of the brain drain, and the increasing licensing of foreign practicing doctors, Canada is producing enough doctors for the country. In fact, we are currently producing a surplus to gradually erode the doctor "shortage". (The quotes are there because several people have suggested that it's not so much a "shortage" as a maldistribution). So, over the last few years the number of IMG residency spots in CaRMS has been decreasing, and this trend will continue as fewer and fewer communities find it necessary to sponsor IMGs for residency. In Ontario, specifically, it is projected that there will be NO shortage of family physicians by 2017.

In other words, be grateful that the IMG spots exist at all, because eventually they will be gone.

 

[docbill]

If there were no ROS, there'd be no IMG spots. The ROS pays for the residency. That's the justification.

Back in ?2006 it was decided to add some residency spots through CaRMS that were exclusively dedicated to IMGs. Predictably, the question arose who was going to pay for these. The federal government didn't want to shell out the hundreds of millions of dollars (literally) to fund these spots (each specialty resident costs about $500,000 to train, and each family med resident between $200,000-300,000). So the individual health regions - the communities - banded together to scrape up the money and fund a residency position, usually in family medicine. So, for example, Eskasoni in rural Cape Breton needs two family docs in their community in the worst way, and they just can't recruit one for anything. So they spend $400,000 and sponsor two 2-year family medicine residency spots for IMGs at Dal. But what does Eskasoni get in return?

Enter the ROS. The IMG who takes the spot is required to enter a contract to practice in a designated in-need community. For example, in the case of Eskasoni, the IMGs who took the two seats would both agree to practice family medicine in the Pas for two years after graduating. After this period, they would be free to go wherever they liked. Note that (in general) the ROS is attached to the position, not to the IMG (so that if a CMG, in the second round of matching, took that IMG spot, they would also be expected to honour the ROS contract. On the other hand, if an IMG matched to a CMG spot in the second round, there would be no ROS contract applicable).

As the shortage of physicians in Canada decreases, as it has been doing for the last few years now, the number of IMG spots will shrink as fewer and fewer communities find it necessary to sponsor IMGs for residency.

Not true for Ontario. IMGs still have to do a return of service if they match in a CMG spot.

Please provide evidence for what you posted above, ie communities funding each spot.

In Ontario IMGs doing residency will be able to work anywhere outside GTA and Ottawa. However, there has to be a position in their desired location.. or else they will have to go to the rural areas... read undesired regions in order to meet the ROS requirements.

 

[TheTruthIs]

We all pay taxes, if Canada prides itself in its healthcare the govt should and it is their duty to pay for those spots not communities - they need to get their priorities straight then. The specialty spots are also over priced because teaching is so inefficient...taking 5 plus years to train for most of the programs is ridiculous. That also does not explain why 2 years of family med training = 5 years of ROS in Ontario. Also, the brain drain still continues and doctors in Canada are getting older not younger, so in the future I think that Canada will rely on IMGs more than ever. The doctor shortage is shrinking in recent years due to IMGs. In the end it does not matter why ROS exist, but if we all work for the same degree and get paid the same wage in residency, it is just plain unfair and unjust to make IMGs work 5 years up North on top of 5 years residency. 5+5 = 10 years of torcher at lower than factory wages for the first five years + interest from medical school. I say IMGs are better off not to have false hope dangled in front of them, get rid of IMG spots, ROS, just do things fairly so people can get on with their lives.

 

[Giemsa]

Please provide evidence for what you posted above, ie communities funding each spot.

I was just finishing my residency out west when they introduced the IMG seats, and I was peripherally involved. I'll see if I can find some of the original documentation somewhere on the internet - the communities indeed did fund the seats.

 

[JPR22]

We all pay taxes, if Canada prides itself in its healthcare the govt should and it is their duty to pay for those spots not communities - they need to get their priorities straight then. The specialty spots are also over priced because teaching is so inefficient...taking 5 plus years to train for most of the programs is ridiculous. That also does not explain why 2 years of family med training = 5 years of ROS in Ontario. Also, the brain drain still continues and doctors in Canada are getting older not younger, so in the future I think that Canada will rely on IMGs more than ever. The doctor shortage is shrinking in recent years due to IMGs. In the end it does not matter why ROS exist, but if we all work for the same degree and get paid the same wage in residency, it is just plain unfair and unjust to make IMGs work 5 years up North on top of 5 years residency. 5+5 = 10 years of torcher at lower than factory wages for the first five years + interest from medical school. I say IMGs are better off not to have false hope dangled in front of them, get rid of IMG spots, ROS, just do things fairly so people can get on with their lives.

With the increase in CMG spots, and as ontario approaches the optimal number of physicians, IMGs may play less of a role. Although it is politically popular, I agree with Giemsa that the ROS is going to be gone very soon. It really doesnt make sense anymore. Furthermore, money is being spent in transferring overtrained specialties to family medicine.

 

[Knight_MD]

be aware...
if you are applying for a specialty in Ontario after your residency you must do a return of Service and they only have Northern locations that you must serve for 5 years ... by NORTHERN I mean anything Sudbury and higher latitude:

http://www.health.gov.on.ca/english/providers/program/uap/desiglist_mn.html

This is like blackmail because IMGs are doing work in residency. Without IMGs those spots would go unfilled anyways because the schools do not train enough of their own doctors for the country. Why should IMGs be forced to work where no one else wants to with no added perks on top of that ? After training where one chooses to work should be their own choice ... I think that this is a major problem that needs to be looked at, there is no justification for this ROS, as IMGs have families too and do not want to pack their bags and move up north. At least in the US docs have the choice to move to smaller towns and get paid more .. any opinions?

Do you have any sense whatsoever? The ROS is the ONLY reason Canada takes IMGs. If you don't like it, apply in crappy US.

You should be grateful that they're training IMGs and putting aside spots for them, instead of having Canadians choose for themselves and leave the rest for us.

 

[TheTruthIs]

Do you have any sense whatsoever? The ROS is the ONLY reason Canada takes IMGs. If you don't like it, apply in crappy US.

You should be grateful that they're training IMGs and putting aside spots for them, instead of having Canadians choose for themselves and leave the rest for us.

Knight_MD or whatever you really are, Canadians should be thankful IMGs are here to scrape healthcare out of its mess. For your info I am only applying in the US and it is a lot better place for training and working than you think. They see more diverse patients, learn more procedures and have pretty awesome hospitals, technology and benefits for their staff. My point is that the US is a lot better option and I feel bad for people applying in Canada because they are wasting their time for inferior jobs that they most likely will not even get. Also, do you in your mind have any sense of ethics? Even if communities pay for those spots, they should not do it because it is blackmail (taking advantage of people who may feel like they have no other choice). Good luck becoming a compassionate doctor buddy. People should strive for equality not just be grateful something is there.

 

[Giemsa]

Ironically enough, the image is from MacDoctor's website.

 

[Jocks]

Ironically enough, the image is from MacDoctor's website.

Jesus lads, calm down.

Giemsa, you've got a point: if the communities are funding the spots, then a ROS is fair (although your numbers a bit overblown).

I was in Cape Breton this summer doing a FM elective. These communities are crying for doctors. So my question is this: since the provincial governments heavily subsidize medical undergraduate education, why not require CMG's to practice for X number of years in an underserviced area upon completion of residency?

Jocks

 

[Arb]

I doubt the communities are paying for the IMG positions. Maybe for some of the FM ones but which community is funding the Pediatric Neurology programs? How about all these Psychiatry residency programs? Plastic Surgery? Ophthalmology? I doubt any of these under-serviced communities are funding anything.

Also, Canada has been taking IMGs for decades. It's not a new thing that came with the ROS lol.

If only Canada had an US type Constitution. Our Charter of Rights and Freedom that covers mobility rights for Canadians just doesn't cut it. Atleast Manitoba believes in the spirit of the document.

 

[Giemsa]

Giemsa, you've got a point: if the communities are funding the spots, then a ROS is fair (although your numbers a bit overblown).

Bear in mind these numbers are several years old; actual cost is higher now.

Ontario 2004-2005:

http://dsp-psd.pwgsc.gc.ca/collection_2009/sc-hc/H29-1-2009E.pdf

 

[Arb]

http://www.health.gov.on.ca/english/providers/project/img/serv_agreem.html

"MOHLTC [The Ministry of Health and Long Term Care] supplies the money necessary to support, assess and train the participants."

"Provided the 5-year ROS agreement is successfully completed with an underserviced community, the investment paid for by the Government of Ontario is considered recovered and no monies need to be paid back to the Government of Ontario by the participant."

ROS is fine and will be happy to fulfill it if I get the opportunity. What I'm concerned about is that communities and governments will take advantage of IMGs. What happens if communities/FHN, etc. decide to offer a lower salary to IMGs because they must honour the ROS? Already, it's a slippery slope. In Nova Scotia, the IM ROS is for general internal medicine and they will not allow you to do a fellowship. Imagine, the government telling you what you can do for your livelihood. You want to be a cardiologist and there are programs willing to take you? Too bad. Is this the Canada we want to live in?

 

[Giemsa]

if the communities are funding the spots, then a ROS is fair

Fair / not fair.

It just is the way it is.

 

[Jocks]

Fair / not fair.

It just is the way it is.

Things change.

 

[Blitz2006]

Just had to pitch my 2 cents as well.

I agree with a lot of the posts....plus, I don't get why IMGs moan and complain about ROS? You knew there was an ROS when you signed up to go to medical school, so deal with it.

No one put a gun to your head and said study medicine outside of Canada.

 

[Arb]

That's stupid. Practically everything is a choice. I guess you can't complain about anything at all especially anything government related since we choose to live in US/Canada. The founding fathers are rolling in their graves at your words. It's a good thing there are some strong people in the world who still fight against discrimination and injustice of any sort. To clarify, I'm not against ROS as long as it's relatively fair to both the government and the doctor.

 

[med2UCC]

Just had to pitch my 2 cents as well.

I agree with a lot of the posts....plus, I don't get why IMGs moan and complain about ROS? You knew there was an ROS when you signed up to go to medical school, so deal with it.

No one put a gun to your head and said study medicine outside of Canada.

Um, actually there was no RoS when I started med school. It was only brought in when IMG's were permitted to apply on the 1st round of the match, which started with the match in 2007. Anyone who got into med school abroad before that did it on the assumption that they would be applying on the second round of the match, and would be applying for left over spots without RoS obligations. So, the about statement regarding "knowing" about RoS when you applied only applies to people who applied after January of 2007, the point where it became obvious where all this was going. These would not be the people applying for residency this year, that's for sure!
Cheers,
M

 

[Blitz2006]

I didn't know that, but fair enough. In that case I can see why people matching in the last few years would be upset.

I started meds in 2007, so I guess I knew what I was getting into.

If thats the case, then why are Canadians still so upset? Sure, RoS is not ideal obv, but at least now we have a chance at 1st round in a separate, parallel IMG stream (at least for ontario), which is far better than fighting for the leftovers..no?

Um, actually there was no RoS when I started med school. It was only brought in when IMG's were permitted to apply on the 1st round of the match, which started with the match in 2007. Anyone who got into med school abroad before that did it on the assumption that they would be applying on the second round of the match, and would be applying for left over spots without RoS obligations. So, the about statement regarding "knowing" about RoS when you applied only applies to people who applied after January of 2007, the point where it became obvious where all this was going. These would not be the people applying for residency this year, that's for sure!
Cheers,
M

 

[med2UCC]

I didn't know that, but fair enough. In that case I can see why people matching in the last few years would be upset.

I started meds in 2007, so I guess I knew what I was getting into.

If thats the case, then why are Canadians still so upset? Sure, RoS is not ideal obv, but at least now we have a chance at 1st round in a separate, parallel IMG stream (at least for ontario), which is far better than fighting for the leftovers..no?

If you'll do the counting again, the people applying this year are people who applied to international med schools before 2007. The cohort next year and the year after mostly won't be able to bitch (although some would be in 5 and 6 year programs, so the entitlement to bitch won't completely expire until the fall of 2013). However, it is human nature to kick against the pricks, so I suspect this will continue to be a thread for many years to come. Also factor in the constant rumours that someone out there has filed a law suit because those RoS contracts are a)unconstitutional or b) have loopholes you could drive a truck through or c) pick the rumour of your choice that means you can get out of it (neither of these are true - I had a lawyer check my RoS contract, a fairly standard one, and he couldn't see any loopholes, and cautioned me against signing it with the intention of trying to get out of it) and you can see why the discussion continues.
I think part of this is also the perception that the posts available to IMG's are undesireable places (and if you planned to come back and practice in Toronto or Vancouver, indeed they are) and that Canada has already somewhat screwed us by limiting the number of med school spots at home, thus forcing people to apply to pricey overseas schools if they want to pursue their ambition of becoming a physician. I certainly would never have gone to Ireland if I had managed to get a spot at home. Not everyone is in that boat, but certainly most of the people in the Irish schools are people who couldn't get in to med school in Canada for whatever reason. Also factor in that the US still seems to be an open shop with lots of spare residencies, so there is also a feeling that Canada should be more like that and stop trying to artificially limit the number of residents and thus the number of doctors practicing in Canada. Most of the difference in residency numbers boils down to politics, as there is really no reason beyond finances to limit the number of residents trained in Canada (well, and a practical desire from the practicing physicians to keep numbers down and thus keep bargaining power high).
That being said, at least there are positions for us in the match when we come home, regardless of the shackles attached. I think the current situation is marginally better than the squabbling over scraps in the 2nd round that went on previously, and it seems to be leading to better match rates, at least for the Irish grads. Good luck to everyone interviewing this year,
M

 

[Dreaming]

The argument that an RoS has to be done because someone has to fund the residency spots does not make sense. Why don't graduates from Canadian schools have to do a RoS? If anything they costed the system more since taxpayer money subsidizes Canadian med school spots while IMGs fund their own medical education outside of Canada.

 

[Blitz2006]

Thats cool, I completely respect your 2 cents.

I guess I just have fundamental difference in outlooks perhaps? I mean, if you can't get into medical school in Canada, and then you decide to go overseas, I'm assuming ppl do some research before dumping 250-300K and boarding a flight...

It just seems that a lot of Canadian IMGs (I'm not saying you or everyone, but a large number) all of a sudden in the upper years (3rd, 4th, 5th) start panicking and realizing that they can't be a "Plastic Surgeon in Vancouver" or ENT guy in TO.....thats just the impression I get, especially from the Irish schools (I'm in the UK, so I can't say this is true first hand, but I have a few friends who are in Ireland from college and this is what I hear)

And then they start bitching and complaining about RoS (fair enough, I guess before 2007 entry they have that right, but like you said, it will probably be a topic of discussion even after 2013).

I think I get frustrated because I'm tired of hearing Canadians whine about this. If your only goal in life is to live in Toronto or Vancouver then don't go to medical school, don't become a doctor. Being a doctor is about sacrifices (ie. long nights of studying, exams, etc.), and going to an overseas school will only compound those stresses/issues. Like I mentionned in an earlier post, no one forced anybody to go into medical school. There are other career options in the health care field.....nursing, physiotherapy, occupational therapy, psychology, where you pay 1/4 the tuition fees and can have a much better chance of living in your 'ideal' city (whether its calgary or TO or vancity).

I guess my 2 cents turned into a rant, lol.

If you'll do the counting again, the people applying this year are people who applied to international med schools before 2007. The cohort next year and the year after mostly won't be able to bitch (although some would be in 5 and 6 year programs, so the entitlement to bitch won't completely expire until the fall of 2013). However, it is human nature to kick against the pricks, so I suspect this will continue to be a thread for many years to come. Also factor in the constant rumours that someone out there has filed a law suit because those RoS contracts are a)unconstitutional or b) have loopholes you could drive a truck through or c) pick the rumour of your choice that means you can get out of it (neither of these are true - I had a lawyer check my RoS contract, a fairly standard one, and he couldn't see any loopholes, and cautioned me against signing it with the intention of trying to get out of it) and you can see why the discussion continues.
I think part of this is also the perception that the posts available to IMG's are undesireable places (and if you planned to come back and practice in Toronto or Vancouver, indeed they are) and that Canada has already somewhat screwed us by limiting the number of med school spots at home, thus forcing people to apply to pricey overseas schools if they want to pursue their ambition of becoming a physician. I certainly would never have gone to Ireland if I had managed to get a spot at home. Not everyone is in that boat, but certainly most of the people in the Irish schools are people who couldn't get in to med school in Canada for whatever reason. Also factor in that the US still seems to be an open shop with lots of spare residencies, so there is also a feeling that Canada should be more like that and stop trying to artificially limit the number of residents and thus the number of doctors practicing in Canada. Most of the difference in residency numbers boils down to politics, as there is really no reason beyond finances to limit the number of residents trained in Canada (well, and a practical desire from the practicing physicians to keep numbers down and thus keep bargaining power high).
That being said, at least there are positions for us in the match when we come home, regardless of the shackles attached. I think the current situation is marginally better than the squabbling over scraps in the 2nd round that went on previously, and it seems to be leading to better match rates, at least for the Irish grads. Good luck to everyone interviewing this year,
M

 

[Der Kaiser]

So, over the last few years the number of IMG residency spots in CaRMS has been decreasing, and this trend will continue as fewer and fewer communities find it necessary to sponsor IMGs for residency. In Ontario, specifically, it is projected that there will be NO shortage of family physicians by 2017.

In other words, be grateful that the IMG spots exist at all, because eventually they will be gone.

If the projection regarding the IMG residency spots is true, this is very worrying for me. I have applied via ABP, and was planning on going over if accepted. The competition for Ontario Med school spots now is still very intense, and it will take a number of years to improve my application enough to get in. I feel that Ireland is the most pragmatic option. If the 2017 projection is accurate, I may be stuck without a residency (for the record I was willing to do ROS and was probably going to go into FM).

I do feel that 2017 is pretty optimistic, and though I have not read the document, I suspect that 2017 is a best case scenario. The reality is that the doctors that are retiring in the next 5-15 years are the doctors that put the most work in. In addition, many female doctors cut down their hours significantly after having children (of course they may resume those hours when the children are out of the house). Lastly, while med school spots have increased, I was under the impression the 5 million Canadians are without a family doctor. That represents about 2500 doctors assuming each one has a large practice of 2000 patients. If there was almost retirement of the older doctors, I guess our problem might be solved.

Anyway, could you possibly provide the Cliff notes of the above document in terms of the assumptions the authors make about retirement, number of hours worked by new doctors, choice of specialties, number of foreign doctors admitted?

 

[sop]

Anyway, could you possibly provide the Cliff notes of the above document in terms of the assumptions the authors make about retirement, number of hours worked by new doctors, choice of specialties, number of foreign doctors admitted?

Der Kaiser - it really isn't relevant what the manpower stats might or might not indicate. The bottom line is that the number of postgraduate training positions made available to IMGs is a political decision. Provincial governments have shown by their past actions that they have never seriously considered the IMG talent pool to be part of the solution to a physician manpower shortage - and it is unlikely they will act any differently in future.

If you don't think you will be able to get into a Canadian medical school, you must reassess your career goals. An intelligent and talented person at your stage in life should be making better use of four years than spending them in a foreign medical school training for a career they have only a slim chance of ever completing in Canada.

 

[Der Kaiser]

Der Kaiser - it really isn't relevant what the manpower stats might or might not indicate. The bottom line is that the number of postgraduate training positions made available to IMGs is a political decision. Provincial governments have shown by their past actions that they have never seriously considered the IMG talent pool to be part of the solution to a physician manpower shortage - and it is unlikely they will act any differently in future.

If you don't think you will be able to get into a Canadian medical school, you must reassess your career goals. An intelligent and talented person at your stage in life should be making better use of four years than spending them in a foreign medical school training for a career they have only a slim chance of ever completing in Canada.

I'm sorry, but do you have some sort of intimate knowledge of my life that you can judge whether medicine is the right career for me? And clearly IMGs are making it back to Canada or the U.S. as the numerous Irish grads that have posted on this thread will attest to. My question relates to whether the Ontario government will stop taking in as many IMGs, because at the moment they are taking in quite a few to solve the shortage. Anyway, I can handle my own life and my own career decisions, and I do not require the assistance of an anonymous internet poster, who has clearly made numerous assumptions about me.

Your point re: residency spots and IMGs being a political decision is well taken. Whether there is a shortage or not in 2017, the paper saying there will not be will be used as a justification to reduce spots.

I am sorry if I sound harsh, its just that I recently did reassess career goals and from a personal perspective medicine is the best fit. I guess I am irked because the decision to change career paths was one I contemplated very heavily. I am willing to risk not practicing in Canada if it means becoming a doctor. I am well aware of the risks and alternatives to medicine in Canada.

 

[ssshh]

Hello,
Does anyone know how much it is to buy the ROS from Ontario for a 2 yr residency program?
Thanks in advance

 

[med2UCC]

Hello,
Does anyone know how much it is to buy the ROS from Ontario for a 2 yr residency program?
Thanks in advance

Since all Ontario residencies require 5 years RoS regardless of actual residency length, you would owe $300,000.00, $60,000.00 for each year of service not rendered. Cheers,
M

 

[Handsome88]

That's stupid. Practically everything is a choice. I guess you can't complain about anything at all especially anything government related since we choose to live in US/Canada. The founding fathers are rolling in their graves at your words. It's a good thing there are some strong people in the world who still fight against discrimination and injustice of any sort. To clarify, I'm not against ROS as long as it's relatively fair to both the government and the doctor.

http://www.petitiononline.com/IMGsROSD/petition.html

Sign petition!

 

[leviathan]

The error in logic with the ROS is that it 'costs' to train residents. How does it cost to train them? Are residents not doing work every day at the hospital and doing patient care? They may have oversight from staff, but they are still doing the bulk of the work for a measly salary.

 

[AStark]

Well, residents have academic half-days, didactic teaching, simulation, and they are of course paid salary, benefits, call stipends, and educational allowances. Yes, they provide "service", but so do med students. Amazingly, community hospitals manage to function without many if any residents or learners and there is quite an obvious cost to residency training programs.

Another issue that hasn't been mentioned previously is simply the requirement of sufficient resources - and case-loads - for training programs. It doesn't really take that much to max-out the available spots in a given centre.

 

[jnuts]

This should be a new thread.

To answer the question, the Return of Service Contract for Ontario has no section that describes how much it would cost to "buy out." There is a clause that states that if you breech the government may come after you for your salary and benefits during the time you spent in Residency plus interest . Whether or not that constitutes punitive damages (which I've been told aren'tallowed under Canadian contract law) is an open question until someonechallenges it in Court or there's a public settlement.

In response to the comment above (and quoted below), the service provided at a community hospital is substantially different from an academic centre. As far as I know there are no tertiary care non-teaching hospitals in Ontario. If you need evidence residents provide a service look at the States. In the US private hospitals recruit and pay residents because it improves throughput. Certainly we're worth the small salary they pay us (which ties into the punative damages stuff).

Medical students also get paid for their clinical duties in Ontario.

Well, residents have academic half-days, didactic teaching, simulation, and they are of course paid salary, benefits, call stipends, and educational allowances. Yes, they provide "service", but so do med students. Amazingly, community hospitals manage to function without many if any residents or learners and there is quite an obvious cost to residency training programs.

Another issue that hasn't been mentioned previously is simply the requirement of sufficient resources - and case-loads - for training programs. It doesn't really take that much to max-out the available spots in a given centre.

 

[AStark]

There are many, many large community hospitals in Ontario which have few if any housestaff.

Medical students are not paid for their clinical duties anywhere but receive stipends to varying degrees. If they were even paid $10/hour they'd be making several times what these stipends amount to. At my school, our stipend was only $2800, which only a little more than half of what I'd earn receiving the resident call stipends alone since the start of clerkship. We're not talking about how things work in the US either, but ROS arrangements in Canada.

 

[leviathan]

Well, residents have academic half-days, didactic teaching, simulation, and they are of course paid salary, benefits, call stipends, and educational allowances. Yes, they provide "service", but so do med students. Amazingly, community hospitals manage to function without many if any residents or learners and there is quite an obvious cost to residency training programs.

Residents improve throughput of hospitals. They are increasing the number of patients that the hospital can admit and treat and discharge (compared to a solo attending without residents) at rock-bottom prices. Each resident is far from doubling the output of a solo attending, and they have academic half-days and other training, but when you balance it out at the end of the day, they are still at the very least earning every dollar they make.

 

[Bingo2018]

The MOH just changed some terms of ROS breach of agreement . Any idea how much would the training costs be for a buyout (Ontario. 5 year PMR residency)