Is the job market in Canada really this bad?

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rekrul

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Just a few short years after Canada underwent its own version of "doctor shortage" concern trolling. Sound familiar...?

http://news.nationalpost.com/health...cant-find-residencies-and-full-time-positions
.....

Michael Brandt found a residency, but when he finished the five years of instruction to qualify as an ear, nose and throat specialist (ENT), he was unable to find a full-time job. And still hasn’t four years later.

A study he just published suggests those following him have it even worse. A stunning 78 per cent of the ENT specialists who graduated last year failed to find a position, with another 30 about to come on the market.

Neither Lurie nor Brandt are unique, though. More Canadian medical-school students are going “unmatched” with a residency, while the ranks of unemployed, intensely skilled specialists continues to swell — half a decade after the surprising problem first emerged.

It begs the question: what is wrong with Canada’s medical-education system, and why is so much high-cost talent being squandered — at least temporarily — as patients still line up for many services, or go without a family physician?

“It’s a tragedy that here I am, I’m a Canadian medical graduate willing to work, willing to be a doctor, but unable to,” says Lurie. “It sucks both for patients and for myself … The more it sets in, it just feels like a waste.”

Experts agree that the roller-coaster ride of falling and then dramatically increasing medical-school enrolment, doctor unemployment and, now, stranded medical graduates stems from a complex array of factors. For Ivy Bourgeault, however, the underlying fault is relatively simple.

What the University of Ottawa professor says is needed sounds like common sense: a national system that analyzes demographics and other data to project future health personnel needs, then adjusts the training pipeline as closely as possible to those projections.

Pretty much every country has some sort of system like that, other than Canada

Common sense or not, “this does not happen now,” Bourgeault says bluntly. “I am always surprised and perplexed at how little rational planning there is … Pretty much every country has some sort of system like that, other than Canada.”

Instead, individual provinces and universities determine the size of medical-school classes, the number of residencies, and how the training positions are divided between specialties — with seemingly haphazard attention to society’s needs.

Worried that there was a costly surplus of doctors, all provinces decided in the early 1990s to cut medical-school enrolment by 10 per cent.

Concern about a perceived shortage of physicians soon took over, though, prompting a dramatic increase in admissions in the 2000s. By 2012, enrollment had almost doubled, with a parallel increase in the number of residency positions.

The country was also admitting more international medical graduates, including Canadians who earned degrees overseas; even now, about 3,500 of those Canada-born medical students are studying abroad, most hoping to come back here.

Yet as the growing tide of new doctors entered a system that seemed to need their services, at least one crucial piece of the puzzle was missing.

Surgeons and some other physicians require additional resources — from operating rooms to anesthetists and nurses — to treat patients, so they rely on obtaining appointments from hospitals or health regions. But hospitals struggling with restricted governing funding often could not afford to hire any more of the specialists, after taxpayers had invested hundreds of thousands of dollars in their decade-long education.

The tightening job market has been compounded by a growing number of older physicians delaying retirement, and clinging to their operating room privileges.

When Brandt graduated in 2010 from Western University as an otolaryngologist, he says, he and his wife were willing to go anywhere in the country for work.


But he couldn’t find a position, and instead did a year of sub-specialty training in the U.S. Despite learning reconstructive facial plastic surgery from the physician who literally wrote the textbook, as well as having published 30 medical-research papers himself and won various awards, the 37-year-old returned to face six months of unemployment.


By now Brandt’s family had settled in Toronto, restricting his options further. He has cobbled together various locums, filling in for absent colleagues, but has still not found that coveted full-time appointment.

Meanwhile, with $350,000 in student debt, he came within weeks of having to declare personal bankruptcy.

“It becomes all-consuming and very hopeless to some extent,” he says of the experience. “It’s depressing, it’s challenging, it’s very difficult to get up every day and not be able to work … You want to look after people.”

And it seems more ENT doctors are needed. Patients in the Toronto area can wait a year to have benign thyroid nodules removed, and up to two years for some sinus surgery, he says.

Brandt’s problems are shockingly common. About 16 per cent of specialists graduating in 2011 and 2012 failed to find work, concluded a report by the Royal College of Physicians and Surgeons, which certifies specialists.

A “whopping” 178 fully trained orthopedic surgeons in Canada are currently unemployed, says the Canadian Orthopedic Association. Meanwhile, wait times in the field are hardly insignificant. More than 80 per cent of patients get hip replacements within the target time period, but that is six months after first seeing a specialist.....

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It's funny. When I first began to entertain the idea of becoming a doctor years ago as a college freshman, one of the aspects of the field that appealed to me was the rock solid certainty of medicine guaranteeing you a stable, prosperous career. Sure you could potentially make more money in law, business, etc, but medicine seemed to have a pretty high "floor" that those other fields did not.

But now I'm beginning to come to the conclusion that medicine is actually the most risky field to get into. You are investing 7-10 years of your life and hundreds of thousands of dollars based on today's reality, but by the time your investment "vests" half a generation will have passed and the reality will be much, much different. And worst of all, there is no ability to course correct once you start on this massive, lengthy endeavor. Each additional year of medical training puts you further and further in the hole, and your only hope is that there will be that mythical attending job and salary at the end of the journey 10 years from now that will allow you to pay back your debt and start to recover lost ground over your peers who have been in the workforce for a decade.

At least in business, engineering, etc, you are investing one week, one month, one year at a time. And you are getting paid throughout the process. You have the ability to look at upcoming changes and adjust your career accordingly based on the trends you see in the market. With medicine, there is no escape, you are hostage to forces entirely beyond your control.
 
Here is another sobering article:

http://www.winnipegfreepress.com/opinion/analysis/doctor-glut-in-pipeline-227773631.html

VANCOUVER -- Earlier this year, the Paris-based Organization for Economic Co-operation and Development released the results of a survey of average waiting times for medical care in 25 countries. This was not a shining moment for Canada.

Waits for most medical services are far longer here than in most of the comparator countries. This is simply the latest evidence seemingly supporting the rhetoric of a "doctor shortage" that has been a recurring theme in the Canadian public discourse for the past 20 years. But let's take a closer look at the evidence.


Over the past 15 years, first-year medical school enrolments in Canada have almost doubled, from 1,575 in 1997-98 to about 3,000 in 2012-13. The number of foreign medical graduates entering practice in Canada annually has also more than doubled since the year 2000. Over that same period, the number of Canadians who obtained their medical degrees internationally and entered practice in Canada annually has increased 250 per cent.

The Canadian Institute for Health Information (CIHI) reports released this week indicate that between 2008 and 2012, the number of physicians rose three times faster than the growth of the overall population, and for the sixth year in a row, the number of physicians per population has reached a new peak and is continuing to rise.

While this need not necessarily translate into equivalent amounts of additional care provision, it does highlight some troubling trends. We are just beginning to see the effects of the expansion in domestic training capacity. In other words, we are in the early stages of a dramatic expansion in physician supply that will continue for decades.

Canada will soon have too many doctors. Contrary to the continuing doctor-shortage rhetoric from ill-informed or interested parties, a "physician glut" appears already to be in the pipeline.

But, we are told, Canada needs more doctors because the population is aging. True enough, but every study ever done has found that demographic change adds only about 0.5 per cent annually to per capita use of services.

Well, what about the women? The physician workforce is becoming increasingly feminized and female physicians put in fewer hours per year over a lifetime of practice; so goes the argument. Moreover younger male physicians are also working fewer hours than their predecessors. So, many more doctors will be needed.

But again, the awkward facts intrude. Average medical expenditures per physician in Canada (adjusted for fee changes) have been rising, not falling, even as the overall supply expands and becomes increasingly female. If average hours of work are falling, how is it that adjusted payments per physician are rising? Either physicians are delivering more services per hour, or their fees are actually rising much more quickly than the official fee schedules show (or both).

And if they are finding ways to deliver more care, in spite of putting in fewer hours, how is it that we need more doctors?

None of this denies the fact some patients continue to have difficulty finding family doctors, and face excessive waiting times, particularly for certain specialists and some diagnostic tests and surgeries. But evidence is beginning to emerge of Canadian-trained doctors who cannot find work. We suspect this is the beginning of a new and unfortunate trend.

Nevertheless, some pundits and politicians advocate pumping more doctors into the system by making it easier for Canadians studying medicine abroad (CSAs) or foreign-trained medical graduates (FMGs) to enter practice in Canada.

This would be an obvious response to a doctor shortage -- if there was one. An estimated 3,570 Canadians are currently studying medicine at schools in the United Kingdom, Australia, Poland, the Caribbean and elsewhere. Assuming a four-year training program, these CSAs represent a potential increase to domestic supply of nearly 900 new physicians per year, well above the numbers of CSAs entering presently.

Alas, a barrier stands in their way: To enter practice they must not only pass Canadian qualifying examinations and complete residency (specialty) training here; but there are far fewer residency positions available for CSAs than there are CSAs looking for them. Should Canada create and fund more residency slots for them? At another time and place, the case might be compelling. But not here, and certainly not now.

What is needed, instead, is a comprehensive and co-ordinated set of national policies that recognize the reality of the new domestic training situation, and use the opportunity to better manage the overall system, and get physicians with the right training, expertise and resources to where they are needed.
 
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While Canada has a very different health system than ours, these concerns are relevant to the US. A lot of the naive, idealistic premeds/Med students are buying the AMA's misinformation about an alleged "physician shortage" hook, line, and sinker (look no further than, say, all over the pre-Allo and Allo boards here).

I'm not going so far as to say the sky is falling, but people should be very careful where their idealism and sense of social justice takes them . . .
 
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My state still has a doctor shortage. The trick is to live in a place that isn't on the coast, isn't a major city. The cost is access to culture, sporting events, nice restaurants, etc.
 
My state still has a doctor shortage. The trick is to live in a place that isn't on the coast, isn't a major city. The cost is access to culture, sporting events, nice restaurants, etc.

As has been explained ad nauseum, there is a distribution problems, not a physician shortage overall. The people who can't grasp this concept are advocating increasing the number of physicians trained in this country (bad idea) instead of figuring out out to incentivize physicians to go to underserved areas (admittedly a difficult task).

The answer is not "keep increasing the number of doctors until they have no choice but to go to these areas", because the profession on a national scale will have been ruined long before this goal would be accomplished.
 
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As has been explained ad nauseum, there is a distribution problems, not a physician shortage overall. The people who can't grasp this concept are advocating increasing the number of physicians trained in this country (bad idea) instead of figuring out out to incentivize physicians to go to underserved areas (admittedly a difficult task).

The answer is not "keep increasing the number of doctors until they have no choice but to go to these areas", because the profession on a national scale will have been ruined long before this goal would be accomplished.

Not only this, but I wonder what kind of methodology "these people" use to figure out there is a shortage in certain areas. Many "underserved" areas are underserved because they just don't have the volume to support physicians/hospitals. Piedmont, pop. 100 doesn't have a neurosurgeon? Must mean we must train more neurosurgeons! Not. Unless you are a corporate type and want your neurosurgeons cheap, that is. Then it makes sense to use that data point to shill for increased supply.
 
I can't imagine how inept that guy in the video must have been to not get a residency in family. Family and psych are the two residencies that are a sure thing even for IMGs.

There are also a lot of people who bitterly complain about not being able to find a job, while not mentioning that they were only looking in Toronto. It can be tough if you're completely inflexible about where you want to live, but if you're willing to go somewhere with a population under 1 million then it starts getting a lot easier.
 
Not only this, but I wonder what kind of methodology "these people" use to figure out there is a shortage in certain areas. Many "underserved" areas are underserved because they just don't have the volume to support physicians/hospitals. Piedmont, pop. 100 doesn't have a neurosurgeon? Must mean we must train more neurosurgeons! Not. Unless you are a corporate type and want your neurosurgeons cheap, that is. Then it makes sense to use that data point to shill for increased supply.
This is a good thing to keep in mind because people often complain about specialist distributions as well. Every town of 10,000 people doesn't need someone who is willing to do whipple procedures or heart transplants. Many times patients actually have worse outcomes when they have a large procedure done by a specialist who can only perform very few per year and it is performed in a hospital that does not have access to all of the ancillary services that may be needed by a patient. I realize it is a pain in the ass that some patients have to travel 100+ miles to get to the proper doctor sometimes, but it is actually best for everyone if the traveling decreases severe complications.
 
While Canada has a very different health system than ours, these concerns are relevant to the US. A lot of the naive, idealistic premeds/Med students are buying the AMA's misinformation about an alleged "physician shortage" hook, line, and sinker (look no further than, say, all over the pre-Allo and Allo boards here).

I'm not going so far as to say the sky is falling, but people should be very careful where their idealism and sense of social justice takes them . . .
honestly, with more agenda being pushed down the throats silently by NPs and PAs, I don't really buy any of this shortage stuff. A friend told me that in his rural home, he hasn't seen a doctor for five years...everything is being taken care of by mid-lvl providers whose job is to basically do the primary care. I was also told in my profession (that is non physician related) that there was a deep shortage but I practically had to wait 4 months trying to get one (and that one too with connections). Still the job doesn't appreciate you and you're worked like a dog. I'm surprised that when people leave, replacement is found that much quicker. This whole aura of shortage is a big sham. The moment there will be a true shortage, there will be shortcut methods for other professions to take over that portion. It's sad that canada is having this crisis, but the US is not that far away. With more schools pumping out grads and residency positions staying the same, in the near future, I would be stressed to find even a residency spot after so much work in medical school.
 
honestly, with more agenda being pushed down the throats silently by NPs and PAs, I don't really buy any of this shortage stuff. A friend told me that in his rural home, he hasn't seen a doctor for five years...everything is being taken care of by mid-lvl providers whose job is to basically do the primary care. I was also told in my profession (that is non physician related) that there was a deep shortage but I practically had to wait 4 months trying to get one (and that one too with connections). Still the job doesn't appreciate you and you're worked like a dog. I'm surprised that when people leave, replacement is found that much quicker. This whole aura of shortage is a big sham. The moment there will be a true shortage, there will be shortcut methods for other professions to take over that portion. It's sad that canada is having this crisis, but the US is not that far away. With more schools pumping out grads and residency positions staying the same, in the near future, I would be stressed to find even a residency spot after so much work in medical school.

lol, precisely. There is a shortage of everything, we are told. A shortage of unskilled workers (lol!), so we must bring in millions of people from Mexico. A shortage of engineers and programmers, so we must bring in millions of people from India. A shortage of doctors, so we must train more and more even as the physician/pop ratio is by far the highest it's ever been and scope and number of midlevels is exploding.

It's very simple to explain. The corporate class wants cheap labor, and its propaganda organ (the media) shills for the same. All these hysterias over crops rotting in the fields, doctor shortages, genius programmers from overseas etc etc are simply a way to flood the labor market and in so doing reduce costs and increase profits.
 
I say we increase the amount of medical schools and residencies and socialize healthcare!

I noticed that the ENT they interviewed was a DO. Isn't it very difficult to get a job as a DO in Canada
 
I say we increase the amount of medical schools and residencies and socialize healthcare!

I noticed that the ENT they interviewed was a DO. Isn't it very difficult to get a job as a DO in Canada
please don't ride on that horse lol. Residency spots are the only thing right now keeping physician salaries at bay. I would much rather have less schools and know that each year is a new chance for me to apply than having had applied, succeeded, and then worrying about my prospects as a physician whose layout in job opportunities might become more similar to a lawyer in the future. Both IMGs and local people have to go through it. If spots increase, we're going to see physicians having ulcers from a ton of stress to try finding jobs (which isn't easy by a long shot and isn't as depressing compared to a bachelor lvl person trying to find a job and waiting).
 
I say we increase the amount of medical schools and residencies and socialize healthcare!

I noticed that the ENT they interviewed was a DO. Isn't it very difficult to get a job as a DO in Canada

Please tell me you're joking. Lie, if you have to.
 
Please tell me you're joking. Lie, if you have to.

Depends completely on the province. In Ontario I think it's really unfavourable for DOs right now, other provinces not that bad. I'm not applying to DO schools for this reason though
 
please don't ride on that horse lol. Residency spots are the only thing right now keeping physician salaries at bay. I would much rather have less schools and know that each year is a new chance for me to apply than having had applied, succeeded, and then worrying about my prospects as a physician whose layout in job opportunities might become more similar to a lawyer in the future. Both IMGs and local people have to go through it. If spots increase, we're going to see physicians having ulcers from a ton of stress to try finding jobs (which isn't easy by a long shot and isn't as depressing compared to a bachelor lvl person trying to find a job and waiting).

Please tell me you're joking. Lie, if you have to.

Definitely sarcasm. Sorry it didn't travel through the electrons very well
 
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