This past week the Royal College of Physicians and Surgeons of Canada published a report entitled What’s really behind Canada’s unemployed specialists? Too many, too few doctors? 1 The report discusses the growing concern that residents who finish training programs are having increasing difficulty in finding full time employment as specialists. The report surveyed graduating residents across Canada. The response rate, for a study of this kind was excellent, in and around 35%. Ostensibly the report found that of the 1325 respondents, 410 (31%) had found employment, 656 (49%) were pursuing planned additional training, and 208 (16%) reported that they had no job at the completion of their training. Importantly, of these 208 residents, 122 were embarking on further training to make themselves “more marketable”, and 86 (6.4% of the total cohort) were struggling and underemployed or unemployed.
The survey delved into the reasons behind some of these statistics, and offered several root causes for the situation. They included:
- The Economy: more physicians competing for fewer resources. As well, poor stock market performance delaying retirements.
- Health System Structure: newer interprofessional models of care have resulted in a diminished reliance on physicians. As well, there has traditionally been a heavy reliance on residents for manpower in academic centers.
- Sub-optimal health human resource planning.
- Poor career planning has lead to mismatches of available jobs and career desires.
By all reports, the College is to be commended for undertaking this study. Readers should take the opportunity to review the complete report. I would, however, advise caution when interpreting the results. It will be easy to jump to conclusions that we are overproducing physicians. This will be especially true for decisions that are politically driven. This would be a mistake. Not so long ago we had a serious problem with physician shortages, especially in primary care specialties. In 2006 the shortage was so acute, that in Nova Scotia a new physician took to holding a lottery in order for her to find a way to choose her patients.2 The last decade has seen wait times for services emerge as a major front burner issue. Many of us remember the early 90’s, when based on a few flawed reports, governments starting diminishing funding for physicians. We also well remember the “brain drain” of the last few decades, a situation which saw precious resources leave the country.
The stark truth is that we don’t have a good handle on physician needs in this country. For starters, we should be approaching this issue on a national basis, especially given portability of licensure in Canada, and yet funding and decision-making is provincially driven. Data from the CMA reveals that “Canada’s ratio of 2.4 physicians/1,000 population is considerably lower than the OECD average of 3.1/1,000, placing us in a tie for 26th place among member countries”.3 According to AAMC estimates, the United States faces a shortage of more than 90,000 physicians by 2020.4 It would be curiousindeed that the U.S. should be facing such a marked shortage and Canada consider itself to have a surplus.
What the report really calls for is further study; and better coordination of efforts nationally. The report also points to the fact that there is heterogeneity in the manpower situation depending on which specialty we are referring to. Indeed, the worry of employment is most acute in procedural specialties, which are reliant on hospital resources. In addition, it is clear that Canada has a mal-distribution problem that needs to be addressed, likely more so than any problem with over-production.
From the Dean on Campus Blog, by Dean Dr. Richard Reznick, Dean Faculty of Health Sciences, Queens University, Kingston, Ontario. – http://meds.queensu.ca/blog/?p=2462.
