“The first National Physician Employment Summit was hosted by the Royal College in Ottawa, Ont., from February 18-19, 2014. The summit, a pan-Canadian meeting of more than 100 attendees, included representatives from government and all of Canada’s major medical organizations, all of whom are committed to ongoing efforts to help highly-trained doctors find work and meet patient needs.”
The above is a post from the Royal College of Physicians and Surgeons of Canada’s Facebook feed on March 18th, 2015. I am assuming there is a mistake in that the meeting was held in 2015, not 2014, but if it had been held in 2014, that would mean it would only have been oh say, about 19 years too late, instead of 20. Now I was not invited to the summit, but for all of you non-medical people, what the title means in plain language is that our medical organizations, universities, medical schools, residency training programs, hospitals and governments have screwed up, big time. After years of playing fast and loose with their responsibilities, they are now hopelessly treading water over a problem they created but don’t seem to have any real interest in fixing. I really hate how in the world of medical regulation the people making the decisions are mostly people whose lives will never be affected by those decisions. The people who are adversely affected by medical administrations pretty awful oversight (or lack of it) are the young doctors. To become a doctor, one will now spend a minimum of three years in undergraduate work, four years in medical school, and then, by and large, the ones that are unemployed, will have spent 5 years in specialty training. Specialty training being anything other than family medicine. They may have done extra training as well on top of that, and are also usually pretty heavily in debt by the time they are finished. There are now hundreds, if not thousands of physicians across Canada who are not working, not working in the field they have trained in, or who are not working as much as they would like.
Just as an FYI, I am an overemployed, not underemployed, general surgeon. Meaning I would like to work less, but can’t because of the way the health care system and hospital positions are set up. Now I was told, repeatedly, in medical school and residency, that there was a looming crisis in general surgery in Canada, and the country was going to be woefully short of general surgeons in the coming decades. Ditto when I worked in Australia. I don’t know what that advice was based on but boy was it WRONG! We now have a glut of surgeons, not just in general surgery, but in all surgical specialties and some of the medical ones as well. We are going the way of the UK in decades gone by, where people would wait, sometimes decades, for someone to die to be able to get a position in a hospital. Thanks to the elimination of the internship and the general license that followed, there are very few job options available for those finishing specialty training outside of that specialty.
Someone decided several decades ago that more mature medical students were, basically, just what the doctor ordered. Not sure what sort of data or statistics that was based on, but McMaster started it, and a lot of medical schools have followed. I am also not sure any evidence based approach was involved with this change, ironically. The requirement to even allow application to medical school in Ontario went from minimum of two years of undergrad to 3 years in the early 1990s. But a lot of the time students starting medicine are now much older, having finished post graduate degrees. Maybe admitting older students to medicine was a good decision, maybe it wasn’t. But when you have people graduating who are a lot older than in previous decades, you have to expect that they are going to move along with their lives a little bit while going about their minimum of 12 years + of post-secondary training. Meaning they are likely to get married, have kids, or have aging family members that they need or want to be close too. That means settling down, buying a house, and yes in a lot of cases wanting to stay geographically close to where their spouse or partner potentially has a job already. I’m not saying the same issues don’t come up in other employment areas, but generally the stakes are not as high. All of the training programs are based in large cities, and then guess what? People want to stay where they have trained, close to family and friends. That this is more of an issue as the average age of people finishing their training rises should not come as a huge surprise to anyone. There was also a push in the last several decades to have more “well rounded” people enter medicine. And again guess what? People who have interests outside of medicine don’t want to be on call 24/7, 365 days a year. They want to have time to indulge the interests that made them well rounded in the first place. While this likely means happier, higher performing physicians and less physician burnout, it also means a lot of physicians want to be part of large call groups, not covering the entire area north of the Artic Circle by themselves without relief for their entire careers.
Who pays for all of this training-going-to-waste, you might ask? Good question, because it’s YOU, the taxpayer. While the tuitions fees for medical school have skyrocketed, medical students still only pay a fraction of what it actually costs to educate them. After this it then it also costs money, a lot, to have a person in a specialty training program (where you are a quasi-employee, quasi-student) for 5 years as well. And the taxpayer foots the bill, virtually every single time. We’re talking hundreds of thousands of dollars per trainee here.
The combination of the global financial crisis and the generally poor money management skills of physicians have meant long delayed retirements for many doctors. We as physicians are expected to save for our own retirements. No pensions, holiday pay, or benefits for us. Also, by the way, NO business training to help you manage your finances. There is also no mandatory retirement age for physicians. Having your medical license revoked because of age related problems is unusual, except in cases of gross incompetence. Physicians in private practice with no hospital privileges (and sometimes with hospital privileges) can work ad infinitum. A patient recently told me their family doctor is 83 years old. This is coupled with the fact that physicians entering practice are getting older and older before they start to reap the benefits of their long years of training, meaning they must work longer before they can retire.
Now some believe this is good for Canadians, that the cream will rise to the top. Meaning poor physicians will be unable to get jobs, while those better at their jobs will be providing service to you, the public. The problem is, nobody is measuring this. You either get your fellowship or you don’t, there aren’t any objective measures of whether Dr. X or Dr. Y is the better surgeon. Hiring practices for hospital positions are not exactly fair all of the time, with cronyism, nepotism, favoritism, or old boys club connections/gender bias influencing the decisions. Sometimes it’s the well connected cream that rises to the top. In addition to this, I have been through a surgical residency, and let me tell you, nobody who has put in that much work, for that long, should jump through all the hoops (and believe me there are a LOT of hoops) and not expect to be doing what they were trained to do at the end of a very long road.
In our overregulated industry of medicine, somebody really, really fell asleep at the wheel here. So while these organizations continue to extract exorbitant fees from physicians (and lots of funding from you, the taxpayer), I have lost all confidence that they are keeping their eyes on the road. They either are not tracking physician workforce numbers in any meaningful way, and if they are, they aren’t acting on the information they have. Now the issue is obviously complex. Financial realities have set in for a lot of provinces, and operating room time and hospital beds are expensive. But the first and most obvious solution would be to stop training all of these people in specialties that are already oversupplied in the first place. The training programs, hospitals, and other organizations have not done this, and the question I ask on behalf of my unemployed colleages is why on earth not????