Last week, I attended a meeting of the Association of Faculties of Medicine of Canada. There I joined the 16 other Canadian deans in discussion about common issues. We spent considerable time at this last meeting looking at the question of doctor production in Canada. Also present at the meeting were two provincial deputy ministers of health and two assistant deputy ministers who have human health resource planning as part of their portfolio.
The discussion was interesting and concerning. In the last few decades, manpower planning in Canada has been, by in large, disappointing. In the early 90’s, the Barer- Stoddard report concluded that Canada had too many physicians.1 The report influenced policy decisions that ultimately resulted in the closure of many medical school seats. A decade later, educators were complaining that Barer-Stoddard had it all wrong, having failed to take into account many impactful issues such as the lag time between training and practice, the decreasing work week of practitioners, and the disappearance of the solo GP; all issues that would ultimately create an underestimate of physician need. Fueled by increasing wait times and severe shortages of family doctors across the country, the late 90’s saw a 180-degree reversal of policies, and an almost doubling of physician throughput over the last 15 years.
Fast-forward to 2013, and we are again at risk of concluding that we are producing too many doctors. Indeed, there is mounting evidence that many of our graduating residents, especially in specialties that are dependent on significant hospital resources, are having difficulty finding jobs. Last year, Jeremy Petch and Joshua Tepper wrote that a “growing number of Canadian doctors are underemployed after finishing their training.”2 They added …“There are a number of likely causes, including a lack of infrastructure funding, delayed retirements, and a lack of health human resource planning at the national level.”
The Royal College of Physicians and Surgeons of Canada has recently undertaken a significant study of what they refer to as “an alarming new trend in Canada: medical specialist underemployment and unemployment.”3
And Moris Barer, when recently interviewed by the Huffington Post, concluded that “The die has been cast, our future has been set in stone, and now we watch. And I think the people who should be really worried are the funders and policy makers across the country — because the cost pressures are going to increase dramatically.”4
What seems clear to me is that:
- we do not have robust national statistics,
- we do not have a coordinated national approach to addressing this issue,
- we have a problem of maldistribution, both geographically and across specialties,
- we have not factored in potential changes to scope of practice, amongst and between health professions. In other words, we cannot look at physician manpower in isolation,
- we need to factor in changing demographics of our populations,
- we need to take into account the growing issue of “Canadians Studying Abroad”; as there at this moment, 3600 individuals studying medicine outside of Canada, most of whom wish to return to work in Canada.
The Royal College is part way through its significant national study on this issue. However, Andrew Padmos, the College’s CEO, has already concluded that…“more than 14 percent of 2011 Royal College Certificants did not find staff appointments or employment within 4 to 12 weeks of writing their exams.” Indeed, many residents from across the country are reporting the need to take additional fellowships to augment their chances of employment, or are settling for jobs for which they are over-qualified, such as functioning as a surgical assistant.6
This issue is coming to a head very quickly. It will require a serious national approach, seriously improved manpower planning, and a broad perspective that forecasts changing definitions of who in the medical work place does what.
If you have any experience with the issue of physician under-employment, respond to the blog…or better yet, please drop by the Macklem House, my door is always open.